The General Practice Forward View (GP Forward View) sets out a plan, backed by a multi-billion pound investment, to stabilise and transform general practice, by putting funding on a proper footing with the rest of the NHS, enabling more self-care, managing demand on services and expanding the workforce.
Rising indemnity costs are a concern for general practice. GPs have made clear in recent years that they feel they have been subject to unsustainable, above-inflation rises in the amount they must pay to buy indemnity against clinical negligence. It is thought that rising indemnity could discourage GPs from taking on certain work, like out-of-hours care.
The GP Forward View recognised these concerns. In May 2016, NHS England and the Department of Health established a GP Indemnity Review group to consider proposals to address the rising costs of indemnity in general practice, working with the profession and medical defence organisations.
The outcomes of the GP Indemnity Review have been published. They set out evidence for the scale of indemnity inflation and its underlying cost-drivers, as well as a series of proposals for ways to address indemnity pressures and underlying factors.
Key outcomes from the review
- In 2016-17, a new GP Indemnity short term financial support scheme started, providing special payments to practices. These payments were linked to unweighted patient population, to offset average indemnity inflation. The first special payment to practices was made from mid-March 2017. A sum of £30 million was distributed to practices to offset 2016/17 inflation, which was calculated at 51.6 pence for each registered patient on practices lists as at 1 December 2016. A sum of £60 million was distributed to practices from mid-March 2018 to offset 2017/18 inflation, calculated at 101.7 pence for each registered patient on practices lists as at 1 January 2018. See our GP Indemnity Support Scheme – questions and answers and Policy Statement for more information.
- The GP Winter Indemnity Scheme ran from October 2016 to April 2017 and again from October 2017 to April 2018.
- The Department of Health and Social Care is working to better understand the options for constraining litigation costs in primary and secondary care. Further work in this area is integral to our goal to supporting the NHS to become a learning and improving system that seeks to prevent harm and reduce risks, and when healthcare harm does occur there is an improved response that ensures a positive and meaningful experience for the patient and their families, and – where appropriate – fair compensation. At the same time, we must consider the right balance between funding NHS services for all, and awarding compensation to those who have been negligently harmed by the NHS when things go wrong.
- NHS England is working with the profession and the medical defence organisations to identify practical steps which will help improve safety in practice and the handling of patient complaints.
- NHS England is working with the Department of Health and Social Care and other stakeholders to consider what the most appropriate indemnity arrangements for GPs for the future are, for example national schemes, risk sharing agreements etc. We will also need to ensure future systems equally support clinicians both in traditional models and in new, evolving models of primary care. The profession has also raised concerns about maintaining a sense of equity between New Care Models and those working under traditional contracts. NHS England will take forward discussions on these issues in the coming months.
Development of state-backed scheme for England
Rising indemnity costs are having a serious impact in general practice. Doctors and their patients must be able to rely on effective cover when things go wrong. While NHS England have implemented short term measures including currently offsetting inflationary rises in GP indemnity and investing in the GP Winter Indemnity Scheme, we believe that a long term, sustainable solution is needed and have been working with the Department of Health towards achieving this aim.
In October 2017, the Secretary of State for Health announced that the government is planning to develop a state-backed indemnity scheme for GPs, aiming to deliver a more stable and more affordable system for GPs. Significant work is being undertaken to develop the details of the scheme, involving appropriate engagement with a wide range of stakeholders.