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GPs could bear cost of changes to nurse indemnity

Authors: Helen Jaques 

Publication date:  03 Nov 2011


The Royal College of Nursing has announced changes to its indemnity scheme for general practice nurses that could force practices to upgrade their coverage or pay for coverage of nurses themselves.

Currently, clinical negligence cases involving nurses employed by general practices are dealt with by the practice’s medical indemnity provider, which then recovers some or all of the costs from the royal college.

However, the college is changing the conditions of its indemnity scheme, a benefit for all members, from 1 January 2012, so that the costs of any clinical negligence action will not be recoverable from its scheme and will instead fall on the employing practice and its indemnity provider.

As a result many practices will have to upgrade from individual cover for their GPs to practice-wide cover at a cost of thousands of pounds, said Richard Vautrey, deputy chairman of the BMA’s General Practitioners Committee. Practice-wide cover provides “vicarious liability,” by which GPs can seek assistance if a claim against a nurse directly employed by their practice is brought against them as the employer.

Medical indemnity organisations have been unable to rule out whether this change could lead to an increase in premiums for practice-wide schemes. The Medical Protection Society admits that indemnity for any liabilities “comes at a price.”

In addition, practice-level schemes generally don’t cover nurses who work in extended roles, such as those who take on prescribing, said Dr Vautrey.

In these instances practices might have to pay out for personal insurance for their nurses, as the Royal College of Nursing has advised its members that employing practices should not insist on nurses taking out their own insurance. In a statement it said, “If your employer wants to change your contract to oblige you to take out personal cover, this is a contractual dispute and you should seek the assistance of your RCN regional office.”

Medical indemnity organisations have expressed surprise over this change, on which they were not consulted. “We are planning to meet with the RCN to understand exactly who will be affected and what benefits they will be losing,” the Medical Defence Union has said. “We would be concerned if this led to individual nurses being left exposed.”

The royal college estimates that claims against members who work in general practice cost £5m a year, 90% of its indemnity scheme expenditure, despite amounting to only 40-50 cases a year. NHS trusts and independent sector employers accept “vicarious liability” for the actions of their staff and do not pursue the college, or the individual at fault, for costs.

The college says that this disparity represents “an unacceptable financial burden” and that it must act to ensure that cover for all members remains affordable.

Helen Jaques news reporter BMJ Careers

 hjaques@bmj.com

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