Why move to state-backed GP indemnity?
The annual cost of indemnity has risen to around £8,000 per average GP, reports suggest. The BMA says GP fees increased by a staggering 50% from 2010 to 2016, and GPonline reported earlier this year that nine out of 10 GPs had seen their costs rise in 2017.
At a time when the government faces an uphill battle to reach its target of increasing the GP workforce by 5,000 by 2020, soaring indemnity costs are driving growing numbers of doctors out of the profession altogether and pushing many more to reduce the number of sessions they work or turn down shifts.
DH guidance published lin November 2017 acknowledged that rising costs were a 'great source of concern for GPs and impacts negatively on the GP workforce'. It added: 'We are seeking to put in place a more stable and more affordable system of indemnity for general practice.'
How will the state-backed deal work?
The DH has admitted developing a state-backed GP indemnity system will be 'complex', that there are 'many issues still to address' and that plans are at an early stage.
However, officials have confirmed that the scheme is likely to offer cover to GPs through the organisations they work in, rather than individually. DH guidance says: 'We envisage the scheme would provide clinical negligence cover to providers of GP services, through which the activities of individual GPs will be covered.'
This will cover providers on GMS, PMS and APMS contracts, offering indemnity for all practice (or, for example, out-of-hours provider) staff including students or trainees, and could yet be extended to offer cover for prison GPs and other public-sector roles.
It will cover clinical negligence liabilities for work carried out as part of the delivery of NHS-contracted primary medical services, meaning GPs will need to take out additional indemnity cover any non-NHS work they undertake.
GPs will also need to buy cover for legal representation in criminal or GMC investigations and for 'good samaritan' acts. These are also outside the Clinical Negligence Scheme for Trusts - often incorrectly referred to as 'crown indemnity' - that indemnifies doctors working in NHS hospitals.
When will the state scheme begin?
Talks between the DH, medical defence organisations, the RCGP and BMA are ongoing. The DH said in November it could take 12 to 18 months to develop the state-backed scheme. A significant element of the talks could involve determining who will run the scheme - will it be administered through existing medical defence organisations, or run directly by the DH or NHS England?
The DH confirmed on 30 November that it had appointed NHS Resolution to administer the state-backed GP indemnity deal. NHS Resolution is an organisation made up of the former NHS Litigation Authority, National Clinical Assessment Services and the Family Health Services Appeals Unit, and already administers the Clinical Negligence Scheme for Trusts - mentioned above.
Will state-backed indemnity apply to GPs UK-wide?
The Welsh government issued an update on its progress developing a state-backed scheme in July 2018. It is currently working with GPs, MDOs, health boards and the Welsh Risk Pool to develop the way that its scheme operates. As in England, it will only cover clinical negligence liabilities for work carried out as part of an NHS contract.
In Scotland, indemnity costs are traditionally lower, but the Scottish government has also suggested it will not allow its GPs to be disadvantaged relative to England.
What will happen in Northern Ireland - and when - remains unclear.
Will state-backed indemnity cover historic claims?
In the wake of Mr Hunt's announcement last October, the MDU set out plans to cut costs for GPs with a 'transitional scheme' designed to take advantage of the switch to a state deal, while the other defence organisations have maintained their existing indemnity schemes.
The organisation believes the government will assume responsibility for historic claims under the state-backed deal, as was the case when the NHS indemnity scheme for hospital doctors was introduced in 1990 - although the government has suggested it may not take on these liabilities. The Welsh government has also said it is yet to decide whether its state-backed scheme will extend to liabilities incurred before April 2019.
If it doesn't, GPs on the MDU's transitional scheme could have to pay for extra 'run-off' cover - although the MDU says this will only apply for a maximum of seven years, and cost no more in total than standard indemnity cover.
Will state intervention solve the indemnity crisis?
Medical defence organisations warn that a state-backed indemnity system will not tackle the overall problem that rising indemnity costs are consuming a growing proportion of the NHS budget. They have called for a cap on the fees lawyers can charge, particularly in cases involving low-value claims, and reform of tort law to bring down costs.
A controversial change to the discount rate announced early this year by the government will also drive up the cost of negligence payouts - with the cost of some claims set to double.
How much money will be needed?
If the estimate that an average GP now pays £8,000 a year for indemnity is correct, the profession's total annual bill comes to around £300m. The BMA says fees rose 50% from 2010 to 2016, and GPonline polls confirm further sharp rises in 2017 for many doctors.
The government has already put £30m a year for 2016/17 and 2017/18 into a GP Indemnity Support Scheme being distributed through practices to ease the cost of indemnity.
But with costs set to rise further before the state-backed scheme is rolled out in 2019 - assuming it isn't delayed - this annual investment will likely have to be quintupled or more to bring GP indemnity costs down to the level they were at when the current decade began.