Mind the gap

State-backed indemnity, which started on 1 April 2019, only provides indemnity for clinical negligence claims arising from primary care work under an NHS England or Wales contract.

GPs still need the expert guidance MDU membership provides, such as support with patient complaints, GMC referrals, ombudsman investigations, performers' list actions, coroners' inquests and even criminal investigations.

About state-backed indemnity

Is state-backed indemnity enough?

In the last 12 months, the MDU has opened over 6,000 case-files on behalf of GPs and their staff relating to matters that will not be covered by the new scheme such as patient complaints and GMC investigations. As doctors ourselves, we know that you will still need the expert support and guidance that MDU membership provides. We are here to help defend your reputation and career.

How does the introduction of state-backed indemnity impact my subscription?

As the state-backed indemnity scheme will cover clinical negligence claims arising from work you do under an NHS contract in England and Wales, after 1 April 2019 your MDU subscription will significantly reduce. We will write to members to explain the impact on their membership, ahead of their next renewal.

Will the state-backed indemnity scheme provide indemnity for private and fee paying work?

The scheme is not intended to provide indemnity for this work.

We know that some types of fee paying work are part and parcel of a GP’s job. That’s why MDU membership includes indemnity for the types of fee paying work that GPs would ordinarily undertake.

Can I include indemnity for claims for clinical negligence for my private work in my MDU membership?

Yes you can. You have a continued professional obligation to have indemnity in place for all clinical work you do, including work which is not indemnified under the state-backed indemnity scheme. Simply tell us what private work you intend to do when you approach your renewal and we will adjust your subscription accordingly.

What fee paying work is indemnified as part of my membership?

The MDU can typically indemnify the work in the list below. Where the services relate to the provision of care to patients, they must be patients registered at the practice (and only occasionally non-registered patients such as temporary residents). If this is the case, the MDU does not have a cap on the income that can be earned from this work.

  • Provision of medical reports, including for:
    • Insurance purposes
    • Driving, aviation and sea farer roles
    • Sports (or other activity) participants
    • Armed forces
    • Patient’s employers
    • Disability assessment
    • Adoption medicals
    • Benefit certification
    • Housing applications
    • Office of the Public Guardian
    • Firearm licensing
    • Court exemption
    • Solicitors (regarding patients registered at the practice)
  • Provision of witness statements for the police or Criminal Injuries Compensation Board
  • Safeguarding work/MAPPA meeting attendance
  • Assessment of testamentary capacity
  • Provision of travel services (advice/vaccinations etc) to practice patients
  • Signing medical certificates of cause of death and cremation forms (including pacemaker removal)
  • Academic, research and lecturing activities including the supervision of students
  • Clinical and non-clinical audit
  • Involvement in training courses (beyond training own NHS staff) e.g. first aid or resuscitation courses
  • Responsible officer and appraisal work
  • Acting as Care Quality Commission (CQC) registered manager
  • Health screening work
  • Acting as an examiner
  • GMC assessor for PLAB or for FTP performance assessments
  • Medical appeal tribunals
  • Mental health review tribunals
  • Good samaritan acts (worldwide)
What fee paying services are likely to attract an additional subscription?

The activities listed below are likely to require payment of an additional subscription. GP members doing such activities should contact our membership team to confirm that we can indemnify the work and whether an additional subscription is payable.

  • Provision of private GP services (including online/telemedicine services)
  • Any surgical procedures not covered by the state scheme (including circumcision or cosmetic procedures)
  • Paid medico-legal work as an independent expert witness (including the provision of medico-legal reports and acting as an expert witness in court)
  • Acting as a medical officer at sports events/concerts and other events
  • Occupational health services
  • Repatriation services
  • Providing services to patients at a nursing home or hospital where the patients treated are not registered with the practice
  • Private work undertaken in specialist areas including:
    • Travel clinics
    • Vaccination clinics
    • Weight loss (slimming) clinic work or bariatric procedures
    • Family planning services including obstetrics and/or fetal scanning
    • Termination of pregnancy work
    • Cosmetic and lifestyle interventions
    • Prison healthcare or work as a forensic medical examiner
  • Complementary or alternative medicine
  • Sports work involving professional or amateur sports people
  • Any clinical work undertaken outside England and Wales
  • Any procedure that is experimental or not standard in general practice (eg 3D printing, use of lasers).
Who do I contact about a claim after 1 April?

If all of the care resulting in the claim was provided after 1 April 2019 then you should contact NHS Resolution in England or NHS Wales Shared Partnership - Legal & Risk Services.

For all other matters (medico-legal advice, complaints, GMC investigations, Coroner’s inquiries, police investigations etc) and for claims where the care in question was provided before 1 April 2019 you should contact the MDU as you did before.

Do I need to tell the MDU about claims that NHS Resolution are handling under the state scheme?

You are welcome to contact the MDU’s medico-legal advisory team to gain their input into any statements you have been asked to make in relation to a claim being handled by NHS Resolution. However if you have everything you need there is no requirement to contact the MDU.

Will the state-backed scheme include existing (historic) liabilities to cover incidents that may have occurred during my MDU membership before 1 April but have not yet been reported?

The precise arrangement of the state-backed indemnity scheme is still not known. Once we know the full details of the scheme we will update members.

What about indemnity for claims for clinical negligence for GPs in Scotland and Northern Ireland?

There is no change as the devolved governments in Scotland and Northern Ireland have not introduced a state-backed indemnity scheme for GPs and as yet have not indicated an intention to do so.

One single clinical incident can lead to multiple investigations

In our experience, a GP is likely to receive claims for clinical negligence infrequently in their career, whereas the likelihood of needing assistance with a complaint or other professional matter such as GMC investigations, is much higher.

GPs should not compromise their own protection.

What MDU membership provides and state indemnity will not:

  • Support with GMC fitness to practise investigations.

  • Indemnity for work not covered by the NHS state-backed indemnity scheme, including activities such as writing reports as well as any private clinical work you do.

  • Representation at disciplinary investigations.
  • Help preparing responses to patient complaints.
  • Assistance with criminal investigations arising from clinical practice, e.g. gross negligence manslaughter.
  • Representation at the coroner’s court.
  • 24-hour access to award winning medico-legal advice.
  • 24-hour access to press and media helpline.
  • Indemnity for Good Samaritan acts worldwide.

Renewing MDU membership

What does Continued Right to Report mean on my renewal letter?

Continued Right to Report means that you have a continued right to report matters from a period of transitional benefits membership.

Will I get a refund?

MDU members have already benefited from significant savings on their subscriptions as a result of transitional benefits membership.

State indemnity was introduced for claims arising from care provided from 1 April 2019. However, no state arrangement is yet in place to support MDU members with claims relating to care provided before that date. Because of this, we are not currently in a position to provide partial refunds of subscriptions for that year.

Our intention is to provide partial refunds to members who had a substantial part of their transitional benefits membership year still to run when the state scheme was introduced, and who converted to the new form of membership.

We will contact members as soon as this situation changes.

Will I need to buy run off cover from you?

As set out in the MDU's member guide, run off is payable in the following circumstances:

  1. if you leave the MDU before the state-backed indemnity scheme is introduced
  2. if the state-backed indemnity scheme is introduced without picking up historic liabilities and you were to leave the MDU before the normal retirement age for your NHS pension scheme.

Otherwise there would be no need for you to purchase run off from us.

Will my MDU membership change when state-backed indemnity is in place?

GP members on transitional benefits membership will renew onto traditional MDU occurrence membership.

Importantly, MDU membership will include:

  • GMC fitness to practise investigations
  • indemnity for work not covered by the NHS indemnity scheme (including activities such as writing reports as well as any private work you do)
  • representation at disciplinary investigations
  • preparing responses to patient complaints
  • criminal investigations arising from clinical practice, e.g. gross negligence manslaughter
  • representation at the coroner's court
  • 24-hour access to award winning medico-legal advice
  • 24-hour access to press and media helpline
  • indemnity for good Samaritan acts.
 

Mind the gap: MDU membership and state-backed indemnity

We know how it feels when you get 'that call'.

Watch our video which follows a fictitious case, based on real MDU files. It demonstrates how a seemingly simple patient examination can lead to multiple investigations.

We can offer GPs support and guidance that state-backed indemnity will not provide.

Support for your practice

What will the state-backed indemnity scheme provide for GP members and practice staff?

State-backed indemnity will provide support for clinical negligence claims for GPs and primary care staff arising from contracted NHS duties in England and Wales.

State-backed indemnity will not provide support for complaints made against any practice staff, costs associated with matters brought to the GMC or other registration bodies, or any criminal investigations.

 
Will the state-backed indemnity scheme provide indemnity for practice nurses, nurse practitioners, advanced nurse practitioners and other practice staff?

Yes. State-backed indemnity scheme will provide support for clinical negligence claims for primary care staff arising from contracted NHS duties in England and Wales.

Do my nurses need MDU membership now?

All practice staff working under an NHS contract will have access to the state scheme for indemnity for clinical negligence claims but there are elements that the state scheme does not support. Nurses would not be supported with a disciplinary hearing at the NMC for example.

Nurses in extended roles, paramedics, pharmacists and physician associates undertake more advanced duties and should remain in MDU membership to access the other benefits of membership, such as representation at NMC or other registration body hearings, support with complaints, coroners’ investigations, access to 24 hour medico-legal support and access to indemnity for fee paying work on patients registered at the practice. They should also declare any work they do on patients not registered at the practice which may incur an additional subscription.

Practice nurse membership is no longer free, although existing free members will continue until their renewal date. Practice nurses are welcome to remain in MDU membership to obtain the services highlighted above. While retaining MDU membership is optional for practice nurses for work indemnified by the state scheme (and for primary care services provided to practice patients which fall outside the state scheme such as travel vaccinations), they would need to retain MDU membership to receive indemnity for any work they do on patients not registered at the practice. This work should be declared to the MDU.

We will continue to support members (both partners and practice managers) in their management of medico-legal matters arising from care provided by all members of the practice team.

As a GROUPCARE practice how will the introduction of state-backed indemnity affect our GROUPCARE scheme?

We have enhanced our GROUPCARE scheme and introduced new benefits. We are currently writing to GROUPCARE practices about the changes we have made and encourage scheme administrators to check and update their scheme details to ensure they continue to access the many GROUPCARE benefits.

Does the MDU indemnify fee paying/private travel vaccinations?

Yes. If practice nurses are doing fee paying/private vaccinations on NHS patients registered at the practice they don’t require individual membership for this. This means that they would rely on their practice partners’ membership to support a claim should an incident arise. If practice nurses are doing fee paying/private vaccinations on non-registered patients (such as private vaccination or travel clinics) they would need individual paying membership.

Does GP state-backed indemnity cover vaccinations to practice staff?

NHS Resolution has indicated that providing work-related vaccinations such as flu and hepatitis B to practice staff would not usually fall within the scope of the CNSGP scheme, as such services are not generally provided under a GMS, PMS or APMS contract.

MDU membership includes indemnity for providing such services to staff working at the practice at no additional charge (including where such services are provided by nurses or phlebotomists based at the practice). It is important that all GP partners have their own indemnity in place in respect of their potential vicarious liability for such services.

GPs or other clinical colleagues are providing work-related clinical services to members of the practice team to should follow their normal procedures for dealing with unregistered patients.

A nurse in my practice was previously not paying for MDU membership. Why are nurses now having to pay?

Previously the cost of free practice nurse membership was part of a GP partners’ subscription as they could be held vicariously liable for the nurse’s acts or omissions. Practice nurses were given full membership so we could deal directly with them on a claim and also assist with other medico-legal matters linked to the claim.

Going forward the state scheme will pick up nurse claims therefore we are simplifying our GROUPCARE scheme and removing the partner subscription supplement. This means practice nurse membership can no longer be subsidised.

Practice nurses are welcome to remain in MDU membership to receive personal access to our 24 hour helpline and support with issues such as NMC referrals. While maintaining membership for practice nurses for work indemnified by the state scheme (and for primary care services provided to patients registered at the practice that fall outside the state scheme such as travel vaccinations or completing employers forms or medical reports for third parties) is optional, they would need to retain MDU membership to receive indemnity for any work they undertake on patients not registered at the practice. This work should be declared to the MDU and an additional subscription may be payable. We will continue to support practices (both partners and practice managers) in their management of medico-legal matters arising from care provided by all members of the practice team.

Why have the subscriptions for nurse practitioners and advanced nurse practitioners not reduced as a result of the state scheme?

In past years, nurse practitioners in GROUPCARE practices would typically pay a reduced subscription (compared to our standard non-GROUPCARE nurse practitioner rates) because the price was subsidised by an additional subscription collected through the GP partner supplement reflecting the practice’s vicarious liability for its employees.

In the last 18 months, nurse practitioner subscriptions were further reduced due to the transitional benefits scheme, which offered benefits on a claims paid basis.

Once the new state scheme launches, NHS care provided by nurse practitioners will be covered by the scheme. As a result we are simplifying our GROUPCARE scheme and removing the partner subscription supplement. This means nurse practitioner membership can no longer be subsidised.

Nurse practitioners should remain in MDU membership to access the other benefits of MDU membership, such as representation at NMC disciplinary hearings, support with complaints or coroners’ investigations, access to 24 hour medico-legal advice and indemnity for fee paying work for patients registered at the practice. Nurse practitioners would also need to declare to the MDU any work they do on patients not registered at the practice which may incur an additional subscription.

Why are HCAs and phlebotomists no longer offered MDU membership?

The state scheme will provide indemnity for clinical negligence claims for all practice staff working under an NHS England and Wales contract and therefore HCAs and phlebotomists will no longer require individual membership for medico-legal support. Where members in these roles are part way through their membership year, their membership can continue until their renewal date, but renewal will not be offered. Practice managers can ask for advice and support for issues arising from HCAs and phlebotomists through their own membership.

Case studies

Real-life member experiences where state-backed indemnity wouldn't have been enough.