By Dr Surina Chibber


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NHS England recently announced the introduction of a £60 million Indemnity Support Scheme for GPs to compensate the rising costs of indemnity. At first glance this seems like a welcome relief to tackle spiralling costs. Although there is no denying that it is a step in the right direction, a closer inspection shows that there seems to be no relief for sessional GPs who are amongst those taking the hardest hit regards indemnity costs. Before NHS England's announcement, Dr Preeti Shukla helped to collate key questions that sessional GPs had regarding indemnity. I brought these questions to MDDUS CEO Chris Kenny. Here is what he had to say:

What framework/tools do you use to calculate indemnity? Is a uniform tool used? 

MDDUS charges subscriptions that are based on a detailed consideration of likely future costs – including the costs of claims which have occurred but not yet been reported – based on our previous claims experience and incorporating expert actuarial and underwriting analysis. 

Many GPs can't understand why there is such a variation in prices among members. Why are different prices quoted by different MDOs for the same work undertaken by GPs?

As a not-for-profit, mutual organisation, MDDUS is committed to providing a high-quality service that is competitively priced. This is one of the reasons why our market share among English GPs has risen threefold in the past decade. 

Our rates are set at a level that is deemed appropriate to cover any potential liabilities, based on our experience and judgement about what may happen in future. We take into account many factors including number of sessions worked as well as doctors’ professional duties and responsibilities.

We offer a range of benefits to medical professionals who work in a practice where the majority of GPs are MDDUS members. 

We continue to evolve our products to the changing market. So, for example, we are making major improvements to our out-of-hours coverage which will see some prices fall by 80 per cent. Reduced subscription rates are available to new GPs in their first years of completing training, with similar discounts available to those returning to GP work. And we will continue to look for other opportunities to support both the recruitment and retention of GPs. 

We encourage all GPs to compare rates and offerings across the MDOs and insurance providers before their renewal. 

Many GPs feel that indemnity rises if you ring your indemnity provided for advice as it’s quoted as potential claim - is this true?

As we have repeatedly made clear to the BMA and a number of LMCs who raise this issue, we can give a categorical assurance that the underwriting and pricing decisions of MDDUS are not driven by the number of contacts with the organisation.  

Indeed, MDDUS positively encourages members to make use of the 24-hours advice line that is available to them as a benefit of membership We do not penalise members for using this valuable benefit of membership as we believe that seeking our advice will assist the member in adopting safer clinical practice.

We understand that the UK is becoming more litigious however as a profession, we fail to see why indemnity is so high. The rate of indemnity is increasing annually at such a rate that we estimate in the next 24 months it will unaffordable for most GPs. Where can we go from here?

We have been forced to increase our subscriptions to reflect a growing number of claims and increasingly generous awards made to claimants by the courts, as well as the increased legal costs on which we are urging government to act.

We strive to ensure that our subscriptions represent the very best value possible, whilst of course needing to ensure that we collect sufficient funds to ensure our continued ability to respond to members’ requests for assistance in future. 

If you are a GP who has undergone a GMC investigation how does this affect your indemnity? 

MDDUS is a mutual organisation owned by our members. That means that we have a responsibility to act in our members’ best interests. Claims and complaints can affect any doctor – we do not seek to weight subscriptions against doctors who have had a claim. Risk sharing across the profession is at the heart of what we do.

How do you plan to lower the indemnity cost to the NHS? What steps are you taking to increase pressure on the government for reform?

We are currently in discussions with the government and NHS England on key issues such as proper resourcing and legal reform in order to reduce the costs faced by the profession.

MDDUS has long believed that the object of a fair system for resolving clinical negligence claims should be timely, proper and just compensation for those wrongly damaged. We strongly support the introduction of a fixed recoverable cost scheme, especially for lower value claims.

We welcome the planned investment to improve patient care and reduce the workload on general practice. Greater resources and new ways of working will reduce risk and can address rising numbers of complaints and claims.


Looking at the overall picture, it seems neither the MDOs or NHS England yet have a sustainable answer. It is now even more imperative that GPs make a concerted effort to highlight the issue and identify proactive solutions. Otherwise, as costs continue to rise, sessional GPs simply won't be able to afford to work and as a result there could be further unprecedented work force demands on an already fragile profession.