OOH Medical Indemnity
FAQ’s for GP's
1. Why are SELDOC doing this?
Historically individual GP’s have purchased their own individual discretionary cover for medical indemnity as a part of their membership of the Medical Defence Organisations (MDOs). Similarly, the OOH providers have purchased insurance cover for the various entities operating within the organisation to cover the entity and all other clinical and non-clinical staff.
The rising cost of GP indemnity has meant that some doctors have been discouraged from providing OOH services. In addition, the discretionary nature of the MDO cover means that GPs could potentially be left without cover endangering patients, the GPs and the Providers.
Therefore, from a cost and corporate governance standpoint it made sense to investigate whether a better solution might be available.
2. What is being proposed?
UHUK have been working with global insurance broker Lockton and specialist healthcare insurer Beazley to devise an insurance solution. What has been developed is a bespoke insurance policy that covers not only the Providers but all clinical and non-clinical staff, including GP, s for their work carried out while under contract to the Providers.
Cover is not provided for any activities carried out in a GP’s usual surgery or outside of their contract with the Provider. GPs will therefore need to continue their membership of the MDOs but can advise them that cover is no longer required for OOH work.
3. Who are Lockton?
Lockton are a global insurance broker with revenues of over $1bn and 5,500 staff worldwide. They are healthcare specialists with a variety of clients ranging from GP’s to private hospitals. Lockton’s role is to represent the Provider and provide advice and assistance to the Provider and individual clinicians. Lockton are regulated by the Financial Conduct Authority.
This differs from the current situation with the MDOs where the individual doctor is not represented and is always subject to the discretion of the MDO.
4. Who are Beazley?
A Lloyd’s based specialist Insurer founded in 1986
Listed on the London Stock Exchange 2002
Worldwide offices: UK, US, Australia, Brazil, Dubai, France, Germany, Norway, Singapore
Rating: Lloydsan excellent (A.M Best), A+ Strong (S& P).
Beazley insurance Company an excellent
Write in excess of US$125m of premium income in Healthcare worldwide.
Regulated by the Financial Conduct Authority.
Lloyd's has been underwriting insurance since the 17th century and is backed by a compensation fund of more than £10bn should any insurer suffer financial failure.
5. What difference will this make to GPs indemnity costs?
Providers may charge back some of the cost of the OOH indemnity cover to GPs on a proportional basis and for those GPs carrying out more than two sessions per week this will mean a significant saving over their own current private arrangements. For those carrying out few sessions there may well not be a cost advantage and Providers need to balance this against the need for broad, consistent, contractual insurance. SELDOC will not be asking for a contribution.
6. What are the advantages to Providers?
Providers will be assured of consistent insurance cover for all activities and for all employees and GPs working under contract. Importantly Providers will retain an active involvement in claims and complaints handling rather than cede control to the MDOs.
The risk management policies and procedures that have been refined over recent years mean that insurers are able to offer competitive premiums and the savings can be passed on to the GPs while also reducing the overall insurance cost to Providers.
7. What happens in the event of a patient complaint or letter of claim?
At present any matter notified to a GP will be passed by them to their relevant MDO. Under the new arrangements if a GP becomes aware of a circumstance which may give rise to a claim then they should notify the Provider in the first instance who will then follow the claims protocol.
8. What is the claims protocol?
Insurers and Lockton will develop an individual claims protocol with each Provider. The basic premise is that the Provider is best placed to make an initial judgment around a complaint and will deal with the complaint as they see fit unless they foresee that such complaint could give rise to a claim with a potential of more than 50% of their self-insured retention (the policy excess). At all times the Provider and the GP's concerned will have access to the nominated legal advisers either to make a formal notification or to discuss the matter in confidence. The legal advisers will assist the Provider and the GP throughout the process and will take over the handling of any matters if this is the right thing to do. GPs will also be protected in respect of any GMC investigation.
9. Why are premiums charged by the insurers lower than the cost of OOH discretionary cover from the MDO’s?
The Insurers and UHUK have spent many months putting this new arrangement together. Insurers have taken the time to visit Providers and understand the emphasis that we place on patient care and clinical risk management. They are therefore able to charge lower rates.
10. Is cover available to all GPs?
The new Insurance covers all GPs for all OOH work that they do while under contract to Providers. GPs will retain their MDO membership for their other work. Cover for the Provider is subject to a process of approval.
11. Who do GPs call if they require general advice or wish to discuss an issue outside of a patient complaint or possible claims?
As above under “claims protocol” the GP will first contact the Provider but Lockton and Mills and Reeve are the advisers to the scheme and have been chosen because they offer experienced specialist medical indemnity teams. All GPs will have 24-hour access to the legal advisers, Mills and Reeve, and to Lockton. Lockton can deal with all general queries while Mills and Reeve can offer legal advice and guidance on indemnity related matters. Both teams incorporate GP medico-legal advisers. All of the team understand the constraints on a GP's time and are available out of hours.
12. What happens if a GP leaves the Member or in case of death, ill health or retirement, is a GP's family and estate protected?
This new insurance is an important change and reflects the way in which other professionals protect themselves. The policy is purchased by the Provider on an annual basis and remains in force for as long as it continues to be purchased. The basis of the cover is “claims made” and the cover responds at the time a claim is made or circumstance notified. Should the Provider cease to trade for any reason then the policy contains a clause which allows run-off cover to be purchased at a pre-agreed premium. SELDOC has purchased run-off cover.
13. How does the insurance compare to the cover provided by an MDO?
The new arrangement is different, it is an insurance policy and therefore provides GPs with broad cover under a legally binding contract. This insurance policy contains conditions and exclusions and it is important that the Providers and the GPs are aware and adhere to them. As an example it is important that a Provider discloses all information which is material, for example any claims of which they may be aware. Failure to do so may render the insurance void.
The discretionary cover provided by the MDO's is, as its name suggests, left to the discretion of the MDO concerned. Determination of indemnity is only granted at the time of a claim and there is no certainty or obligation to provide indemnity. As per 12 above and as is the case with other professional service providers, law firms being an example, the proposed new cover is arranged on a Claims Made basis and remains in force for as long as the Provider continues to purchase cover or for the relevant run-off period if the Provider ceases to trade.
14. The MDOs are mutual, how can this insurance be cheaper?
One of the main problems with mutual’s is that the good subsidise the bad. Insurers recognise the clinical governance that exists within UHUK Providers and the care and attention that they embed in managing risk. Collectively the GPs contracted to Providers spend a great deal on OOH indemnity and by purchasing cover collectively significant discounts can be achieved.
15. Is there a policy excess, whereby GPs meet the first amount of any paid claim?
The insurance cover does have an excess applicable to each and every claim, however in the event of a claim this excess will be payable by the Provider.
16. What is the limit of indemnity under the new insurance?
It is anticipated that Providers will purchase cover for £10m each claim with a total aggregate limit of £25m in any one year. Higher limits are available if required.
SELDOC’s cover as suggested above.
17. Is cover included for regulatory matters such as a GMC investigation?
Yes. The cover that has been arranged will provide for regulatory investigation matters arising out an insured medical indemnity claim.
18. Is the individual representation and defence of doctors in case of referral on to the GMC, or other professional conduct disciplinary proceedings/ hearings, fully covered in relation to SELDOC work?
Yes, if the incident is in relation to a clinical negligence issue where a potential patient claim is likely. NO if the incident involves a matter of breech of rules and regulations where SELDOC does not necessarily have an interest – say a Doctor is practicing when under the influence of drugs.
19. If a court appearance were to be required in connection with a SELDOC patient, will individual doctors be covered for personal representation in court?
As 18 above.
20. Is there individual representation, advice and support for doctors if a complaint in relation to a SELDOC patient was to go to the NHS England, a Clinical Commissioning Group or the Health Service Ombudsman?
As 18 above.
21. Would each doctor be covered for individual assistance at coroner's inquests connected with SELDOC patients?
As 18 above.
22. Will individual doctors be covered for assistance and advice in the preparation of reports for litigation or medico-legal purposes in relation to a SELDOC patients?
Yes, if the incident is in relation to a clinical negligence issue where a potential patient claim is likely.
23. Will individual doctors have 24-hour access to personal medico-legal advice, assistance and support including dealing with the press in relation to a SELDOC patients?
Yes, in the first instance they will notify SELDOC and will then have 24-hour access to medico-legal advice.
24. Is there a limit to the financial cover provided? If the costs go over that limit is it SELDOC or the individual doctor who would cover the additional costs?
The limit of indemnity is £10m each claim and £25m in the aggregate. It would depend on the individual circumstances but in most cases as the original patient contact is via SELDOC it would be SELDOC that would be legally liable and will respond to claims as the employer and the service provider.
25. Is it retrospective/ occurrence-based cover – so that even if a doctor has retired/moved out of the area etc. and so is not working with SELDOC any more then are any claims still covered for the period the doctor was working with SELDOC?
This new insurance is an important change and reflects the way in which other professionals protect themselves. The policy is purchased by SELDOC on an annual basis and remains in force for as long as it continues to be purchased. The basis of the cover is “claims made” and the cover responds at the time a claim is made or circumstance notified. Should the Provider cease to trade for any reason then the policy contains a clause which allows " extended reporting period" cover to be purchased at a pre-agreed premium. SELDOC has purchased this additional cover.
26. Does the individual doctor have the ultimate right to decide, and be fully involved in, how the defence of a SELDOC case is to be handled in view of the potentially damaging effect on the professional reputation and career of the doctor depending on the outcome of the case?
The policy is bought by SELDOC and SELDOC have agreed a claimsprotocol with insurers such that most matters within the policy excess can be dealt with by SELDOC. For matters likely to go above the excess Insurers and their medico-legal advisers will work with the doctors and with SELDOC to resolve matters but insurers will have the ultimate right to conduct any claim.
27. What happens if I let insurers know of a problem that occurred but an actual claim doesn't materialise for 20 years?
As long as a matter has been correctly notified it will be covered even if the actual claim only materialises many years later. this point emphasises the need for GPs and clinicians to notify all circumstances that may give rise to a claim and patient complaints as early as possible. SELDOC is encouraging early disclosure.