Nigel Praities, editor of Pulse magazine, opines on 30th September 2015: Time to stop the indemnity circus . The only way out is no fault compensation…. Or a salaried service with corporate indemnity. The problems for practices in meltdown, where there are too few remaining doctors and no applicants, is that they have grasped the nettle of “nurse practitioner” to diagnose. And guess what, nurses are not trained to make a diagnosis…. The only circus like character is the minister – a clown?
Paying indemnity fees is a necessary evil for GPs, and I have never known a time when they’ve been popular. But the situation has become a circus.
Many GPs tell me they are giving up working in out-of-hours and other settings because the premiums are so high. And who can blame them? A recent survey by the Family Doctor Association revealed that GP indemnity costs have increased by 25% in just one year. Pulse recently reported that one out-of-hours GP was quoted annual premiums of up to £30,000 by a medical defence organisation (MDO).
This isn’t an isolated case. This year’s LMCs Conference heard the cost of out-of-hours cover for some is £35 per hour. And it is not just GPs. One practice recently saw fees for its advanced nurse practitioner rise from £900 to £8,000 in 12 months, despite the nurse facing no complaints during the year.
Premiums will only rise further as practices struggle to recruit GPs and employ staff such as pharmacists and physician associates. The NHS is desperate for practices to take on more specialist care to save cash, but that will mean more hikes in premiums.
And don’t get me started on plans for seven-day working (which are already leading to increases in indemnity costs) and the use of technology, such as Skype consultations, to manage demand.
This problem will not go away. But there is a big transparency problem with the MDOs. In the past, the big three have been able to give Pulse at least a ballpark figure of their annual rise for the average GP. Now, though, they provide no figures at all, merely saying they are based on an individual’s risk.
Pulse asked recently how much it would cost a practice to indemnify a physician associate but got no clear answer from the MDU, MPS or MDDUS. I have some sympathy for them as we live in an increasingly litigious culture, but in what other industry would this lack of transparency be tolerated? I can think of a certain meerkat that would be appalled at how these firms are behaving.
The truth is the system is bust. State intervention is needed to enable GPs to work across different settings and take on greater risk, at a price they can afford. If the health service wants GPs to work more flexibly it will have to find an affordable mechanism to enable them to do so.
In this respect, Wales is leading the way. It has included all GPs in its NHS ‘risk pool’ for out-of-hours. This has significantly cut fees and while there are things it does not cover – disciplinary hearings and criminal proceedings, for example – at least it is a model that has been shown to work.
LMC leaders recently voted to look at whether a crown indemnity scheme for all practices could work in England, and I understand NHS England is considering what it can do nationally. Whether managers can be trusted to choose a scheme that is effective, rather than cheap, is another matter. But I urge them to think imaginatively and quickly.
Any crown scheme needs to be comprehensive enough to make a real difference to indemnity costs. Other mechanisms, such as reimbursing fees for non-routine activity by GPs should also be considered, and confusion over how to indemnify new grades of practice staff needs to be cleared up.
The curtain needs to come down on the indemnity circus, and soon.