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.
- NHS England is running another Winter Indemnity Scheme from October 2016 until 30 April 2017, to assist with the additional indemnity costs of GPs who are able to carry out more out of hours sessions, to specifically address winter pressures. NHS England is also taking forward discussions with clinical commissioning groups (CCGs) and the profession on the best way of tackling the effect indemnity is having on the ability to deliver out of hours / unscheduled care services.
- 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.