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Where will indemnity rises stop?

Hard-wired GP

Luke Koupparis

Wednesday, 24 May 2017

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rising costs_shutterstock_572628049.jpgIndemnity costs continue to rise for GPs and it makes me wonder where it might stop. What proportion of income does this need to increase by before working as a general practitioner is just not financially viable?

Recent legislative changes by the Lord Chancellor to amend the interest rate used by courts to calculate lump sum compensation payments to victims of clinical negligence incidents and other personal injury claims has added hundreds of millions to the cost of claims. A claim in the past that settled for 8.4 million would now settle for 17.4 million.

In the United States, it is not uncommon for huge compensation amounts to be paid out to patients and it would seem that the UK is moving rapidly towards this. GPs, not protected under crown indemnity, are having to bear the brunt of these increases in payouts.

It is clear from looking at the evidence that the quality and safety of the care given by GPs has never been higher. However, demand for appointments has been growing significantly and higher volumes increases the likelihood of a claim being made. In addition, patient expectation has changed with the medical profession being viewed in a very different way to 15-20 years ago. Patients are now more likely to sue a doctor when something goes wrong.

Legal companies compound the problem with increasing numbers and aggressive advertising of potential rewards for little financial outlay aimed at patients. Although it is interesting to note that despite an increase in volume of claims the proportion settled without a claim has increased. However, associated legal costs are borne by the medical defence organisations resulting in higher costs. It would seem that the cynical statement that the lawyers always win bears true here.

In July 2016, as part of the GP Forward View, there has been an attempt to address this increase in indemnity payments by GPs. A scheme has been developed to provide some financial support and reflect the average annual inflationary pressures for indemnity faced by GPs. Running for an initial two-year period, it has provided a payment (£30 million in March/April 2017) to practices to offset average annual indemnity inflation during 2016/17, and a further payment will be made in March/April 2018 for rises in 2017/18.

Practices will receive a payment of 51.6p per patient based on their registered list as at December 2016. The BMA was clear to state that partnerships were duty bound to ensure that their salaried GP colleagues were given the appropriate amount of funding.

However, this amount is a drop in the ocean when compared to overall indemnity fees and with, as yet, no real clarity as to whether NHS England will continue to plug this increase in years to come there is concern in the GP population.

Medical Defence Union officials have called on GPs to lobby parliamentary candidates about the 'potentially devastating impact' that this recent legal decision could have on GP clinical negligence costs so it does look like we will be faced with significant yearly rises for the foreseeable future.

With the general election in full swing, we are unlikely to see any announcements on this topic by the government. However, it is clear that without radical changes brought in to protect GPs from these increases, we are likely to see more opting for reduced sessions or early retirement.

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Luke Koupparis

Luke is a general practitioner in the Bristol area with interests in men's health, child health, minor surgery, online education and medical information technology. He is the IT lead for Bristol clinical commissioning group. He also works as the medical editor to OnMedica helping to deliver high quality, peer reviewed information to the wider medical community. In his spare time he is a keen road cyclist.
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