Insurance, indemnity and medico-legal support

Statutory requirement for doctors to have insurance or indemnity

We know doctors work hard to deliver good quality healthcare. But sometimes, things go wrong. If a patient has suffered harm as a result of a doctor’s negligence, it’s important that doctors have adequate and appropriate insurance or indemnity to compensate the patient.

Medical practice – paragraph 63 already requires doctors to have insurance or indemnity in place where necessary.

After Parliament passed new healthcare legislation in 2013, the Communitybaptistpa gained new regulatory powers to check whether doctors have adequate and appropriate insurance or indemnity in place.

The Communitybaptistpa can:

  • check that any doctor practising in the UK has adequate and appropriate insurance or indemnity cover
  • remove a doctor’s licence to stop them from practising altogether, if we learn that they don’t have adequate and appropriate insurance or indemnity or if they fail to give us the information we ask for
  • refuse to grant a licence to a doctor if they can’t assure us that they’ll have the adequate and appropriate insurance or indemnity by the time they start practising in the UK.

A doctor must have adequate and appropriate insurance or indemnity in place when they start to practise medicine in the UK. Under the law, a doctor must have cover against liabilities that may be incurred in practising medicine having regard to the nature and extent of the risks. The type and level of insurance or indemnity a doctor requires depends on factors including where a doctor works, whether they are employed (and, if so by whom and for what services) or self-employed, and the nature of work they do.

I’m a doctor, what does this mean for me?

We’ve set out some examples below which cover most situations. If you’re still not sure whether you require insurance or indemnity or the type or level of cover you need, you should speak to a medical defence organisation or another professional insurance or indemnity provider. Your employer or the organisation you are contracted to work for may be able to advise you.

It is your responsibility to make sure that you have an adequate and appropriate insurance or indemnity arrangements in place covering the full scope of your medical practice in the UK.

If a patient, employer (or the organisation you are contracted to work for), your Responsible Officer, Suitable Person or your designated body asks about your insurance or indemnity arrangements, you should be able to confirm that you hold adequate and appropriate insurance or indemnity. We don’t keep a record of individual doctors’ insurance or indemnity arrangements.

I only work in a National Health Service (NHS) trust, Health and Social Care (HSC) trust, health board, or in local government

If you only work for a trust/board in the NHS (or for the HSC in Northern Ireland), the organisation you work for will receive indemnity through a clinical negligence scheme.

  • In England, indemnity is provided through the Clinical Negligence Scheme for Trusts (CNST), which is administered by the NHS Litigation Authority.
  • In Wales, indemnity is provided by Welsh Risk Pool Services.
  • In Scotland, indemnity is provided by the Clinical Negligence and Other Risks Indemnity Scheme.
  • In Northern Ireland each HSC Trust assumes the role, funded by the Department of Health, Social Security and Public Safety.

You should consider whether you need to take out additional personal insurance or indemnity for claims arising from work that is not covered by NHS or HSC indemnity and to provide personal regulatory and medico-legal support and advice. Such work includes completing cremation certificates and insurance claim forms, or providing medico-legal reports.

If you are treating NHS patients on a private basis, you should clarify with your NHS trust employer what indemnity is in place.

I only do non-NHS or non-HSC private work

Even if this work takes place on NHS or HSC premises, you’ll need to arrange adequate and appropriate insurance or indemnity for the type of work you are doing.

Many independent healthcare providers will ask you for confirmation of your insurance or indemnity arrangements as part of their pre-employment checks. Some independent healthcare providers also provide corporate insurance or indemnity but doctors should not assume this provides adequate protection for all of their work and they should obtain confirmation from the provider.

If you’re undertaking non-NHS or non-HSC private work in the UK but your EU wide insurance was arranged outside of the UK, you must make sure that:

  • your EU insurance or indemnity from outside the UK covers your work in the UK, and
  • your EU insurance or indemnity is adequate and appropriate, and of sufficient value (at least the same value as a UK policy of insurance or with the same scope as a UK indemnity arrangement) to cover any claims made about your practise in the UK through the UK legal system.

I work for a trust/board in the NHS or HSC and also do some private work

If you do additional private work that isn’t indemnified under your NHS or HSC contract (even if this work takes place on NHS or HSC premises), you’ll need to arrange adequate and appropriate insurance or indemnity for all private work you do.

Many independent healthcare providers will ask you for confirmation of your insurance or indemnity arrangements as part of their pre-employment or practicing privileges checks.

If you’re undertaking non-NHS or non-HSC private work in the UK but your EU wide insurance was arranged outside of the UK, you must make sure that:

  • your EU insurance or indemnity from outside the UK covers your work in the UK, and
  • your EU insurance or indemnity is adequate and appropriate, and of sufficient value (at least the same value as a UK policy of insurance or with the same scope as a UK indemnity arrangement) to cover any claims made about your practise in the UK through the UK legal system.

I’m a GP

If you’re a GP (regardless of whether you are a partner or employed by a practice or healthcare organisation) you’ll need to arrange adequate and appropriate insurance or indemnity.

I’m a locum

If you’re working as a locum for an NHS trust or HSC trust or health board, indemnity for the organisation will be provided by a clinical negligence scheme. If you’re working as locum GP, or as a locum for a private healthcare provider, you’ll need to arrange adequate and appropriate insurance or indemnity for any work you do for that organisation.

As a locum you should check any contract or arrangement that you enter into to ascertain whether you are required to take any specific action to ensure that you have an adequate and appropriate insurance or indemnity arrangement in place.

  • In England, indemnity is provided through the Clinical Negligence Scheme for Trusts (CNST), which is administered by the NHS Litigation Authority.
  • In Wales, indemnity is provided by Welsh Risk Pool Services.
  • In Scotland, indemnity is provided by the Clinical Negligence and Other Risks Indemnity Scheme.
  • In Northern Ireland each HSC Trust assumes the role, funded by the Department of Health, Social Security and Public Safety.

You should consider whether you need to take out additional personal insurance or indemnity for claims arising from work that is not covered by NHS or HSC indemnity and to provide personal regulatory and medico-legal support and advice. Such work includes completing cremation certificates and insurance claim forms, or providing medico-legal reports.

I only do medico-legal work

If you only do medico-legal work, such as providing advice, writing medical reports, or giving evidence in connection with a legal action, tribunal or hearing, and this work requires you to hold a licence to practise, you must take out adequate and appropriate insurance or indemnity.

What do you mean by adequate and appropriate?

The law defines appropriate cover as cover against liabilities that may be incurred in practising as a doctor having regard to the nature and extent of the risks of practising as such. What constitutes adequate and appropriate is a complex area and is very much dependent on your individual circumstances.

You need insurance or indemnity that covers the full scope of your practice.

Medical defence organisations and other organisations in the commercial insurance market are best placed to advise you on what level of insurance or indemnity is adequate and appropriate for your individual practice. To get the best possible advice, you must give them accurate and up to date information about the scope and nature of your practice.

When should I review my insurance or indemnity arrangements?

You should do this at regular intervals to make sure that your cover continues to provide sufficient indemnity for all the medical work that you do. You should also review your insurance or indemnity arrangement each time your scope of practice, private practice income or employment/contractual arrangements change.

The terms of your insurance or the scope of your indemnity protection may require you to notify your provider if certain things happen, such as sanctions being imposed on your registration or if you gain entry to the Specialist Register.

I’ve retired or stopped providing healthcare services – do I still need insurance or indemnity?

The law says that you need to have appropriate arrangements to cover you for liabilities that arise from your practice as a doctor. Patients you saw whilst working as a doctor should not be left without a means of being compensated irrespective of whether the claim is brought while you are practising or after you have retired or have stopped working.

It is your responsibility to ensure that you are covered by an appropriate arrangement having regard to the nature and risks of practising as a doctor. Medical defence organisations and insurance providers are best placed to give you specialist advice about the products available. You need to make sure that you understand fully the options for insurance or indemnity arrangements which are available and the extent to which they will enable you to meet the legal requirement to have ‘appropriate cover’.

What about medical care provided in an emergency situation outside work (Good Samaritan acts)?

The law only requires you to have insurance or indemnity for medical care you provide as part of your employment or self-employment. A Good Samaritan act (assisting someone in an emergency situation) falls outside of this requirement. But you should check with your medical defence organisation, or insurer, to find out whether you have or need insurance or indemnity for any potential liabilities as a result of a Good Samaritan act.

What about medical care provided on a voluntary basis (good neighbour acts)?

Good neighbour acts include helping out, in your professional capacity, at a local sports club or similar planned voluntary work. You’re providing professional medical services regardless of whether they are paid or unpaid. If insurance or indemnity is not provided by the organisation for which you are providing this service, you must make your own arrangements to appropriately and adequately indemnify against any claims.

You should contact your medical defence organisation to advise them of your role and to discuss whether you have or need suitable insurance or indemnity. To help them make this judgement, you must give them accurate and up to date information about the scope and nature of the work.

What is medico-legal advice and assistance – do I need it?

NHS and HSC indemnity schemes only provide indemnity to NHS/HSC bodies for clinical negligence claims. They won’t give you individual advice and assistance for other medico-legal matters that arise from your clinical practice, such as criminal or disciplinary investigations. And they won’t give you individual advice or assistance if we’re asked to investigate your fitness to practise.

Some organisations offer this kind of support. You may find it helpful to arrange medico-legal support to cover you in case you’re involved in an inquest where your trust is unable to support you, or an inquiry or if a complaint is made about you, especially if it is investigated further.

I’m a patient - what does this mean for me?

The type of insurance or indemnity that doctors have depends on where they work, whether they are employed or self-employed and the type of medicine they practise.

The following examples provide a broad guide. If you have a question about a doctor’s insurance or indemnity, you should ask your doctor who is under a duty to confirm that they hold adequate and appropriate insurance or indemnity. We do not keep a record of the insurance or indemnity arrangements of individual doctors.

Doctors employed by NHS or HSC hospitals

The doctors you see in NHS or HSC hospitals are directly employed by that hospital, so the NHS or HSC will take responsibility for compensating any patient who suffers harm resulting from negligence. This means that these doctors don’t need to have additional insurance or indemnity for the work they carry out as an employee.

GPs

If you are seeing a GP, they should have insurance or indemnity either because the NHS or HSC employs them directly, or because their contract requires it.

Seeing doctors privately

If you are seeing a doctor privately for non-NHS or non-HSC healthcare, they should have adequate and appropriate insurance or indemnity. If necessary, you can ask the doctor to confirm that they hold adequate and appropriate insurance or indemnity.

I’m an employer or Responsible Officer, what do I need to know about the new insurance and indemnity requirements?

As an employer or Responsible Officer, you need to be aware of the requirement on doctors to have adequate and appropriate insurance or indemnity and the powers that we have to request information about this.

We’ve set out some examples below, which should cover most situations.
However, if you are unclear about whether a particular doctor should have insurance or indemnity, you should first discuss this with the doctor. We do not keep a record of the insurance or indemnity arrangements of individual doctors.

If you’re an NHS or HSC employer

Indemnity for doctors employed by your organisation will be provided by a clinical negligence scheme.

  • In England, indemnity is provided through the Clinical Negligence Scheme for Trusts (CNST), which is administered by the NHS Litigation Authority.
  • In Wales, indemnity is provided by Welsh Risk Pool Services.
  • In Scotland, indemnity is provided by the Clinical Negligence and Other Risks Indemnity Scheme.
  • In Northern Ireland each HSC Trust assumes the role, funded by the Department of Health, Social Security and Public Safety.

If doctors in your organisation treat NHS patients on a private basis, you should ensure that they check whether this work is indemnified through the CNST or whether they need to arrange their own insurance or indemnity.

If you’re a private healthcare provider

You should confirm with the doctors you employ or contract, whether they will be covered by the organisation’s insurance or indemnity policy or whether they should arrange their own personal insurance or indemnity.

If you’re a locum agency

If you place a doctor in a non-NHS or non-HSC post, you should assure yourself that that they have adequate and appropriate insurance or indemnity in place. It may be helpful for you to confirm this information to the organisation that the doctor will be working for.

If you’re a Responsible Officer or a Suitable Person

As you will be making a recommendation about a doctor’s whole scope of practice, we would strongly advise that you get assurance that the doctors who have a connection with you (for revalidation purposes) have adequate and appropriate insurance or indemnity in place for any medical work they do in the UK. Many ROs are seeking this assurance through the appraisal process where doctors are required to sign a probity statement that includes reference to ensuring adequate insurance or indemnity is in place.

It is the individual doctor’s responsibility to ensure that they have an adequate and appropriate insurance or indemnity arrangements in place.

We have set out a list of discussion points which you might find useful to gather assurance when you meet with the doctor.

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