GP indemnity… where we are

STATE-BACKED indemnity has a new name – at least in England – and that is the Clinical Negligence Scheme for General Practice or CNSGP. No one does acronyms better than the NHS.

The Government has now released details of the scheme as part of a new five-year contract for general practice across England. The CNSGP will start from 1 April 2019 and will be operated by NHS Resolution. All NHS GP service providers in England including out-of-hours provision will be eligible to become members of the scheme and will not have to pay a subscription for membership. NHS Shared Services Partnership – Legal and Risk Services will run a similar Future Liability Scheme (FLS) for general practice in Wales.

The Government has also confirmed that the scheme will be funded through a one-off permanent adjustment to the global sum but investment in the practice contract overall will still rise by 1.4 per cent in 2019/20, even after accounting for the indemnity change.

MDDUS welcomes this news as the only medical defence organisation (MDO) to have constantly lobbied for the need to protect the global sum from the cost of the scheme – ever since plans for state-backed indemnity were first announced in October 2017. This funding commitment now and in future years is good news, particularly as the costs of indemnity will certainly continue to rise in the absence of any meaningful tort reform. It is important that the Government offers assurance that in future no primary care monies will be diverted from frontline services to fund these increases – not just for the lifetime of the current plan.

Recently the Secretary of Health and Social Care commented that changes in practice by trusts are a "necessary part of reducing the number and severity of claims". We believe Mr Hancock is fooling himself if he thinks this will fully resolve the issue of increasing negligence claims and costs. Government should not pass the buck to hospital doctors, GPs and trusts. It should play its part through thorough meaningful tort reform and a much more radical approach to capping costs. Such reform has already proved effective in other countries, such as Australia and the USA. We cannot understand why the UK won’t follow suit and has instead taken the drastic and high-risk step of nationalising not just the cost, but the direct provision of clinical indemnity services in England and Wales.

We perhaps should not expect a Government which contracts with a ferry company with no ships to turn to expert organisations who know primary care inside out to run medical negligence claims – but we’re convinced that choice, competition and direct reimbursement would have provided better outcomes and significantly reduced cost and risk than the model put in place.

But we are where we are. What’s important now is that GPs in England receive more information about how the scheme will operate and particularly any workload impact on practices.

NHS Resolution has pledged to provide further details on the next steps that practices and professionals need to take to ensure that they are covered after 1 April 2019. It has also highlighted the need for practices and staff to take out "separate medical defence organisation cover for professional practice, additional advisory services, and private work". The BMA, too, has advised that MDOs will continue to play an important role in providing legal advice, GMC representation and also representation in potential criminal cases associated with the practice of medicine.

MDDUS has long prided itself on a gold standard service providing medico-legal advice and support 24/7, and we will continue to do so for our members. MDO protection is still necessary and this can be evidenced by the fact that over the past 12 months our team of expert medical advisers handled 6,561 calls and opened nearly 4,000 new case files from GP members relating to issues NOT included in the government scheme. We estimate that almost two-thirds of cases handled by MDDUS in the past 12 months would not have been covered by the new scheme.

All this is not to say we are without concern over the introduction of the CNSGP. Fragmenting the integrated service currently offered by MDOs remains a high risk and we see a real danger that NHS Resolution will face pressure to put the financial interests of the service ahead of the protection of the professional reputation of the GP. MDDUS has been the only MDO pressing publicly for the clearest possible commitments on this and our initial meetings with NHS Resolution to hear more about their operating model suggests that we may have been listened to. We will keep you posted.

MDDUS will still be there for you going forward – and we will never cease to put preservation of the doctor’s professional reputation and integrity at the centre of all decisions. "No decision about me, without me" works for doctors as well as patients.

Chris Kenny in chief executive officer at MDDUS