As part of a broader General Practice Forward View commitment to address the issue of rising indemnity costs, NHS England’s 2016 winter indemnity scheme for GPs was due to run until Friday 31 March 2017 (inclusive) however this has now been extended to run until Sunday 30 April 2017. It is designed to meet the costs of personal professional indemnity for any additional out of hours work undertaken by GPs this winter to enable the freedom to work additional sessions without having to pay additional subscriptions to their medical defence organisation (MDO).
If you are a GP who would be interested in accessing the scheme, we would ask you initially make contact with your local out of hours (OOH) or unscheduled care (USC) provider to check what extra sessions are available to work and whether individual cover will be required. OOHs / USC providers include all those services providing clinical care to patients other than to registered patients of that practice where limited or no access is available to the patients care records. This can include services provided by NHS 111, integrated urgent care services and unscheduled care sessions in traditional general practice settings.
This scheme has been developed with the MDOs and you can find information on how to apply for the scheme via your MDO website at:
Frequently Asked Questions
- How will this work?
- What is the aim of the scheme?
- What do you mean by OOH services?
- What is the timing of the scheme?
- Is the difficulty to recruit GPs to work in NHS 111 and OOH services, the reason why A&Es are so busy?
- Why do some GPs have to pay more in indemnity to do the job they are qualified to do?
- Does the NHS Litigation Authority not cover NHS Providers?
- How much will this cost?
- Is this likely to be a yearly scheme?
- Does the winter indemnity scheme cover the costs of other clinicians (e.g Advanced nurse practitioners or pharmacists?
- Is the winter indemnity scheme available for organisations which have corporate insurance cover?
We are introducing a scheme to support GP out of hours services to operate effectively through the winter period by ensuring that additional indemnity costs do not become a disincentive to GPs to work in out of hours / unscheduled care services. This will support GPs wanting to start working within a OOH setting , or support those wanting to increase their commitment by working additional sessions in an out of hours or unscheduled care setting, including in NHS 111 services.
Care delivered outside a traditional general practice setting with a registered list is more likely to result in a claim against the clinician. This is partly because of factors such as higher acuity of cases, reduced access to tests and referrals, and the lack of access to the patient record. It is linked also to the fact that patients are more likely to make a claim against a clinician they do not know. As a consequence, GPs working in OOH or unscheduled care settings, often incur additional personal costs arising from requirements for additional clinical indemnity. This has become a barrier to recruitment and retention. NHS England is investing £5m in 2016/17 towards offsetting the additional indemnity premium for GPs who are offering to work with OOH providers this winter to ensure that all OOH providers have access to GPs to ensure no OOH shift goes unfilled.
When referring to OOH or unscheduled care this includes services providing primary care services 6.30pm to 8am, weekend and bank holiday services. It also includes unscheduled care service providers, typified by services provided at any time of the day, to a range of patients not registered with the provider and accessing services where clinicians do may have only limited access to clinical records.
The scheme became operational in October and following an extension will now run until 30 April 2017 this will include the Easter weekend.
NHS 111 and OOH services already play a major part in reducing reliance on busy emergency health services. We know that the service has real potential to develop and further improve the service offered to patients, reducing reliance on our emergency health services. As part of this, we want to make it easier for local GPs and other clinicians to work in emergency care / unscheduled care.
Premia for indemnity cover is higher for some clinical settings than others because of evidence that suggests such environments are more likely to be associated with patient claims (whether meritus or not). GPs working in such services do not have the advantage of a long term doctor – patient relationships, and acute presentation of illnesses in an out of hours settling brings with it greater risk; especially where there is limited or no access to the patient’s care record. Where the clinical environment brings higher risk, additional medical indemnity is required.
Where an NHS Trust runs an NHS 111 service or an OOH service, the NHS Litigation Authority can and will cover additional medical indemnity costs for GPs working in the service. Under current legislation however, the NHS Litigation Authority cannot cover other providers providing OOH or NHS 111 services, so additional indemnity will be the responsibility of the provider and/or the GPs themselves. We hear this is a barrier to recruitment to these services and we are having ongoing conversations with Medical Defence Organisations and the profession around these issues. The Winter Indemnity Scheme will help mitigate the risks that GP OOH services and urgent care services are unable to fully recruit to clinical shifts, and will therefore help system resilience over the busy winter period.
NHS England has committed £5m to support this initiative and will be monitoring uptake across OOH, NHS111 and urgent care service providers to evaluate the schemes impact.
No, this year is intended to be the last year that this scheme will run. For 2017/18, CCGs will be required to reflect the cost of rising indemnity in negotiations with providers so that sessional fees in 2017/18 and beyond will more reflect the rise in indemnity costs associated with doing this work.
No, the scheme is being run as last year, focusing on GP sessions. Further work is being undertaken to identify the impact of indemnity costs for non-medical clinicians which will help inform CCGs commissioning intentions for 2017/18.
No, this scheme has been developed to tackle the personal costs of indemnity, it is not the intention of NHS England to extend this scheme to provide organisations with a subsidy for indemnity or insurance costs.
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