The documents confirm that the scheme covers claims for compensation 'arising from the care, diagnosis and treatment of a patient as part of the NHS in England following incidents which happen on or after 1 April 2019'.
Claims for incidents before that date will be covered by GPs' previous indemnity provider. If there is a series of events that straddle both periods, the new scheme will only cover the element relating to post 1 April.
Like the cover GPs currently buy from medical defence organisations all benefits under the scheme are discretionary. NHS Resolution said that the rules should not 'under any circumstances be construed to imply that any contract of insurance exists between any person and the secretary of state'.
NHS Resolution has previously confirmed that the scheme will cover all GPs and other staff working in the delivery of primary medical services, including locum and salaried GPs, nurses and other health professionals, and that there are no formal membership or registration requirements for GPs to be covered.
The documents also reveal that there is no limit of indemnity under the Clinical Negligence Scheme for GPs and no excess. GPs will not be at risk of having to meet part of the claim themselves, 'unless some element of it is not covered under scheme', NHS Resolution said.
However NHS Resolution will have discretion over which cases it will pay out for and which it will defend. It will not pay out for a claim if the GP wants to settle but the scheme recommends defending. In addition, if a GP wants to defend but the scheme recommends the claim is settled, it will only pay out the amount it initially recommended as settlement if the GP pursues their defence.
The scheme will not cover claims for non-NHS work, complaints where there is no likelihood of a claim, GMC inquiries, CQC investigations, inquest representation, disciplinary proceedings against GPs or their staff and other legal issues. NHS Resolution said that GPs should maintain membership of a medical defence organisation or another provider for these matters.
GPonline last week revealed that the GP medico-legal fees will fall by 80-90% when the state-backed scheme begins next month. GPs part-way through an annual indemnity package on 1 April may also be in line for refunds on fees paid in 2018/19, defence organisations have confirmed.
Reporting a claim
As is the case now, GPs are encouraged to contact NHS Resolution or their indemnity provider as soon as possible after receiving a letter of notification or letter of claim.
GPs are also advised to contact NHS Resolution in the following situations:
- If they have been involved in a notifiable patient safety incident which has or may have resulted in severe harm irrespective of whether a claim has been made.
- If they receive a request for disclosure of patient records or some other indication that a claim is being considered.
- If they receive any communication from the health ombudsman (in this case GPs should also contact their MDO)
- Any response to a complaint they are making which amounts to an admission of breach of duty. However NHS Resolution said this should not stand in the way of the need to be open and transparent with the patient at the time.
- If they intend to offer compensation or redress.
- If there is any adverse issue that has the potential to involve a group action by a number of patients.
Once a claim has been reported NHS Resolution will contact GPs by email or telephone within 72 hours to confirm if it is covered by the scheme and allocated a dedicated claims manager.
The rules of the scheme also mean that there will be some exclusions to it providing cover 'in order to maintain the financial integrity of the scheme'. These will be decided on a case by case basis, but will most likely apply if a GP has made an admission of liability without the scheme's agreement, where court proceedings have not been referred to NHS Resolution or if the GP fails to assist NHS Resolution in managing the claim.
In his speech to the LMCs conference yesterday GPC chair Dr Richard Vautrey said that the new scheme would remove the risk of indemnity from GPs. 'In England and Wales, for every NHS GP, partner, salaried GP and locum, working in hours or out of hours, once and for all, we have taken away the burden of unsustainable indemnity payments,' he said.
Full details of the indemnity arrangements for Wales have yet to be revealed, but the Welsh government has said that it will also be up and running by 1 April. However, controversially the Welsh government has said that locums will need to sign up to the 'all Wales locum register' in order to be eligible for its scheme.