Rising indemnity costs are pushing GPs out of practice
3 min read
Short-term Government measures to offset costs are welcome, but a more systemic solution may be needed, argues Alex Chalk MP.
Rising indemnity costs are threatening the pipeline of new GPs. That’s the message which emerged from a survey last year of thousands of GPs.
A poll by GPonline revealed that the majority of full-time GPs pay over £7,500 a year to maintain legal cover. One in seven pay over £10,000.
According to the Royal College of General Practitioners, rising indemnity costs are increasingly contributing to GPs leaving the profession and are acting as barriers to providing out-of-hours services. 80% of GPs surveyed said they had been deterred from taking certain types of clinical sessions.
And the problem is likely to get worse. Studies estimate that average indemnity inflation is around 10% for in-hours care and 20% for unscheduled and out-of-hours care.
The national concern is replicated in my own constituency of Cheltenham. One busy practice reported a 17% annual increase to maintain medico-legal cover. That’s not an isolated case.
It is absolutely right that a patient who suffers as a result of negligence should be properly compensated. But with the number of successful claims actually falling, one key driver of rising costs is inflation in the sum awarded. According to the BMA, it is not unusual for a Medical Defence Organisation (MDO) to pay a claim for more than £5m.
So, despite the fact that the proportion of cases closed without payment has increased from 70% to 80%, premiums are still rising.
Other drivers include a higher volume of patients and a higher expectation of care. The Review draws attention to increased life expectancy, advances in medical treatment and a patient’s “different relationship with their GP”. Critically it stresses the growing number of claims companies and the “aggressiveness of the compensation market”.
The Government is responding. One measure is a short-term support scheme, lasting two years, which makes its first payment in April. That is a cash sum of over £30m to offset some of the increases. It’s very welcome, but there’s a growing sense that something more systemic may be required.
A cap on the amount that legal firms can recover in clinical negligence cases and a constraint on litigation costs would be one option, and so-called ‘tort reform’ is supported by MDOs as the “only workable solution for England”. In ‘high value’ cases, compensation is based on the cost of private provision. One suggestion is for compensation to be assessed on the availability and purchase of NHS and local authority care packages. That approach would see compensation money re-invested within the NHS.
The idea of a wider 'NHS indemnity' has been mooted. Should we spread the risk of indemnification by transferring GP activities, such as out-of-hours and minor surgery, into a state-run scheme? Should we transfer all GP indemnity in a model similar to the NHS Trusts?
The final word should go to a doctor. GPC subcommittee chair Dr Zoe Norris commented, “Until we address the bulk of the expense that is driving GPs out of the profession, and leading them to cut their clinical workload, the problem won't go away.” I agree.
Alex Chalk is the Conservative Member of Parliament for Cheltenham.
Dr Michael Devlin of the Medical Defence Union (MDU) has responded on the issue of the changing discount rates, saying: 'What was already a significant problem has, at a stroke, been made substantially worse for GPs bearing rising indemnity costs.' Read the full response from the MDU here.
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