Indemnity must be based on insurance
Dr Neil Haughton
Opinion
The Independent Doctors Federation is backing the forthcoming big shake-up in indemnity. President-elect and treasurer Dr Neil Haughton gives his views to Independent Practitioner Today.
You may be aware that indemnity cover for all doctors will be changing and the Independent Doctors’ Federation (IDF) has been asked to take part in the Department of Health’s (DoH’s) consultation process on this issue.
The DoH is concerned that the current ‘discretionary’ cover provided by all the major defence organisations (MDOs) does not protect the public or doctors adequately.
There have been high-profile cases where the MDOs refused to pay, as the doctor’s activity was either not legal or they just decided not to; it’s their choice at present.
The IDF welcomes this consultation and will be advocating the introduction of more insurance-based schemes.
We have our own IDF indemnity cover in place, which is insurance-based in order to give our members more choice and invariably with a significant financial saving.
Such schemes are also underwritten by large global insurers, so the risk of them failing is minimal. The main MDOs only deal in one product, remember, so are vulnerable to such proposed legislative changes.
Disadvantages of insurance
But there can be disadvantages, of course; an insurance scheme is like your house buildings’ insurance, so there is a limit on how much money they will pay out. If they agree to £10m and the claim against you is for £11m, then you will need to find the extra.
Also, if you are deemed risky or have had numerous claims already against you, then your premium will be higher.
However, such ‘risky’ specialties are sometimes uninsurable in any other way. The insurance-based schemes are also more closely regulated and are covered by the Insolvency Act to minimise the risk to policy-holders.
GPs’ cover
There are also changes coming to NHS general practitioners, who have traditionally used the usual MDOs, as they are contracted by the NHS rather than employed directly.
Under new legislation, their main cover will be provided by Crown Indemnity as in NHS hospitals; a huge loss to the MDOs.
Crown Indemnity, however, only covers ‘bodily harm’ and not ‘personal conduct’, so the GPs still require external insurance.
The MDOs are understandably reluctant to provide ‘run-off’ cover after losing so much business, so the situation remains complex and unresolved at present.
Clearly, change had to come, as the standard product has become expensive and vulnerable, and some doctors – my colleagues included – questioned the quality of advice provided. The MDOs also penalised private doctors.
My GP cover was 50% higher than NHS GPs, for no proven reason. I was told we had more ‘litigious’ patients and were more likely to practise risky medicine; unlikely in our highly regulated Care Quality Commission world.
The IDF represents the interests of its members, but also will champion any change that will improve the security of independent practice to protect doctors and the public.
We welcome choice and feel the move towards insurance-based indemnity schemes will provide that security.
Dr Neil Haughton is a private GP in London
- See ‘Big indemnity shake-up’