Intended for healthcare professionals


Eight in 10 GPs say indemnity fees are limiting their out-of-hours work

BMJ 2015; 351 doi: (Published 20 August 2015) Cite this as: BMJ 2015;351:h4549
  1. Zosia Kmietowicz
  1. 1The BMJ

A provider of out-of-hours care services has called for GPs, insurers, NHS England, and other stakeholders to find a solution to spiralling annual indemnity fees that threaten to leave gaps in urgent care rotas and to endanger the care of patients.

In a survey by Urgent Health UK, a federation of 26 social enterprises, 79% of 430 GPs said that clinical indemnity fees were limiting the number of out-of-hours shifts they undertook.1 Two thirds (68%) of the GPs said that should fees rise further they would consider reducing or stopping out-of-hours shifts. And more than half (55%) said that they were concerned that their clinical indemnity insurance might not provide adequate cover for all their shifts.

Urgent Health UK covers more than 40% of out-of-hours services in England, Wales, and Northern Ireland. The survey was filled out by GPs from 10 member organisations in June.

John Horrocks, chief executive of Urgent Health UK, said that the survey’s findings highlighted the “very difficult position out-of-hours GPs and our members are in.” He added, “Already across the country many providers of out-of-hours care are struggling to fill rotas due to a range of workforce issues, including the high cost of indemnity. We simply cannot afford for this situation to continue, particularly as we head towards the winter period, when pressure on services is even greater.

“I am aware that NHS England is looking closely into this crucial issue, and I hope urgent action is taken to resolve it.”

In the survey one GP commented, “The renewal notice of my MDU [Medical Defence Union cover] quoted me £20 500 [€29 000; $32 000] for five out of hours’ sessions in a week and three locum sessions in a week.” Another said, “My indemnity cover has risen by about 20% each year for the last two years.”

Another respondent commented, “As a portfolio GP I pay for six sessions a week—only one can be OOH [out of hours]. If I were to do more than this I would have to pay all six sessions at an OOH rate—this would be approximately double, which I am not prepared to pay for. With private locum agencies paying £90/hour for regular daytime work, to work for lesser pay at higher indemnity rates is not practical.”

In response to a request for information on how indemnity fees had changed in recent years, the Medical Defence Union said, “From our experience, most GPs are doing no more than one or two sessions of out-of-hours work alongside their in-house commitments. MDU members in this situation will generally pay a similar subscription to a colleague working the same number of sessions in hours.”

Simon Abrams, chair of Urgent Health UK, added, “There is no doubt that the cost of clinical indemnity is a major barrier to enabling out-of-hours services to fulfil their potential, and this is damaging for the patient experience.

“We are committed to working with GPs, medical defence organisations, and the wider insurance industry and NHS officials to find an effective solution to this issue.”


Cite this as: BMJ 2015;351:h4549



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