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Private vs NHS work in a GP practice: What’s changed?

Private vs NHS work in a GP practice: What’s changed?

The rules surrounding private healthcare services delivered by GPs have now changed, amid fears of a ‘blurring’ of the lines between NHS and non-NHS work.

As part of widespread changes to the GP contract, NHS England has decided to ban the advertising and hosting of private GP services from April 1.

The 2019/20 GP contract states: “To safeguard the model of comprehensive NHS primary medical care, from 2019 it will no longer be possible for any GP provider either directly or via proxy to advertise or host private paid-for GP services that fall within the scope of NHS funded primary medical services.

“NHS England will consult in 2019 on expanding this ban on private GP services to other providers of mainly NHS services.”

What the changes mean for GPs

It’s important to recognise that this doesn’t bar GPs from all non-NHS work. Indeed, a full range of services – from medical reports for insurance to physiotherapy and signing passports will still be a natural part of life for a great many GPs.

However, this stops practices from being able to charge patients for services that are free under the NHS or to get quicker access to their GP. It’s about making it completely clear as to what is available under the NHS and what isn’t – and therefore incurs a charge to the user.

There has been a rise in private treatments offered by GPs in recent years. The Guardian reported that demand for this has been growing after cuts and cost savings instigated by the NHS.

Private providers have offered GP access

Online private GP services have sprung up to offer people out of hours access to a doctor over the internet.

These services are reportedly particularly popular among millennials, with many young people preferring to pay than wait for an appointment. Practice Business noted that three quarters of patients in a network of private clinics were aged between 20 and 39.

It quoted Dan Faber, founder, DocTap, as saying: “Patients are out of patience and they are no longer prepared to wait for or travel to an NHS appointment. They want to see a doctor on their terms and they want to choose the doctor that they want to see. It is clear that the existing NHS GP model is outdated and is unable to service the new millennial generation who want convenience.”

Confidence in the GP service

The NHS England and the British Medical Association in a bid to ‘maintain patient confidence’ in the GP service and set a clear distinction between what is and isn’t allowed.

Dr Richard Vautrey, chair of the British Medical Association’s GP committee, said: “While the BMA represents the breadth of the medical profession, including private practitioners, we have been concerned at the increasing blurring in recent years between NHS and private GP services offered to patients, particularly with the opportunities digital technology is providing.

“This change will provide clarity for patients about what treatment is available on the NHS and what they have the option of paying for privately.

“Both NHS England and the BMA want clarity for patients about what are free NHS GP services and what are not, and we are determined to maintain patient confidence in the integrity of general practice.”

GPs need indemnity for all of their work

The new rules offer a welcome clarification on the dividing lines between NHS and private work. This debate also goes to emphasise that there is much non-NHS work that naturally falls at the feet of GPs – work that will continue unchanged.

This is important to bear in mind when it comes to the new state-backed indemnity scheme, which only covers cases of clinical negligence that come from NHS activities within the scope of the scheme. That means that any non-NHS work is not covered by the Government’s scheme and this is one of the many reasons why GPs will still need to maintain their membership with an MDO.

Why it’s important to review your indemnity

Why it’s important to review your indemnity

We’re delighted to be able to help our GPs to go about their work safe in the knowledge that they have the cover and support that they need.

We’re also confident that more GPs would benefit from joining the MDS family. However, we also know that GPs are busy people – we’re GPs too after all – and indemnity has, traditionally, not been something that many GPs have reviewed on a regular basis. Many of you had to settle for one of the ‘big three’ and stick by your choice out of necessity so that you were legally able to go about your work.

This is part of the reason why we set MDS up. We wanted to offer more choice and to break up an old system that didn’t seem fit for purpose. We vowed to give the best service and the best value for GPs and we’re proud to be doing that for our members.

Intrigued? Here’s what we think you’ll get from reviewing your GP indemnity in order to consider giving MDS a chance.

You can save money on your indemnity

Let’s not kid ourselves, we appreciate that everyone is after a good deal and that clearly means not paying over the odds.

We were staggered to see that the average cost of a GP indemnity had risen to about £8,000 a year – and we’ve been able to come up with a pricing model that has saved 10 to 30% a year for our GPs.

With so much scope for savings, there’s a genuine financial reason to have a review and ensure you’re getting the best value for money.

The Government is changing things

Even if you had no intention of thinking about your indemnity, the Government’s recent actions have made this a necessity.

From the beginning of April, a new state-backed indemnity scheme will be available to cover cases of clinical negligence.

While we welcome this – it’s important that GPs are aware that the cover will not extend to General Medical Council inquiries, NHS England investigations or inquests and court proceedings. It also doesn’t cover medico-legal advice or non-NHS work, so that means things such as DVLA work or employee medicals fall outside the state scheme’s scope. In short, there’s still an acute need for MDO cover.

The reforms – which are part of wider changes to the GP contract – are likely to naturally prompt a review of the cover you need and the obvious extension of this is to weigh up the policies offered by alternative providers too.

We’re just for GPs

We think that GPs deserve indemnity provider who understands their job, is proud to protect their professional reputation and is dedicated to serving their specific needs.

We don’t think the old established order was able to do that – they’re focussed on medical professionals more generally – and that’s why we’re created by GPs for GPs, offering that bespoke service that GPs deserve and need.

In our mission statement we vow to DEFEND:

Defend and respect the GP voice
Empower our staff
Friendly customer service for each member
Empathy with each member during a time of crisis
Nimble, being agile to deliver a personalised approach whenever we can
Desire to be the best

We feel that reviewing your indemnity gives you the option to consider the level of service you receive and embrace a GP-centred indemnity.

We’re offering a referral scheme

Our new referral scheme offers another great reason to consider reviewing your GP indemnity at the earliest available opportunity.

If any of our members refers another GP to us then – to show our gratitude for helping to grow the MDS family – we’ll offer both parties a 5% discount off their membership costs.

Our members can refer up to four GPs each – meaning that they can earn up to 20% off their membership.


Convinced? Why not get in touch so that we can explain our membership offering in full and help you to get the benefit of a cost effective indemnity that is especially designed for GPs.

The new GP contract: What else is in the Government’s five-year plan?

The new GP contract: What else is in the Government’s five-year plan?

The Government’s five-year contract for GPs marked the biggest reforms for our service for 15 years.

As we reported at the time, a key announcement involved the introduction of a new state backed indemnity scheme.

However, this was far from the only measure outlined. In this guide, we’ll give you a summary of the rest of GP contract and a flavour of the reaction to it.

New GP contract: The key points

NHS England’s announcement included:

  • New recruits: 20,000 more staff will be enlisted to support GPs. These staff – a mix of pharmacists, physios, paramedics, physician associates and social prescribing link workers – are intended to help GP practices form a local ‘primary care network’. The theory is that GPs will be freed up to spend more time with patients and practices will be able to offer more services. Setting up these networks could cost £1.8 billion by 2023.
  • Digital first: NHS England vowed that every patient will get the right to ‘digital-first primary care’ by 2021. This will mean increased provision of online consultations – and extra IT support to help provide this. Patients will also be able to get digital access to their full records from 2020.
  • Reform to phone lines: With 111 calls able to make direct bookings into GP surgeries.
  • Clinical reform: New changes were announced to the GP Quality and Outcomes Framework. The Government says these will look at diabetes, blood pressure control and cervical screening – with plans to focus on heart failure, asthma, COPD, and mental health in the future.
  • Earnings transparency: Extra public scrutiny of NHS earnings – and a new process to prevent ‘unexpectedly high or low earnings’.
  • Avoidable A&E: A new £300 fund should see GP practices benefit from their role in cutting avoidable A&E attendance and outpatient appointments.

The reaction to the GP contract

Understandably, this new contract has prompted a flurry of interest and reaction. Here’s a flavour of what some key figures have said:

NHS England Chief Executive Simon Stevens said: “This five-year deal unarguably represents the biggest boost to primary care in more than fifteen years, giving patients more convenient services at their local GP surgery while breaking down the divide between family doctors and community health services. It provides the practical foundation for the big service improvements in the NHS Long Term Plan.

“Patients across England – in towns, villages and cities – will all begin to see the benefits, beginning this year. And it allows us to keep all that’s best about British general practice while future-proofing it for the decade ahead.”

Ian Dodge, National Director for Strategy and Innovation at NHS England said: “General practice is the bedrock of the NHS, and the NHS needs general practice to survive and thrive. Through this comprehensive deal, the BMA and NHS England have sought to solve the big problems that general practice faces, and make it possible to expand services for patients.

“Having a Long Term Plan has allowed us to come up with a five-year funding deal for primary care, for the first time in NHS history. And it is also a good deal for taxpayers, with money going directly into extra staff and services.”

Dr Nikki Kanani, NHS England’s Acting Medical Director for Primary Care, said: “This Contract gives five-year funding clarity and certainty for practices while giving patients improved services. Primary medical and community care resources will increase by £4.5 billion by 2023-24 and rise as a share of the overall NHS budget. And this agreement confirms how much of this new investment will stabilise and transform primary care through general practice and the evolution of Primary Care Networks. It’s a game changer and signals the start of a new era for general practice.”

Health Secretary Matt Hancock said: “I want the NHS always to be there for us when we need it. That means better access to GPs. This new contract provides certainty and security for all those working in general practice, and better, more modern access for patients.

‘GPs are the bedrock of the NHS and I want every patient to be able to access a GP quickly and increasingly online. Today’s agreement, building on our Long Term Plan for the NHS, backed by an extra £20.5 billion a year, will make that a reality.

“Everybody should be able to access a GP when they need to, in a way that suits them – and from embracing digital technology, to providing more flexible options for booking and attending appointments – we are giving greater power to patients to get the care that is right for them.”

Chair of the Royal College of GPs Professor Helen Stokes-Lampard said: “Investing in general practice is investing in the entire health service – and this new contract promises to do just that, in the best interests of our profession, the sustainability of the NHS, and the care we deliver to more than a million patients a day across the country.

“We also welcome the focus on collaborative working with a range of highly-skilled members of the GP team, to support our work and free up our time to deliver care to patients who need our expertise – as well as with other practices in the same locality.”

Kent LMC chair, Dr Gaurav Guptatold Pulse: “I think this five-year contract deal can help stabilise the profession and the state backed indemnity will go some way in easing the recruitment crisis. Practices need to be at the centre of and lead primary care networks for full benefits of the deal to be realised. Much more work is needed to make general practice sustainable for the future but this deal is a good step in the right direction.”

A spokesman for the National Pharmacy Association said: “We are fully behind the principle that multi-disciplinary working, designed locally, based around the patient and delivered in the community, is the best way to deliver transformative improvements in health care.

“So, we will work with colleagues across the sector to support our members to engage with primary care networks, which are becoming a very significant part of the NHS infrastructure.

“However, today’s announcement intensifies the dilemmas faced by community pharmacy owners who invest in training and development only to see people migrate to general practice.  This is a risk that must be carefully managed, so that these new primary care workforce targets genuinely add to capacity.”

You can also read our reaction to the indemnity plans here.


What do you think of the GP contract? Do you support the Government’s plans? We’re keen to hear what you think.

New GP contract brings changes to indemnity rules

New GP contract brings changes to indemnity rules

New GP contract brings changes to indemnity rules

Jan 31, 2019

NHS England bosses have today announced a new five-year contract for GP services in England which includes the introduction of indemnity state backed scheme.

The new deal – described by the NHS as the biggest reform to GP services in 15 years – follows a series of negotiations between the Government and key health stakeholders.

The Medical Defense Society has been engaged in talks about the changes, which come into effect in April and introduce a state backed indemnity scheme to cover some of the activities carried out by GPs.

CEO Rohan Simon said: “We are happy to support any policy that contributes towards helping our members. While we think there are elements of this new scheme that will help, we are concerned that there are factors that have not been addressed in this plan.

“There are a number of other factors that have contributed to indemnity costs and these are not addressed by this move. We believe issues such as fees charged by lawyers, tort law and the discount rate on negligence pay-outs need to be considered too.

“ We remain committed to lobbying for the best possible deal for GPs and MDS will be creating a new package for our members to embrace the new changes in the GP contract.”

Medical Defense Society will offer a pro rata refund to members on the portion of fees paid for cover of medical malpractice claims.

Each MDS member will receive individual contact with details about what their new fees will be.

The new state backed indemnity rules

The new rules announced today are in line with the details outlined in our previous post.

The new scheme aims to provide indemnity from cases of clinical negligence that come from NHS activities that are within the scope of the scheme.

The Government says it wants to cut the cost of indemnity and introduce a new process that is similar to the NHS indemnity scheme that has existed for hospital doctors since 1990.

Importantly, however, the new scheme does not cover:

  • Non-NHS work – eg DVLA work or employee medical assessments
  • General Medical Council inquiries
  • Inquests
  • Court proceedings
  • NHS England complaints/investigations
  • Access to medico-legal advice.

On this basis we advise that GPs continue to maintain their membership with the MDO.

For more details on this, check out our guide to the state backed indemnity scheme.

If you want to talk about the state-backed indemnity scheme – or any other matters relating your cover as a GP – contact us today.

What you need to know about the new state-backed indemnity for GPs

What you need to know about the new state-backed indemnity for GPs

What you need to know about the new state-backed indemnity for GPs

Jan 29, 2019

GPs in England and Wales are facing changes to the way in which they get the indemnity they need to do their job.

The Government is still in negotiations over new proposals for a state-backed indemnity scheme, which is likely to be introduced in April this year.

While the Medical Defense Society has been engaged in talks about the changes – and has until now been focussed on representing members’ best interest in these – we think it’s important for GPs to be aware of the broad details of the proposed changes ahead of April .

What the state-backed indemnity scheme aims to provide

The Government’s scheme is being designed to provide indemnity from:

  • cases of clinical negligence…
  • …arising from the NHS activities that fall in scope of the scheme.

Both points are important to bear in mind when it comes to considering the cover you need as a GP – and we’ll come to that in a moment.

Why is the Government introducing a state-backed indemnity scheme for GPs?

The Government says it is acting to try to reduce the cost of indemnity to reduce a potential barrier when it comes to finding and keeping new GPs.

The idea is to introduce something similar to the NHS indemnity scheme that has existed for hospital doctors since 1990.

When it comes to cost, reports suggest that the average price of an indemnity for a GP has risen to about £8,000 a year. Medical Defense Society, which was set up by GPs for GPs, agrees with the need to reduce this cost – and has helped hundreds of members to already reduce the cost of their indemnity.

What won’t be covered by the state-backed indemnity scheme?

The Government’s scheme aims to cover clinical negligence for NHS work – which means it’s important for GPs to consider what’s outside this remit and how to protect themselves for this.

Before we do that, it’s worth considering the detail of what will be covered.

The Government’s advice states the new scheme will cover:

  • Clinical negligence liabilities for all GP staff delivering primary medical services (under GMS, PMS and APMS contracts)
  • Out of hours services under an APMS contract
  • Public health services in arrangement with the local authority such as health visits for toddlers and sexual health services.

That offers useful clarity for GPs – and it’s important to stress that there are no plans for the state-backed indemnity scheme to cover:

  • Non-NHS work – such as work for the DVLA or medical assessments for employees
  • Support for proceedings and inquiries with the General Medical Council
  • Representation at inquests
  • Court proceedings.

While a GP might be covered for a civil matter, therefore, they still need to consider cover for criminal and professional cases that may arise from negligence claims.

Indeed, it’s estimated that as many as 60% of claims might fall outside of the remit of the cover offered in the state scheme.

What about the rest of the UK?

The English and Welsh Governments are both looking to introduce state-backed indemnity schemes in April 2019. There are, as yet, no plans announced to match this in Scotland – where costs are traditionally lower – or Northern Ireland.

Will it work?

The Medical Defense Society is happy to support any policies that help our members. However, there are concerns about the way this is being funded. Taking money for a state-backed indemnity scheme from the existing GP budget does not appear to match with the overall objective of reducing the cost for GPs.

It’s important to stress that there are still details to be decided when it comes to this policy. It’s also worth noting that some of the factors that have contributed to the rising cost of indemnities won’t be directly addressed by this move – and that issues such as lawyers fees, tort law and changes to the discount rate on negligence payouts all need to be addressed separately.


If you want to discuss the state-backed indemnity scheme – or any other matters relating your cover as a GP – get in touch with us. We’ll also aim to update you further once details are confirmed by the Government.

Winter Indemnity Scheme

Winter Indemnity Scheme

Winter Indemnity Scheme

Sept 26, 2018

As recently announced, NHS England will cover the cost of professional indemnity for any additional out of hours work to be undertaken by our GP members this winter.

This will give our members freedom to work additional sessions without having to pay the additional subscription to MDS.

This scheme has been developed in conjunction with NHS England and will run between 1st October 2018 and 31st March 2019. The funding and timing of the scheme are in line with the 2017-18 scheme.

NHS England and MDS would like to advise all our members that you check your current sessional cover, as you may have access to further sessions within your current allocation. This can be found on your membership certificate. We would stress that this scheme is designed to meet the costs of indemnifying additional OOH work this winter; members should not amend their previous levels of indemnity. It is also the member responsibility to inform MDS of any sessions/work that was not carried out.

It is also important to remember that this cover needs to be in place before undertaking any additional sessions as it cannot be put in place retrospectively.