Understanding CNSGP, medical defence organisations and where additional cover may be needed
Your NHS work may be covered, but is everything your practice does NHS work?
For many GP practices, medical indemnity can feel more complicated than it needs to be. NHS general practice in England benefits from a state-backed clinical negligence scheme, while GPs may also maintain membership with organisations such as the MDU, MDDUS or MPS. Add private services, fee-paying work and evolving practice models into the mix, and it is easy to see why there can be uncertainty about who covers what.
The key is not to assume that one arrangement automatically protects every activity carried out by the practice or its clinicians. Understanding the different layers of protection can help practices identify where additional medical malpractice insurance may be appropriate.
What is medical malpractice insurance?
Medical malpractice insurance is a specialist form of professional liability insurance designed to protect healthcare professionals and healthcare organisations against claims arising from alleged clinical negligence, errors, omissions or breaches of professional duty.
Depending on the policy, cover may include the legal costs of defending a claim together with compensation, damages and associated costs where an insured is legally liable. The exact scope of cover, limits, exclusions and insured parties will depend on the policy wording.
Doesn’t the NHS already indemnify GP practices?
For qualifying NHS general practice work in England, clinical negligence liabilities are covered by the Clinical Negligence Scheme for General Practice (CNSGP), administered by NHS Resolution. The scheme applies to incidents occurring on or after 1 April 2019 and covers clinical negligence liabilities arising from activities within its scope.
This means that a GP practice should not simply purchase duplicate insurance for NHS clinical negligence exposures that are already protected by CNSGP. The more useful question is whether every clinical activity undertaken by the practice falls within the state-backed scheme.
Where do the MDU, MDDUS and other medical defence organisations fit in?
Medical defence organisations remain an important part of the protection many GPs arrange. CNSGP is focused on clinical negligence liabilities within the NHS scheme; it does not replace the wider medico-legal assistance that a doctor may need during their career.
Depending on the organisation and the individual membership arrangement, an MDO may provide advice, assistance or indemnity for matters such as complaints, inquests, disciplinary or regulatory proceedings and certain private or fee-paying work. Doctors should check their own membership carefully because the scope of support and indemnity is not identical across providers or membership types.
So where can commercial medical malpractice insurance fit?
Commercial medical malpractice insurance can be relevant where clinical activities sit outside CNSGP, or where a practice wants contractual insurance protection for particular private or non-NHS services. Depending on the policy, it may also be possible to insure the healthcare organisation itself as well as specified clinicians.
This can be particularly important as GP practices diversify their services. A practice may provide a mixture of NHS-contracted work and services for which a fee is charged, but the fact that a service is delivered from an NHS GP surgery does not automatically mean that it falls within CNSGP.
Examples of activities worth checking
Practices should review the indemnity position whenever they introduce or expand services such as:
- Private medical examinations or certificates
- Insurance reports and other fee-paying reports
- Occupational health or employer-funded services
- Private or independent consultations and treatment
- Travel or vaccination services where the activity does not fall within the relevant NHS arrangements
- Other new private services delivered by the practice or its clinicians.
These are examples to prompt a review, not a definitive list of services excluded from CNSGP. Whether a particular activity is covered depends on the nature of the service and the contractual arrangements under which it is delivered.
Do not only think about the individual clinician
A further consideration is who could actually be named in a claim. Indemnity arranged by an individual clinician does not necessarily mean the partnership, company, PCN or other healthcare entity has identical protection.
Where a practice is providing private or non-NHS clinical services, it is sensible to check both sides of the exposure: the protection held by the individual healthcare professional and the protection available to the organisation contracting with the patient or delivering the service.
Claims-made cover: an important detail
The medical malpractice policy currently proposed by Practice Cover operates on a claims-made basis. In simple terms, the policy that is in force when the claim is first made and notified is normally the policy expected to respond, subject to its terms, retroactive date and any applicable exclusions.
That makes continuity of cover important. Practices should also consider what happens when a clinician stops a particular activity, leaves the practice, retires or when a policy is not renewed. Depending on the circumstances, run-off or an extended reporting arrangement may be required so that later claims relating to earlier work are not unintentionally left without protection.
Before introducing a new service, ask these questions
- Is the activity being delivered under an NHS contract or is it private / fee-paying work?
- Is it within the scope of CNSGP?
- What protection does each clinician already have through an MDO, employer or other arrangement?
- Is the practice, partnership or company itself protected?
- Does the proposed insurance cover every profession and activity involved?
- Is the policy claims-made, and if so, are the retroactive date and run-off arrangements appropriate?
How Practice Cover can help
GP practices are continually evolving, and the line between NHS-contracted activity and additional private services is not always obvious. At Practice Cover, we specialise in insurance for healthcare practices and can help you understand where your existing arrangements apply and where a commercial medical malpractice policy may be appropriate.
If you are introducing a new clinical service, increasing private work or are simply unsure whether your current arrangements cover everything your practice does, speak to the Practice Cover team before the service goes live. We can review the activity with you and help identify the insurance questions that need answering.
Important: This article is for general information only and does not constitute legal, regulatory or insurance advice. The scope of CNSGP, MDO membership and commercial insurance varies according to the activity, contractual arrangements and applicable terms. Practices and clinicians should check their own arrangements before relying on cover.
