Understanding the new state-backed indemnity scheme

NHS Resolution is operating a new state-backed indemnity scheme for general practice in England, called the Clinical Negligence Scheme for General Practice (CNSGP).

The CNSGP provides GPs and others working in general practice similar cover to that provided to all NHS hospital doctors under the clinical negligence scheme for trusts (CNST).

How does it work?

All staff members working in general practice are automatically covered for clinical negligence claims in relation to NHS services, as of 1 April 2019.

No payments are required to benefit from the indemnity provided under the scheme, and there are no formal membership or other registration requirements, either for individuals or practices/other providers.

The indemnity provided continues to apply where a GP or other person is no longer practising or working in general practice at the time a claim is made – which may be many months, or even years, after the alleged clinically negligent act or omission.

Who is covered?

All GPs, be they partners, locum or salaried, healthcare professionals such as pharmacists, nurses and physiotherapists, and all other GP practice employees (including management, reception and admin staff).

Locum GPs working through a limited company are also covered. GP trainees are covered for clinical negligence claims through CNSGP with additional professional cover provided by Health Education England.

The liabilities covered are those:

• Incurred on or after 1 April 2019, and arising from an act (or omission to act) in connection with the provision of primary medical services under a GMS, PMS or APMS contract on the part of a GP or other person working in a general practice setting.
• Connected to the diagnosis, care or treatment of a patient.
• Resulting in personal injury or loss to a patient.

Cover is discretionary, as with medical defence organisations. NHS Resolution has advised cover is unlikely to apply if: 

• An eligible person has made an admission of liability without NHS Resolution’s agreement.
• Court proceedings have not been referred to NHS Resolution.
• An individual has not complied with a condition imposed by NHS Resolution or failed to assist NHS Resolution in managing the claim information.

What work is covered? 

There is some confusion about which activities will be covered. If in doubt, ask yourself these questions; if the answer is ‘yes’ to each, then you are covered:

• Are you carrying out an activity that consists of, or is in connection with, the provision of NHS services?
• Are those NHS services being provided by, or under a contract with, a person or organisation whose principle activities are to provide primary medical services (that is, NHS services as part of general practice)?
• Is the activity connected with the diagnosis, care or treatment of a patient?

Importantly, all NHS primary care enhanced services – both local and national – are covered, such as the fitting of coils and implants, minor surgery and public health activities such as prescribing medicine in the event of a flu outbreak.

What if a claim is made against my partner or the practice as a whole?

Vicarious and joint liability claims made against GP practices or other organisations are covered under the CNSGP for activities relating to primary medical services or other NHS services as outlined above. Similarly, joint liability claims against a GP practice partnership in respect of one of its partners will be covered.

What MDO cover is needed?

You will still need separate cover from an MDO as the CNSGP only covers clinical negligence claims and only for certain activities.

Activities for which you will need MDO cover include:

• Non-NHS or private work for non-registered patients.
• Fee-paying work for registered patients – anything you do that is outside your NHS contract and is paid for by the patient, including: life insurance reports and medicals, and travel insurance reports and claim forms; private prescriptions; travel vaccinations; statutory notification forms such as for notifiable infectious disease; private certificates, such as fitness to attend court or sit exams; GANFYD letters; cremation forms; adoption/fostering medicals; DVLA medicals; and occupational reports. 
• Work for the Ministry of Defence and Department of Work and Pensions, unless you are working through an APMS contract for the MOD or completing DWP forms as part of general practice activity.
• Primary care NHS dentistry, optometry and community pharmacy.
• Work for ex gratia payments.
• Voluntary work, including Good Samaritan work and overseas work.

NHS Resolution provides a list of activities/roles covered under the CNSGP on its website.¹

Professional issues for which you need MDO cover include:

• Regulatory and disciplinary proceedings, such as CQC investigations.
• Breach of data regulations.
• Support for complaints.
• GMC investigations.
• Coroner inquests.
• Criminal investigations – for example, gross negligence manslaughter, employment and contractual disputes, and non-clinical issues such as defamation, and public, property, employer and cyber liabilities.

MDOs also provide 24-hour access to medicolegal advice, and a press and media helpline. If you have concerns about whether a claim falls within CNSGP or other queries about the new scheme you can email NHS Resolution at [email protected]

Reference

1 NHS Resolution. Am I covered under CNSGP?

Dr Preeti Shukla is a GP in Blackburn