As part of the General Practice Forward View commitment to address the issue of rising indemnity costs and to assist with winter resilience in primary care, NHS England will be running a winter indemnity scheme for GPs, beginning on 1st October 2018 and concluding on 31st March 2019. It is designed to meet the costs of personal professional indemnity for any additional work outside of core hours undertaken by GPs this winter, enabling GPs 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, you should initially make contact with the service provider to check what extra sessions are available to work and whether individual cover will be required (Eligible services include; out of hours (OOH), unscheduled care (USC) or improving access (IA) providers as well as services provided by NHS 111, and integrated urgent care services) .
NHS England winter indemnity scheme covers additional sessions in the following settings and during the times stated:
- Extended Access 18:30 – 20:00 (Mon – Fri), 08:00 – 20:00 Sat/Sun and bank holidays)
- OOH 18:30 – 08:00 (Mon – Thurs), Fri 18:30 to Mon 08:00 and bank holidays
- OOH in Integrated Urgent / Unscheduled Care settings 18:30 – 08:00 (Mon – Thurs), Fri 18:30 to Mon 08:00 and bank holidays
The winter indemnity scheme is not intended to cover any urgent / unscheduled care sessions during core general practice hours i.e. Mon-Fri 08:00 – 18:30 (except bank holidays).
This scheme has been developed with the MDOs and you can find information on how to apply for the scheme via your MDO.
Frequently Asked Questions
- Why are you running the scheme?
- What is the aim of the scheme?
- What do you mean by OOH services?
- Can I work extended hours in a GP Practice?
- What is the timing of the scheme?
- How will the scheme work?
- 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 NHS Resolution not cover NHS Providers?
- How much will this cost?
- Does the winter indemnity scheme cover the costs of other clinicians (e.g. Advanced nurse practitioners or pharmacists?
- What cover does the winter indemnity scheme provide?
- Can I do some sessions and arrange my cover afterwards?
- What if I don’t use my sessions?
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 £10m 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.
This year, the scheme will cover additional sessions worked as part of the extended access initiative. This could within a GP practice setting where session are for example delivered through a hub arrangement.
The scheme will begin on 1 October 2018 and conclude on 31 March 2019.
GPs must first make contact with their intended OOH provider to check sessional availability, and thereafter contact their MDO to discuss additional cover requirements. In order to have access to the scheme, GPs will be required to provide consent to their MDO to share their details with NHS England to enable appropriate audit checks to be undertaken. The details will be the GP name, and the place at which they expect to undertake their sessions.
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.
NHS Resolution provides clinical negligence cover to NHS Trusts. Where an NHS Trust runs an NHS 111 service or an OOH service, NHS Resolution can and will cover additional medical indemnity costs for GPs working in the service. Under current legislation however, NHS Resolution 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 £10m to support this initiative and will be monitoring uptake across GP Practices, OOH, NHS111 and urgent care service providers to evaluate the schemes impact.
No, this scheme is run with the Medical Defence Organisations and is limited in scope to GP sessions.
The scheme provides occurrence based cover (by all MDOs) for individual GPs. It does not provide for organisational cover.
No, the scheme is entirely forward facing and cannot cover any sessions already undertaken. Retrospective cover is strictly prohibited, therefore we would encourage GPs to ensure that they have cover in place as soon as possible and that they review their requirements regularly so that they can gain access to further sessions where needed, before they are undertaken.
NHS England is providing this scheme to ensure we maximise amount of cover provided across the country, therefore if you are claiming for sessions you are not undertaking this hampers the ability of the NHS to improve patient care. It is therefore your obligation as part of the scheme, to inform your MDO if you will not be able to undertake the sessions you had originally intended. There is no penalty or problems attached to notifying your MDO of your reduction in sessions, and you will be enabling those sessions to be allocated to someone else who can assist with winter pressures. Should NHS England find, upon conducting random audits, that sessions have been paid for but not undertaken, this may affect future eligibility for schemes.
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