Viewpoint: Seven-day NHS could ease cost of GP indemnity, says Chris Kenny

A properly funded seven-day NHS could ease the rising cost of GP indemnity, argues Medical and Dental Defence Union of Scotland (MDDUS) chief executive Chris Kenny. Meanwhile, shortages of out-of-hours GPs and early retirements should not be blamed entirely on soaring indemnity fees.

MDDUS chief executive Chris Kenny: seven-day NHS can cut GP indemnity costs
MDDUS chief executive Chris Kenny: seven-day NHS can cut GP indemnity costs

MDDUS has been looking after GPs' interests for over 100 years and shares their concern about the rising cost of indemnity.

We cannot wish away the cost pressures of the growing numbers of claims and increasingly generous awards. Our subscriptions take account of the best actuarial advice about likely future costs, including claims which have not yet been reported to us, and have to reflect the current situation. It’s tough, even for organisations like us who do not seek to make a profit.

However, in our opinion, indemnity costs do not prevent out-of-hours working. Out-of-hours cover for MDDUS general practice partners is presently included in the core subscription. So we’d be surprised if the cost of cover were the sole or even the main factor in leading GPs to withdraw from out-of-hours services or retire from general practice altogether.

GP indemnity costs

It is too easy to make the cost of indemnity a convenient whipping boy for challenges in the general resourcing of primary care.

Will rising cost mean that aspirations for seven-day working are stillborn? Not if the proper resources are in place.

There’s a key distinction between genuine seven-day working and unscheduled work out-of-hours. The latter involves managing emergency and urgent presentations of acute illness, often through interim treatment or diagnosis without case records.

'Seven-day' routine care should be far closer to regular core hours work, where a doctor has access to patient records and a familiar environment, backed by sound governance structures. A properly resourced extension of this model might reduce the relative risk of out-of-hours care for primary care providers and so lessen pressure on indemnity costs.

Crown indemnity

Given other pressures, we don’t think that the government will – or should – extend NHS indemnity to cover general practice. Even if it did, NHS indemnity would not cover disciplinary issues, GMC referrals, coroner’s inquests and general ethical advice. Doctors would still need individual membership of a defence organisation for expert medico-legal knowledge and services to protect their careers.

But the government must act quickly and decisively to cap legal costs in clinical negligence cases. It is in everyone’s interest to ensure that patients rather than the legal services industry benefit from properly advanced claims and settlements. Aspects of the law of compensation also require reform to bring them into the 21st century.

Proper resourcing and legal reform: they are the issues MDDUS is pressing forward with in debate along with our colleagues at the BMA and with NHS England and the DH as we seek solutions to common problems. If that’s delivered, then the profession will remain in control of its indemnity risk, which its own expert bodies like MDDUS are best placed to manage.

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