The tone and content of the health secretary’s speech to the RCGP conference in Liverpool was quite extraordinary.
At its heart was almost a mea culpa. ‘Because we have underinvested in general practice, we have made it much harder for you to deliver continuity of care,’ said Jeremy Hunt gravely, jacket thrown aside and in full-on-man-of-the-people mode. ‘That is part of the magic care of general practice, and I want to turn that around.’
Whether you believe his contrition was serious or not (and his later comments did not really help to persuade he was) his speech did contain some genuine new policy.
Firstly, a further 200 GP trainees will be offered £20k ‘golden handshakes’ to persuade them to work in areas with shortages. Secondly, a consultation will be launched to regulate physician associates and enable them to prescribe. But the most tantalising announcement was on GP indemnity.
As trailed in advance by Pulse, Mr Hunt announced that a ‘state-backed’ indemnity scheme would be launched for all GPs by April 2019 covering all their NHS work, including locums and those working out of hours.
Crowned with the delicious irony that such state interference in a private marketplace was being announced by a Conservative health minister, it was a bold move from Mr Hunt. Negotiators have been holed up for weeks talking through a sustainable solution, and although it does not solve the immediate problem of rising indemnity fees, this may hold hope for the future.
Most of the GPs I meet are intrigued but sceptical at yet another promise of ‘jam tomorrow’. And with good reason. There are many unanswered questions that are fundamental to whether the scheme will be a boon or a bust. I have listed some below:
1. Will it be any cheaper?
The new state-backed scheme will not be free and the likely membership fee has not been revealed.
Mr Hunt was careful to say that the new scheme would ‘stabilise’ rather than reduce indemnity costs, and it has since emerged that it is likely to only provide clinical negligence cover. GPs will still need their own indemnity for professional and regulatory issues such as GMC proceedings and coroners’ courts, and any private work.
But Mr Hunt said that the advantage of the Government stepping in would mean that it could ‘control a number of variables that have caused indemnity costs to increase substantially’. The GPC told me it was confident that overall premiums will end up becoming cheaper, although there is no official guarantee yet that they will be. But it falls short of the demand from LMCs (and 300 Pulse readers) for full reimbursement.
2. Will all practice staff be covered?
In answer to questions at the RCGP conference, Mr Hunt said it would cover ‘all GPs for all NHS work’ but stopped short of saying it included practice staff as he said he did not want to misspeak and u-turn later.
However, documents seen by Pulse are encouraging. They say the DH is planning for the scheme to ‘include the activities of practice staff working in the delivery of GMS, PMS and APMS services’. The suggestion is that it will be a policy that the practice – or out-of-hours provider – holds for those working for it, although quite how this will work for non-core work or peripatetic GP locums is a bit unclear.
3. What does ‘state-backed’ even mean?
Let’s be clear, it does not mean so-called ‘crown indemnity’. Hospitals, which pay their staff’s indemnity costs, have their risk pooled by the NHS Litigation Authority and it does not look like the Department of Health is keen to further extend this scheme to GPs.
The status of the existing medical defence organisations is unclear – one has already panicked and slashed their fees by 50% in an attempt to steal a march – and the financial impact of the Government going with just one provider could be devastating for the others, potentially leading to higher indemnity costs for non-core GP work.
The big wins here are from reforms to cap the costs that lawyers can charge for compensation claims and there is no sign of that happening yet. And, as it state-backed, rather than state-run, it is a still bit unclear what incentive ministers will have to curtail costs in this way.
4. What support will GPs get under the scheme?
Say what you like about the ‘big three’ they have built up large teams able to provide advice to GPs who need guidance (although they might make you pay for it later by hiking your fees) and the MDDUS has a valid point when it says: ‘The recent outsourcing of PCS to Capita shows the harm caused to doctors and the NHS when untested outsourcers blunder into sensitive healthcare markets.’
The risk is also that having just one massive provider of GP indemnity will mean that it may be more likely to admit blame early on after a complaint, rather than fight expensive cases for GPs who are being falsely accused. There may be cheaper fees, but the real cost could be GP reputations.
Rest assured Pulse will be on the case in trying to seek answers to these questions for you over the next few months. If you have any others then leave them in the comments below and we will look into them for you.
Nigel Praities is editor of Pulse