State-backed indemnity was introduced with the establishment of the Clinical Negligence Scheme for General Practice in April 2019. This covers GPs and their practice teams in England and Wales for clinical negligence incidents, putting them on a par with hospital doctors.

While the scheme provides cover for clinical negligence claims, it doesn’t cover every eventuality or risk that practices may face. It’s therefore not surprising that Medical Protection receives a number of calls from practice staff who are uncertain exactly who to turn to for assistance.

What is state indemnity?

Incidents that occurred on and after 1 April 2019

On 1 April 2019, state indemnity schemes for general practice in England and Wales started covering clinical negligence liabilities arising in general practice for incidents that occurred on or after 1 April 2019.

In England, NHS Resolution handle these claims under the Clinical Negligence Scheme for General Practice (CNSGP).

In Wales, NHS Wales Shared Services Partnership (NWSSP) – Legal & Risk Services (L&R) handle these claims under the General Medical Practice Indemnity (GMPI).

Incidents that occurred before 1 April 2019

From 1 April 2021, Medical Protection members working in primary care in England and Wales can turn to state indemnity schemes, called the Existing Liabilities Scheme (ELS), for help with any claim related to the provision of NHS primary medical services, regardless of when the incident occurred.

As these are different schemes with different routes to reporting claims, it is crucial that members of Medical Protection contact NHS Resolution (England) or NWSSP – L&R (Wales) if you receive notification of a claim for the NHS work you have undertaken.

The schemes were established so all claims are handled by the same organisation regardless of when they occurred.

What does state indemnity not cover?

These state indemnity schemes do not cover the following:

• Clinical negligence claims arising from private, non-NHS and non-GMS contract work
• Disclosure of record requests from patients (where there is no intimation of a claim and it is not a request from the patient’s solicitor)
• Complaints (where there is no intimation of a claim)
• Regulator (GMC/NMC/HCPC) referrals and hearings, inquiries and representation
• Criminal proceedings
• CQC or Healthcare Inspectorate Wales (HIW) investigations
• Inquest representation
• Disciplinary proceedings against you or your staff
• Awards made by the Parliamentary Health Service Ombudsman (England) or Public Services Ombudsman for Wales (unless there is an overlap with compensation payable for an injury resulting from clinical negligence)
• Ex-gratia payments
• Defamation claims
• Breach of Data Protection regulations
• Employers’ liability claims
• Public liability claims
• Property or occupiers’ liability claims
• Cyber liabilities (for example, costs resulting from system shutdown as a result of a cyberattack)
• Primary and community care dentistry claims, community pharmacy and optometry claims (Wales)

This list is very similar for both England and Wales, but is not exhaustive and is subject to change, so it is advisable to check the websites of both NHS Resolution for England and NWSSP for Wales for the most updated information. This includes checking the scope of both schemes and details of activities and roles covered by the state indemnity schemes.

How Medical Protection membership fills the gap

As the world’s leading medical defence organisation, we provide two specific kinds of tailored protection in England and Wales – Professional Protection and Claims Protection. Under our Professional Protection, we continue to provide members with the right to request assistance and support for general medicolegal advice, guidance on complaint handling, regulatory (GMC) matters, inquest representation and disciplinary proceedings arising out of your professional clinical practice.

When to seek Medical Protection’s assistance with clinical negligence claims

Under Claims Protection we provide members with the right to request indemnity and claims handling support for clinical negligence claims not covered by state indemnity.

If your work includes services provided outside an NHS primary medical services contract, you should add Claims Protection as this is not automatically added to your membership.

Common examples of work requiring Claims Protection:

• Work in private clinics
• Report writing
• Passport forms
• Insurance forms
• Private prescriptions
• Travel vaccinations and letters
• HGV medicals
• Taxi medicals
• Cremation forms
• Delivering private online consultations
• Private cosmetic or aesthetic medicine
• Health screening
• Offering services for voluntary or humanitarian work
• Provision of NHS services outside an NHS primary medical services contract (eg local community minor surgery clinics or vasectomy clinics contracted by a secondary care Trust or Federation). It is crucial that you check the terms of your contract and investigate the indemnity position with your contractor, subcontractor or commissioner.

When to seek Medical Protection’s assistance with non-clinical negligence claims

Patients can also bring claims against you and your practice for matters arising out of healthcare provision that are not clinical negligence claims, hence may not be covered by your medical defence organisation or state indemnity schemes. These matters might be associated with breach of contract, the Human Rights Act, the Equality Act, defamation, discrimination, the Consumer Rights Act, the Supply of Goods and Services Act, criminal acts and data protection. It is advisable to explore indemnity for these claims with an insurer with these policies, such as your public liability insurer and employers’ liability insurer.