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 – to start to put funding on a proper footing with the rest of the NHS, enabling more self-care, managing demand on services and expanding the workforce.
A key concern within general practice in recent years is the ongoing rise in the costs of indemnity. GPs have made clear that they feel they have been subject to unsustainable, above-inflation rises in the amount they must pay to buy indemnity against clinical negligence. Concerns have also been raised about the potential for rising indemnity in discouraging GPs from taking on certain work, like out-of-hours care.
The GP Forward View recognises 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 and set out evidence for the scale of indemnity inflation and the underlying cost-drivers as well as a series of proposals to address indemnity pressures and underlying factors.
Key outcomes from the review
- A new GP Indemnity short term financial support scheme, will start in 2016-17 and provide a special payment to practices, linked to unweighted patient population, to offset average indemnity inflation. The Scheme will initially run for two years, when it will be reviewed. The first special payment to practices, linked to unweighted patient population figures, to offset average indemnity inflation will be made from mid-March 2017. A sum of £30 million will be distributed to practices for this, which is calculated at 51.6 pence for each registered patient on practices lists as at 1 December 2016. See our GP Indemnity Support Scheme – questions and answers and Policy Statement for more information.
- Running a GP Winter Indemnity Scheme – which was in place from October 2016 to April 2017.
- The Department of Health will work 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 and fair compensation. And we must consider the right balance between funding between NHS services for all, and compensation to those who have been negligently harmed by the NHS when things go wrong.
- NHS England will work 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.
- We will consider what the most appropriate indemnity arrangements for GPs for the future are, including consideration of national schemes or risk sharing agreements. We will also need to ensure future systems equally support clinicians in traditional models and in new, evolving models of primary care, some of which challenge the historic boundaries between primary and secondary care.
- The profession have also raised concerns about how to maintain 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 DH 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. We recognised that significant work will now need to be undertaken to develop the details of the scheme, following appropriate engagement with a wide range of stakeholders.
NHS England believe that any new scheme should:
- meet the needs of current and future GPs
- be in the interest of patients
- represent value for money for taxpayers
We understand the scheme will need careful negotiation and will take at least 12 to 18 months to establish. NHS England will continue to work closely with partners.
GPs should continue to make sure they have appropriate indemnity cover, in line with General Medical Council (GMC) requirements, to enable them to practice.