Indemnity when working at scale

Dr Nick Clements, Head of Risk and Underwriting Policy, answers questions about how new care models and other changes in primary care can affect your medical indemnity. 

Do GPs need to make separate indemnity arrangements for their federation, or are they protected by Medical Protection?

GP indemnity is usually provided through an individual membership arrangement with us.

If the nature and extent of your work remains unchanged, simply being a part of a GP federation should not impact on your membership. However, if being part of a GP federation requires you to undertake additional clinical work, such as working in unscheduled care or directly employing healthcare professionals in new roles within your practice, then you will need to contact us as it may affect your indemnity arrangements.

Regardless, it is a good idea to speak to us to ensure that you are adequately protected.

Does this change if the GP federation is set up as a limited company? 

If a GP federation is set up as a limited company, and is responsible for providing additional or enhanced services, or is directly employing staff to treat or triage patients, then both individual staff members and the limited company or legal entity could be at risk of a claim or complaint. The federation must therefore ensure it has its own corporate protection in place. We offer a corporate membership arrangement tailored to individual organisations. This can provide an organisation with the right to request assistance and indemnity in respect of the defence and/or settlement of civil law claims of clinical negligence made against the company. Such claims might arise from the act or omission of the organisation, its employees or individual contractors for whom the organisation is responsible.

Who is responsible if something goes wrong when a consultant from a local hospital provides a service in primary care?

This will depend on the nature of the agreement with the consultant and the incident. Consultants, like GPs, have a legal obligation to ensure they hold adequate and appropriate indemnity for all the work they undertake. In some cases, a consultant working in general practice will still be employed by their NHS trust and will therefore benefit from the trust’s indemnity arrangement. However, if the consultant is employed by a GP practice, a GP federation, or is working on a locum basis, then additional indemnity arrangements would need to be made by the consultant with us. Before accepting a consultant into your practice to work, you should look into the details of their arrangements to make sure they have appropriate protection in place. It is also important to keep a written confirmation of this position.

What should practices or federations do if they employ healthcare professionals in new roles that have not traditionally existed at the practice before, such as pharmacists, physician associates, paramedics, and physiotherapists?

It is important that you ensure you have appropriate indemnity in place for all your staff. As an employer, you might be leaving yourself vulnerable if you employ healthcare professionals without adequate indemnity arrangements. This means that before employing a new member of staff, always check that we can provide a membership arrangement for them, and what the cost of that arrangement will be. Medical Protection provides membership for a number of new roles which are now becoming commonplace in general practice. If we are unable to provide a membership arrangement for a specific role, we will try and sign-post other options that may be available.

Will the introduction of seven-day GP services have an impact on the cost of indemnity?

While we cannot comment on subscription rates for other medical defence organisations, the move to seven-day GP services alone should not directly impact on subscription rates with us. We believe we have led the way on supporting extended opening by changing the way we calculate subscriptions. 

"We would always recommend that practices and federations contact us as a priority before tendering for new contracts".

We now calculate a price based on the number of weekly sessions members undertake, according to whether the care is ‘scheduled’ (when a GP treats registered patients, via appointment, during the regular opening hours of the practice and with access to the patient’s full medical records) or ‘unscheduled’ (such as sessions undertaken at any time of day in walk-in/urgent care centres).

Initiatives like the Prime Minister’s Access Fund therefore should not have had an impact on the subscription rate members pay, as in most cases GPs undertaking extended opening hours will be providing ‘scheduled care’.
While there may be some indirect impacts on the cost of indemnity resulting from more sessions taking place in general practice rather than in secondary care settings, it is too early to say what the long term impact, if any, of seven-day GP services will be. We will continue to monitor this and update you regularly. 

How do GPs work out who is responsible if something goes wrong when a group of practices provide a service that is run out of one practice’s premises?

GPs should always have adequate and appropriate protection for all their work and will be accountable for their patient interactions regardless of the setting.

However, where practices create ‘hubs’ and share staff to deliver services across the federation, it can be difficult to attribute responsibility. Ultimately, both the organisation and the healthcare professionals who are delivering the service may carry some responsibility.

We would generally advise against staff sharing, in favour of an approach where staff who are delivering a service are clearly contracted to a practice or GP federation.

This provides assurances that rigorous employment checks have taken place and that there is clear accountability for actions.

However, we understand that many initiatives are currently in the pilot stage, and that there is a reluctance to put in place cross-practice employment contracts. 

To support these initiatives, we have extended our membership benefits for GP partner members who are part of our Practice Xtra Gold scheme. This provides them with the right to request assistance with issues arising from certain groups of healthcare professionals that are loaned to their practices to deliver hub working.

However, certain exclusions apply so it is important that members contact us to confirm their arrangements.

What should practices and federations bear in mind about indemnity if they are preparing to bid for new contracts or services?

We would always recommend that practices and federations contact us as a priority before tendering for new contracts.

One issue we often come across is that providers may not adequately account for protection costs when tendering and pitching for new contracts. We want to work with you to ensure that you are fully informed and have complete peace of mind.

Therefore, as part of the process, it is important you get in touch to make sure you can obtain protection for the new service you are wishing to deliver, and that you know and fully understand all of the costs involved so you can factor this into your tender.