Questions and answers

The following questions and answers (Q&As) address key queries around the new GP Indemnity Support Scheme, which started in 2016/17 and provide a special payment to practices, linked to workload, which will offset average indemnity inflation.

The scheme will initially run for two years, when it will be reviewed. During this period we will be working with the Department of Health to consider more fundamental reform around indemnity. NHS England will develop the details of the scheme in discussion with the profession.

Before reading these Q&As, we recommend reading the findings of the GP Indemnity Review to get a full understanding of the proposals and next steps.

Will these payments go to GPs or the practice? 

The funding goes to the practice as they have the contractual relationship with NHS England.

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On what basis will the amount that GPs receive, be worked out?

The total cost of the scheme will be based on the average annual inflationary rises experienced by individual GPs, multiplied by the number of GPs. The reason for using average annual inflation is to maintain competition within this market and an incentive for GPs to shop around for the best rate.

We will calculate this based on the best available data, and ensure that the methodology is transparent and visible to the profession, while ensuring that the cost remains within overall spending limits. Each practice will receive a proportion of the total figure calculated for the scheme. NHS England will provide this as an additional, identifiable payment to each practice.

The first payment were made in March 2017, to address inflation experienced in 2016/17. The amount a practice receives will be determined based on its list size, not on weighted capitation. Inflationary costs for 2015/16 were also recognised retrospectively in the 2016/17 GP contract.

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How will inflationary rises be worked out?

As set out in the GP Indemnity Review report, in hours indemnity inflation has been found to be rising at 10 per cent per annum and this informed the payments being made in March 2017.

We know that indemnity inflation for out of hours is rising at around 17%, therefore NHS England are undertaking discussions with the profession and CCGs to establish how we can best deliver on the principle of protecting GPs working out of hours from indemnity inflation rises.

It is envisaged that the in-hours indemnity inflation costs in 2017/18 will be measured by a future data collection, and out of hours inflation will be established by further future discussions with CCGs.

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Is this for all GPs including sessional GPs/locums?

The practices will receive their payment which is intended to be used for all GP staff, not limited to just Partner GPs. Locums however are and will continue to be able to negotiate their rates with practices as appropriate. We do not intend to create an automatic bolt-on for locums or remove, affect or interfere with that locum and practice interaction.

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When will GPs receive this funding support?

This funding, for 2016/17 inflation, was paid to practices in March 2017.  We envisage the date for the second year payment will be around the 2017/18 year end, so possibly between March and April 2018.  However, the exact date will be confirmed in due course following discussions with the profession.

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Why aren’t GPs just given crown indemnity?

There is no such thing as ‘crown indemnity’. Every type of cover is either paid for by individuals or their employers, it is not paid for by the crown.

Hospitals have the Clinical Negligence Scheme for Trusts (CNST), which each trust contributes to each year. There is no evidence that this or a similar scheme to which GP practices (as providers like NHS trusts) would have to similarly contribute would be any cheaper.

Also, simply adopting this cost for GPs would have to be paid for by an adjustment to the GP contract and therefore holds little merit.

The CNST provides no ‘run off cover’ to cover claims after an individual has stopped practising. As Trusts are such large healthcare providers they will always provide care, even if they change in format slightly so they will always have people covered because the Trust remains in the scheme.

Individuals are different; for example a GP or the whole practice could stop working and their list be dispersed, so their patients may not be covered by anyone if a claim was to arise from the time when the GP was in practice. As general practice continues to evolve, and grows in scale, it may be that a further look at a different model for indemnity may be appropriate.

CNST itself is not a solution to the issue of rising costs and how they are funded, and the Department of Health is working to better understand the options for constraining litigation costs in primary and secondary care.

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Isn’t this going to involve filling in lots of complicated forms?

No. Subject to the necessary changes to directions being made, an automatic payment was made to each practice through the normal contractual payment routes for the in-hours scheme in April 2017 and will be again at a date to be determined during 2018.

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Will this potentially disadvantage practices with more doctors per head of population?

The practices will all get a contribution based on their unweighted population. This is to provide the fairest split of the funds. It will remain the practice’s responsibility to ensure they use this payment to contribute towards indemnity costs of their practice teams, including the wider workforce.

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