Further details of a state-backed indemnity scheme (SBIS) for GPs have been released as the Government launches a new five-year contract for general practice across England. This will now be known as the Clinical Negligence Scheme for General Practice (CNSGP). It 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 automatically become members of the scheme and will not have to pay a subscription for membership. Government has 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. Non-recurrent funds will be paid to practices for the 2018/19 increases in indemnity costs.
The Welsh Government has announced that NHS Wales Shared Service Partnership – Legal and Risk Services will operate the scheme for GPs in Wales in relation to clinical negligence claims arising from 1 April.
Why you still need an MDO
Remember that GPs will still need MDDUS to provide comprehensive protection that the new CNSGP alone won’t deliver. You can find out more about why you should remain a member of MDDUS here.
CNSGP will not cover you for non-NHS work, representation at inquests, GMC hearings and disciplinary investigations and will also not include advice and support –something highly prized by MDDUS members. This is evidenced by the fact that over the past 12 months, MDDUS’ team of expert medical advisers handled over 6,500 calls and opened nearly four thousand new case files from GP members relating to issues NOT included in the government scheme.
As these figures show, there are a huge range of areas where GPs will not get support from the new scheme and as a result will need to ensure they remain in membership of MDDUS in-order that they have access to expert assistance and support. Your MDDUS membership is annual and our service for non-claims continues beyond the 1 April 2019 until your renewal date. Your subscription fees will be lower for this period and a refund will be provided to you if required. We will still be there for you.
That’s why the BMA recently reminded GPs of the importance of retaining their MDO subscription when CNSGP is introduced. Advice from the BMA states that “MDOs will continue to play an important role” and “it will be essential to maintain medical indemnity.”
You can also read our response to the Department of Health and Social Care (DHSC) announcement on the new GP contract from MDDUS CEO Chris Kenny here.
Since CNSGP was announced in October 2017, MDDUS has constantly highlighted the need to protect the global sum from the cost of the future liabilities scheme (FLS). We have continually lobbied for this, so we welcome the commitment to fully fund the FLS now and in future years.
This commitment to funding 2018/19 increases and the FLS in future years is crucial as the costs of indemnity will continue to rise in the absence of any meaningful tort reform measures. CNSGP will not slow the rate of increase in indemnity costs without legal reform and may indeed increase pressure as claimant solicitors “try their luck” with a new organisation, so increasing cost pressures in the long-term. It is key that the proposed joint work monitors this to ensure primary care monies are not diverted from frontline services to fund these increases.
Remember that GPs will still need MDDUS to provide comprehensive protection that the new CNSGP alone won't deliver.Chris Kenny, MDDUS CEO
We have been waiting for more detail on how this will operate so we welcome the confirmation that the scheme will operate from April this year, though much operational detail is still missing as are details on the management of existing claims. What’s important now is that GPs receive more information about how the new scheme will operate and particularly any workload impact on practices in handling claims. Much operational detail is still missing and we are working hard to explain to NHS Resolution the operational issues where more certainty is needed quickly.
Fragmenting the integrated service offered by MDOs is an inevitable consequence of this change. We are concerned that there is a real danger that NHS Resolution may face pressure to put the financial interests of the service ahead of the protection of the professional reputation of the GP. MDDUS continues to press for the clearest possible commitments on this when we meet DHSC and NHS Resolution to hear more about their operating model.
The rising cost of indemnity has been a major issue for GPs in England and Wales. MDDUS believes that the reasons for this are down to Government’s failure to take decisive action to reduce the increasing number and value of claims and the addition of significant new cost by the misguided lowering of the discount rate to -0.75%.
We and the rest of the MDO sector continue to urge action on these issues, which CNSGP does nothing to tackle. Indeed, dependent on the model chosen, it may well increase claims costs and numbers.
As a ‘not-for-profit-mutual’ funded by our own members with no shareholders to pay, we have been able to keep our costs as low as we can, ensuring adequate indemnity for all our claims: historical, current and future. We will maintain this commitment to our members buying our new product to cover them for non-NHS work.
What are we doing?
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WHAT DO WE KNOW ABOUT THE CLINICAL NEGLIGENCE SCHEME FOR GENERAL PRACTICE (CNSGP)?
What is CNSGP and who will it cover?The Government has said the new scheme will provide GPs in England with indemnity against clinical negligence claims arising from NHS contracted work. It will extend to all GPs and all other staff working in delivery of primary medical services. It will automatically cover contractor and salaried GPs, GP locums, GPs in training and other schemes such as retainers, prison GPs and the MOD, nurses, allied health professionals and the wider NHS primary care work, including out-of-hours cover. The Welsh Government plan to implement a similar scheme to that planned for England. Close
When will the scheme be introduced?CNSGP is due to be introduced at the start of April 2019. Close
How will the scheme work?
As yet there are no final details on how the scheme will work, but the DHSC has confirmed the scheme will be administered and run by NHS Resolution and will cover clinical negligence liabilities for work carried out as part of their NHS contract. It will cover providers on GMS, PMS, APMS and standard NHS contracts and provide indemnity for clinical negligence for all staff including students and trainees. GPs will therefore be covered through the GP practices that they work in, rather than individually as is now the case.
Government is committed to funding the FLS now and in future years. It is still unclear whether and if so how the new state-backed scheme will take on responsibility for historic claims - i.e. cases that are ongoing when the scheme begins and those that come to light later but relate to incidents that happened before the scheme started. We are in detailed discussions with Government on this issue, seeking to protect members’ financial and professional interests.
As with most of the questions on this proposed scheme we are awaiting more detail from the government before we can fully answer all the issues. We will update members when we know more.Close
Is CNSGP going to be free?The costs of the scheme will be met by NHS England. It will be centrally-funded through a one-off permanent adjustment to the global sum. Future costs of NHS practice under the scheme will be funded centrally, not met individually or by practices. Close
Does that mean I could have several different types of indemnity cover with different providers?You will automatically be registered into CNSGP but you will need additional cover from MDDUS for the many areas of support and representation that CNSGP does not cover. Close
Will it cover the whole of the UK?
The scheme will cover GPs in England. In October 2017 former health secretary Jeremy Hunt announced that a new state-backed indemnity scheme would be introduced for GPs in England from April 2019. Read our reaction at the time here. Matt Hancock, Health secretary confirmed at the RCGP Conference in October 2018 that the scheme would be introduced from April 2019.
The Welsh government announced in November 2018 that their scheme will be aligned as far as possible to the scheme in England with further details provided in February 2019. You can access the latest Welsh government statement here.Close
What if Scotland and Northern Ireland follow suit?There’s no reason for the other UK nations to follow suit given the totally different market. The issues are very different and, in MDDUS’ view, do not call for a similar response. Our subscription rates in Scotland are significantly lower than England and, in fact, lower than in 2001. Close
Do I still need to be a member of MDDUS once CNSGP is introduced?
Absolutely. CNSGP will not cover you for non-NHS work, representation at inquests, GMC hearings and disciplinary investigations. Such situations can seriously impact your career and could ultimately result in you being struck off. The scheme will also not include advice and support – something highly prized by MDDUS members. It is therefore crucial that you have access to support and guidance from experienced medico-legal advisers.
That’s why the BMA has advised: "The scope of the state-backed scheme is to cover the cost of clinical negligence for NHS services. The MDOs will continue to play an important role in providing legal advice, representation for GMC hearings and also for the rare occasion where a criminal case occurs. Similar to hospital colleagues, it will be essential to maintain such medical indemnity."Close
Only a very small number of GPs need services not covered by CNSGP?Over the last 12 months alone, MDDUS have dealt with nearly 4,000 new cases from GP members and answered over 6,500 advice calls from GP members relating to these issues which will not be included in CNSGP. Close
After the introduction of CNSGP what benefits will I enjoy if I remain in membership of MDDUS?It is important that you remain in membership of MDDUS as CNSGP will not provide you with the comprehensive range of benefits that you currently enjoy with us. Read more here. We will continue to offer you the peace of mind you have come to appreciate in this challenging environment. Further details of our MDDUS occurrence-based new product for GPs will be available shortly. Close
Will MDDUS still provide general support and advice on day-to-day complaints and issues?Yes. We know that the 24/7 service we provide for our members is greatly appreciated. There are a huge range of things where GPs will not get support under the new scheme and will need supplementary expert help. Provided you remain a member we will still be there to support you. Close
If I am referred to the GMC will the NHS offer me assistance?
No. CNSGP will not assist you if you are involved in a GMC matter. It is important to remember that the GMC has the power to suspend, place restrictions on your practice, issue you with a warning and ultimately erase you from the register. With such potentially severe consequences there are a range of advantages of having representation and assistance from an MDO whose focus will be to ensure that your case is dealt with fairly and efficiently and that you are properly represented.
We have assisted over 200 members facing GMC investigations in the last 12 months. Latest figures from the GMC reveal that doctors appearing before disciplinary panels without legal representation are more likely to receive tougher sanctions. Nearly four fifths of doctors who were struck off the register at MPTS hearings in the last three years did not have any legal representation. Compare this to the 80 per cent of doctors who had legal representation and did not receive a sanction.Close
What are the advantages of having assistance from MDDUS at a coroner’s inquest?An individual can be found to be at fault at an inquiry or inquest and any criticisms made can lead to a GMC or a criminal matter being raised against you. With such high stakes it is important to have the support and guidance of a medico-legal adviser with the experience and insight to advise you on how to conduct yourself throughout such a formal and daunting process. MDOs which employ and retain some of the UK’s leading medico-legal solicitors can instruct the best legal representation, which will be made available to members free of charge. In the last 12 months alone we have assisted 513 GP members with coroner’s inquests. Close
Tell me more about the advice the BMA are giving to GPs in England and Wales on MDO membership following CNSGP?
The BMA recently reminded GPs of the importance of retaining their MDO subscription when CNSGP is introduced in April 2019. Advice from the BMA states that GPs “still need to retain membership of an MDO” and “MDOs will continue to play an important role in providing legal advice, representation for GMC hearings and also for the rare occasion where a criminal case occurs.”Close
Will CNSGP be claims only?Yes. We think that’s a recipe for confusion in the many cases which throw up multi-faceted problems for doctors. But with just a few weeks to go until implementation there is still no published statement on how the scheme will operate. Close
Will CNSGP be occurrence-based or claims-made?It is our understanding that it will be occurrence-based, but with just a few weeks to go until implementation we await even the basic details on how the scheme will operate. Close
What happens to historic liabilities, i.e. past claims, claims yet to arise?This is one of the key details under discussion with DHSC. If we do not reach agreement with Government in current talks, members can be assured that, unlike some other organisations, MDDUS is fully funded and can meet both our known liabilities and our best actuarial estimate of the unknown ones. Close
What happens to an existing claim?We are working on the assumption that claims will continue to be managed where they currently lie but with just a few weeks to go until implementation of CNSGP we still await even the basic details on how the scheme will operate. Close
Will the company compete against a new state scheme?We will continue to seek to meet the needs of our members as comprehensively and effectively as we can. We will certainly offer claims services to GPs across the UK for work that is not covered by CNSGP. In addition as mentioned above, GPs in England and Wales will still require cover for the areas this new scheme does not cover. Close
Are you sure CNSGP won’t provide assistance with disciplinary matters etc?CNSGP has been designed in a similar manner to the NHS indemnity provided to your colleagues within secondary care. As a result CNSGP will only provide indemnity for NHS work and will not extend assistance to the individual practitioner’s professional issues e.g. assistance with disciplinary matters, GMC hearings, coroner’s inquests, Good Samaritan acts and non-NHS clinical work. Close
I undertake work outside my NHS contract but why do I have to purchase indemnity from you?CNSGP will only provide indemnity for work undertaken within a GMS, PMS and APMS contract along with other services delivered under a standard NHS contract. As a result you have a professional obligation to arrange indemnity for private clinical work, writing insurance reports, travel vaccination clinics etc. which MDDUS will provide. In addition, CNSGP will not extend assistance to the individual practitioner’s professional issues e.g. assistance with disciplinary matters, GMC hearings, coroner's inquests, Good Samaritan acts and non-NHS clinical work - but MDDUS will. Close
What about my pharmacist, paramedic, NP, ANPs?Your clinical colleagues will also enjoy indemnity provided by CNSGP. Close
I work in the Isle of Man or the Channel Islands. Do I still require MDDUS membership?Those practising in the Isle of Man and the Channel Islands will not be entitled to indemnity via CNSGP. As a result it is important that you maintain your membership with MDDUS to ensure you meet the requirements of the GMC and have access to professional indemnity. Close
Is the introduction of the scheme down to MDDUS poorly managing their business?
Not at all. You have shown your trust in us by moving in large numbers to MDDUS over the last decade – over a quarter of English GPs have come to us since 2010. The MDDUS Annual Reports over the last decade show that we have grown strongly and are on a sound financial footing.
We have two and a half times more members than when Crown indemnity for hospitals was introduced. We’ve done that by innovation and imagination, and we will continue to offer new products to healthcare professionals.
Our reserves are more than comfortably adequate to meet both our known and anticipated liabilities: that is, the claims and non-claims matters that have already been reported to us, as well as those where the incident has occurred but is not yet on our radar.Close
Does CNSGP cover dentists? Does MDDUS think it should?No and no. The market for dental indemnity is very different and fees are lower than for GPs. MDDUS offers particularly competitive subscription rates, which explains its recent rapid growth in England which we expect to continue. Close