GPs taking on out of hours work face higher indemnity fees

BMJ 2013; 347 doi: (Published 02 August 2013) Cite this as: BMJ 2013;347:f4897
  1. Gareth Iacobucci
  1. 1BMJ

General practitioners working out of hours are being hit by huge increases in their indemnity fees because of the “significant number” of claims brought against doctors working outside surgery hours.

Medical defence bodies said that the increases in fees were necessary because of the soaring cost of GP claims, with some of the most expensive involving out of hours doctors.

The BMA has started talks with the government on how to tackle the issue, amid concerns that the increases are dissuading general practitioners from working out of hours shifts.

Latest figures from the NHS litigation authority1 show that the total number of clinical claims in the NHS rose by 10.8% in 2012-13, with the NHS’s estimated total liabilities for clinical negligence claims standing at £22.7bn (€26bn; $34bn), compared with £18.9bn in 2011-12.2

Examples of fees quoted by all three medical defence bodies disclosed to the BMJ indicate sharp increases for out of hours general practitioners. They include one general practitioner predominantly working out of hours whose fees increased from £7200 to £13 500 in one year, and another who faced an increase of £2000.

Last year, the Medical and Dental Defence Union of Scotland (MDDUS) introduced an additional charge of £880 per year for an average of one out of hours session a week for salaried doctors.

A spokesman for the union said that the additional charges “reflect market rates” and only applied to general practitioners who joined the association after May 2012.

He said, “GPs who joined MDDUS prior to May 2012 do not pay an additional subscription for out of hours, they simply include these sessions within their overall calculation, for example six sessions as a locum, plus two out of hours would be seven to 10 sessions.

“From May 2012 onwards, each salaried doctor is charged an additional £880 per out of hours session worked on average per week. There is no extra charge for GP partners.”

Matthew Lee, professional services director at the Medical Defence Union (MDU), said that the fees were necessary. “As a not for profit company owned by its members, we have to be sure that we are collecting sufficient income from subscriptions to meet future claims costs,” he said.

“Over the past few years we have seen a steadily rising number of claims brought against GPs and a significant number of these cases involve patient care provided outside daytime surgery hours. Furthermore some of the largest claims we have settled have stemmed from care provided (or in some cases not provided) by GPs working out of hours.”

Lee added, “MDU GP members working one or two sessions of out of hours work alongside their in-hours commitments will generally not pay a higher subscription than a colleague working the same number of sessions in-hours. However, those with significantly greater involvement in out of hours work (or who work primarily out of hours) are exposed to an increased risk of facing complaints and claims and this is reflected in our calculation of their individual subscription.”

Stephanie Bown, director of policy and communications at the Medical Protection Society (MPS), said, “MPS’s experience for GPs undertaking significant work in out of hours care is that they are more likely to be sued than their GP colleagues doing primarily ‘in-hours’ work.

“We encourage members to contact us to discuss their subscription rates as these vary based on the individual’s needs and scope of practice. Our subscriptions are set fairly, which means members pay for the risk associated with their own area of practice.”

A BMA spokesman said, “Discussions are still ongoing with the government about this and at the moment we are open to suggestions as to how this issue is resolved.”


Cite this as: BMJ 2013;347:f4897


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