MDDUS has been at the forefront of negotiations with the Department of Health and Social Care (DHSC) and professional bodies throughout the UK to shape and influence what a state-backed indemnity scheme (SBIS) might look like.
We have been speaking to all levels of government to try to ensure that the form of SBIS chosen is best for GPs, best for patients and best for the taxpayer. There has to be a comprehensive end-to-end service – one that seeks to protect the reputation of the individual doctor as well as the balance sheet of the NHS. That’s vital to protect patient confidence and relationships. The current model for hospital indemnity doesn’t provide that and isn’t therefore fit for translation to the primary care context.
There has to be a comprehensive end-to-end service - one that seeks to protect the reputation of the individual doctor as well as the NHS balance sheet.Chris Kenny, MDDUS CEO
Driving down costs
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 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 state-backed indemnity 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.
Importantly in the current scheme GPs have the right to choose the MDO service they want. MDDUS believes that GPs must be able to retain that choice, free of financial pressure, rather than to be brigaded into a claims-only monopoly state system. Those who want the integrated service must be able to access it. 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.
Why you still need an MDO
A state-backed scheme 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 6,561 calls and have opened nearly 4,000 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 remain in membership with MDDUS to ensure they continue to have access to expert assistance and support. We will still be there for you.
Find out more about why you should remain a member of MDDUS here.
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.”
What do you need to know?
MDDUS shares Government’s objective of driving down the cost of indemnity for GPs, but wants to do so in a way that retains standards, GP centrality and GP choice. As it stands, much of what is proposed remains unknown and information has been slow in coming out about what exactly is proposed and how it will be run. This delay is unhelpful for us all; we cannot advise our members what is best for them without more detail and the MDOs cannot plan ahead for the future.
We will continue to speak out on behalf of our members to ensure that they receive a full professional service, and we are continuing to press the DHSC to provide comprehensive details so we have more information to pass on to you so you can take decisions about your indemnity cover.
Government’s failure to reform the law of tort and cap costs that lawyers are taking from the NHS and GPs at a reasonable level has been the main driver in rising indemnity costs. That’s outside the control of medical defence organisations and a state-backed scheme doesn’t address that. Health expenditure generally and GP remuneration in particular will continue to be squeezed because of this failure.
What are we doing?
Find out more
WHAT DO WE KNOW ABOUT THE STATE-BACKED INDENMNITY SCHEME FOR GPs?
What is a state-backed indemnity scheme?
The Government has said it envisages that the new scheme will provide GPs in England and Wales with indemnity against clinical negligence claims arising from NHS contracted work.Close
Why is Government considering this?They are concerned about rising indemnity costs and threats to GP recruitment and retention. We think they are missing the key issue in not tackling the causes of the number and value of claims and settlements. Close
When will the scheme be introduced?The state-backed indemnity scheme is due to be introduced in April 2019. But we believe that delay is putting that date at risk unless Government chooses to use a model built on the proven success and expertise of MDOs. 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 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 the government before we can fully answer all the issues. We will update members when we know more.
Is SBIS going to be free?No. There may be no invoice but the DHSC has already said it will be funded from within NHS budget with the latest government FAQs stating funding will come from 'existing resources'. LMCs recently called on the BMA to negotiate a ‘wholesale new GMS contract’, warning that core funding for general practice has now been eroded to a level that is ‘unsustainable and unsafe’, adding further cost pressures.
When the GP contract was introduced in 2004 the cost of indemnity at the time was factored into the global sum. Practices have also received additional funding in the last two years to go towards rising indemnity costs. MDDUS has put forward options that would not require reductions in the global sum and give time for tort reform to work. Partners’ income – especially in the most deprived areas – is at risk if this is the route Government choose to fund the scheme. That’s going to hinder retention where it’s most needed.
What happened when NHS indemnity was introduced for hospital doctors?When NHS indemnity for hospital doctors was introduced in 1990, it only covered clinical negligence claims and therefore didn’t provide comprehensive cover. Hospital doctors are still advised to retain membership of MDDUS as it provides those working within the NHS with a range of essential benefits, from 24/7 advice and support on all medico-legal matters, representation for disciplinary matters, GMC hearings and CIs including all legal support, indemnity for Good Samaritan acts and access to a range of learning and development resources. Close
Will the practice or GP continue to be able to choose the indemnity cover they want at a price they have agreed with that provider?MDDUS has continually highlighted to the DHSC through all our discussions the need for GPs and practices to have the right to choose their MDO service and not be financially disadvantaged if they want to opt out of SBIS. We still do not know if there will be a choice in future or if SBIS will be compulsory. We believe that GPs should make their own decisions and not be frog-marched into a claims-only scheme which may not meet all their needs and which may put the interest of the taxpayer ahead of that of the doctor. Close
Does that mean I could have several different types of indemnity cover with different providers?If the DHSC remove the right to choose your indemnity provider you will automatically be signed into SBIS but you will need additional cover for the things that SBIS does not cover. Close
Will it cover the whole of the UK?The scheme will cover GPs in England and Wales. 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 that the scheme would be introduced from April 2019. Read the latest government statement here.
The Welsh government announced in May 2018 that their scheme will be aligned as far as possible to the scheme in England. You can access the Welsh government statement here and our response to the Welsh government announcement here.
What if Scotland and Northern Ireland follow suit?There’s no reason for the other devolved 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 less than England and, in fact, lower than in 2011. Close
Do I still need to be a member of MDDUS once SBIS for GPs in England and Wales is introduced?Absolutely. The state-backed scheme will not cover you for non-NHS work, representation at inquests, GMC hearings and disciplinary investigations. 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.
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."
But that will only be a very small number of GPs?Since the beginning of 2017, MDDUS have dealt with nearly four thousand new cases from GP members relating to these issues which will not be included in the state-backed scheme.
The BMA also recognises the crucial importance of having indemnity cover and 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.” Read the BMA advice here.
After the introduction of SBIS what benefits will I enjoy if I remain in membership of MDDUS?
It is important that you remain in membership of MDDUS as SBIS will not provide you with the comprehensive range of benefits that you currently enjoy with MDDUS. We will continue to offer you the peace of mind you have come to appreciate in this challenging environment via our occurrence based Professional Protection service, which includes:
• 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
• Assistant with disciplinary matters
• GMC representation
• 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.
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 every day of the year is greatly appreciated. There are a huge range of things where GPs will not get support from the new scheme and will need supplementary expert help. Provided you remain a member and take out this important additional indemnity cover we will still be there to support you and answer any questions you may have. Close
If I am referred to the GMC will the NHS offer me assistance?No. It never has and never will. SBIS 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 sanctions and therefore were able to continue to practise.
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 at 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 SBIS.The BMA recently reminded GPs of the importance of retaining their MDO subscription when SBIS 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.”
You can read the BMA advice here and our statement welcoming the BMA advice here.
Will it be claims only?That is our understanding – and we think that’s a recipe for confusion in the many cases which throw up multi-faceted problems for doctors. But with less than six months to go until implementation there is still no published statement on how the scheme will operate. Close
Will it be occurrence or claims made?It is our understanding that it will be occurrence-based, but with less than six months 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 to be discussed with DHSC. Members can be assured that MDDUS is fully funded and can meet both our known liabilities and our 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 less than six months to go until implementation we 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 the state scheme. In addition as mentioned above, GPs in England and Wales will still require cover for the areas this new scheme does not cover. Close
I don’t want to rely on SBIS. Can I secure indemnity for my NHS work with MDDUS?MDDUS will offer an integrated product to all who want it. We believe that you should have the choice on a financially neutral basis. Close
Are you sure SBIS won’t provide assistance with disciplinary matters etc?Certain. SBIS has been designed in a similar manner to the NHS indemnity provided to your colleagues within secondary care. As a result SBIS will only provide indemnity for NHS work and will not extend assistance to the individual practitioner’s professional issues eg assistance with disciplinary matters, GMC hearings, CI’s, 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?SBIS 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, the SBIS will not extend assistance to the individual practitioner’s professional issues e.g. assistance with disciplinary matters, GMC hearings, CI’s, 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 SBIS. Close
I live 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 SBIS. As a result it is important that you maintain your membership with MDDUS in order that 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 en masse 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.
Does SBIS 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
Will my MDDUS membership be affected by Brexit?MDDUS has comprehensively evaluated the risk to the organisation and its member services in the face of the UK leaving the European Union, and it is considered that MDDUS is in a fortunate position in being both a UK- and service-based business; this means that we are relatively insulated from the major and direct impacts of Brexit. A number of indirect considerations have been identified for the organisation and mitigating actions are in place to monitor and control these. As a result we are committed to ensuring that our members come first - they are the focus of all we do. Close