The ultimate goal must be to remove any difference between indemnity fees paid by doctors in hospital and those who work in general practice
The crisis in general practice is all too visible. Increasingly, we hear reports of practices being unable to recruit GPs, leading to some having to close their lists to new registrations in order to safely manage their existing patients. Other practices are closing altogether and handing back their contracts. These are the results of a decade of underfunding and a failure to prioritise general practice, which are clear for all to see.
However, what has largely been a hidden problem to most outside general practice has now come into full view. GPs have had to cope with rapidly rising indemnity costs for many years. They now reach an average cost of around £8000, after a more than 50% rise in costs between 2010 and 2016. As this includes many doctors who are working less than full time, the average figure for a GP working nine sessions a week is significantly more, and for GPs doing out-of-hours sessions, the amount they pay is even higher. It’s as if they have had to pay a personal tax for the privilege of choosing to be a GP, and year on year that growing tax bill has become increasingly unsustainable.
The situation reached critical in February this year when the Lord Chancellor announced a revision to the personal injury discount rate from 2.5% to -0.75%, which would have left medical defence organisations with no option but to significantly increase subscriptions.
Indemnity costs for GPs were already playing a major part in the recruitment and retention crisis we face. The substantial difference between primary and secondary care indemnity fees is a major consideration for anyone thinking about their future career options. Younger doctors are put off from becoming GPs and older ones are looking for the exit door. Even doctors in the middle of their careers wonder whether it’s worth continuing when they receive their annual indemnity bill.
The situation is even worse for GPs doing out-of-hours and urgent care work. They’ve faced an average 20% increase in costs every year from 2010-16. Delivering care in this riskier environment means that indemnity cover is even higher, and as a result GPs who are prepared to work during the night and at weekends are discouraged from doing so. This leaves many organisations struggling to fill rotas and patients put at risk as the services that remain are stretched too thinly.
As practices struggle to recruit GPs, many are turning to other healthcare professionals to work alongside them, such as pharmacists and physiotherapists. However, once again, indemnity fees are all too often thwarting these changes because the current system is designed around GPs bearing all the indemnity responsibilities and therefore all the costs.
All of these problems were happening before the discount rate changes, but the prospect of a doubling (or more) of indemnity rates led even the medical defence organisations to call for radical change. The current system is broken and needs fixing urgently.
After months of sustained lobbying by the BMA’s GP committee, together with the Royal College of General Practitioners, the government has at last accepted the need to move to a state backed indemnity scheme in England. The Welsh government has indicated that they plan to develop similar arrangements and we await details about any plans in Northern Ireland and Scotland. The new scheme in England will provide clinical negligence cover for GPs and practice staff providing NHS primary medical services. It will cover GP contractors, salaried GPs, and locums working in these practices, as well as NHS out-of-hours urgent care services.
The government’s commitment is a landmark change and will be widely welcomed. However, it won’t happen overnight as—with a lot of work still to be done on the detail—a scheme won’t be in place for another 12-18 months. Nor will it remove GPs’ need for their own private indemnity arrangements—to cover non-NHS work they may do—and to have a medical defence organisation to turn to at times of difficulty, such as a GMC hearing.
The ultimate goal must be to remove any difference between indemnity fees paid by doctors in hospital and those who work in general practice. By doing this, we can get rid of one of the major barriers to recruiting and retaining more GPs. It won’t be easy, but it’s a task that the BMA is committed to achieving.
Richard Vautrey is both the chair of the BMA’s GP committee in England and chair of GPC UK. He was elected to these roles in 2017. He has represented GPs in Calderdale, Kirklees, Leeds, and Wakefield on the GPC since 2001. He is also a nationally elected member of the BMA Council. He is a GP partner in a practice in Leeds and the assistant secretary of the Leeds Local Medical Committee.
Competing interests: Richard Vautrey is ex-officio director of the GP Defence Fund. Nothing further to declare.