State-backed indemnity remains a great unknown with information from Government about the scheme and what it means for GPs sadly lacking. While finer details about how it will actually work are scarce, here are five things that we do know about the scheme as the April implementation date looms.
1. State-backed indemnity is not free
Government has always made clear that this is not a nil-cost scheme. So GPs need absolute certainty on how any scheme will be paid for – in 2019/20 and future years. That means precise identification of where reductions are being made elsewhere in GP remuneration and primary care spending. That’s a key issue for today’s partners in particular – but also those who aspire to partnership in future.
The recent Government announcement confirming funding for the scheme would come from existing resources allocated for general practice does little to allay those fears. That means reductions and cost cutting needs to be made elsewhere in GP remuneration and primary care spending.
2. GPs should be given a choice
GPs have a right to expect unfettered choice, so that they can decide for themselves whether to stick with organisations with expertise in the full range of medico-legal issues in primary care, rather than frogmarched into an untested claims-only monopoly state system.
Those who want absolute assurances that their personal professional interest, not the financial interest of Government, will be at the heart of the decision-making must be able to opt for that service.
Planning blight followed by breakneck implementation is hardly a recipe for success.
It is a high-risk approach that fails to protect GPs’ professional reputation, removes choice and, as independent contractors, GPs should have the option to choose an integrated indemnity and advice product as compared to the state-backed scheme.
MDDUS offered up a model for discussion that would have been far better for members and the NHS as a whole. We have sought a guarantee from Government that no GP principal will be financially disadvantaged by this new scheme when compared to proposals MDDUS has put forward. To date, no assurances have been given. That’s bad news for GP partners – and for patients in areas of greatest social need as that’s where any reduction or top-slicing from the global sum will hit hardest.
The medical defence organisation model is recognised as a gold standard. That’s because it tackles GPs’ problems comprehensively – claims, regulation, inquests, discipline. It puts preservation of the doctor’s professional reputation and integrity at the centre of all decisions and doctors are involved in the key decisions on their claims – ‘No decision about me, without me’ works for doctors as well as patients.
Writing MDOs out of a claim service is a false economy – and a threat to GPs’ professional standing. That’s why we expect the state-backed schemes in Wales and England to preserve these principles.
3. GPs don’t have any concrete details on how the scheme will work
We have been pressing Government to provide comprehensive operating and funding details of the new scheme for some time now, yet little has been forthcoming. There are still a great number of unknowns.
The DHSC has confirmed the scheme will cover clinical negligence liabilities for work carried out as part of their NHS contract. It will cover providers on GMS, PMS and APMS 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.
It is still unclear whether and if so how the new state-backed scheme will take on responsibility for historical 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.
As with most of the questions on this proposed scheme we are awaiting more detail from Government before we can fully answer all the issues. We will update members when we know more.
4. GPs will need to retain their membership of an MDO once the scheme is implemented
You still need to retain your membership of an MDO. GPs need MDDUS to provide comprehensive protection that state-backed indemnity alone won’t deliver.
The scheme will not cover you for non-NHS work, representation at inquests, GMC hearings and disciplinary investigations. A massive 60 per cent of cases handled by MDDUS in the past 12 months would not have been covered by the new SBIS.
Such situations can seriously impact upon 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.
This is evidenced by the fact that over the past 12 months MDDUS’ team of expert medical advisers handled 6,561 calls and have opened nearly 4,000 new case files from GP members relating to these issues not included in the government scheme. Also in the past 12 months, MDDUS assisted more than 200 GPs facing GMC investigations and advised 513 members who were called to appear at coroner's inquests. In addition, we helped almost 2,500 members deal with patient complaints - another key area that won't be covered by the SBIS.
As these figures show, there are a huge range of areas where GPs will not get support from the new scheme and will need supplementary expert help. We will still be there for you. That’s why the BMA recently reminded GPs of the importance of retaining their MDO subscription when SBIS 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.”
5. GPs will enjoy the following benefits by remaining an MDDUS member
These are issues with which only an MDO like MDDUS can provide assistance:
• GMC representation – as a member of MDDUS you will not have to pay for your own advice and representation
• Indemnity for private clinical work
• Indemnity for writing insurance reports
• Indemnity for travel vaccination clinics
• Indemnity for worldwide Good Samaritan acts
• 24/7 medico-legal advice
• Assistance with patient complaints
• Assistance with disciplinary matters
• Advice with performers’ list outcomes
• Support with Ombudsman investigations
• Assistance with coroner’s inquests
• Assistance with HR and employment issues
• A range of medico-legal publications, on and offline
• Discounted medico-legal training