Locum Doctors - Is Medical Indemnity Necessary?
This article has been written in collaboration with MDDUS, one of the leading medical defence organisations. They have offered a £50 discount to locum doctors who join them using a voucher code from Messly, which you can read more about here.
As a locum doctor, you are likely to work in a range of different clinical settings and perhaps with a changing cast of colleagues. Asa result, you might be worried about finding yourself in situations with a greater risk of legal issues, patient complaints or even GMC referrals.
In this article, we’ve picked the brains of Dr Richard Brittain who is a medical and underwriting adviser at MDDUS, one of the leading medical defence organisations for doctors.
He graduated from Nottingham University in 2004 and undertook his Foundation Training in Nottingham and Bristol. He then obtained clinical fellow posts in London, whilst completing his legal training. He started working in medical law in 2008 and gained MRCP in 2011, joining the MDDUS in 2013. He continues to work on a part-time basis as a coroner, having been appointed to this role in 2012.
We’ll give you the low-down on what kinds of legal issues can arise for locum doctors, what support you will get from within the NHS and how a medical defence organisation can help.
With a clear understanding of this area, you can enjoy the flexibility and pay benefits of locum work whilst feeling secure that you have peace of mind should the worst case arise.
What kinds of legal issues might locum doctors need protection from or support with?
There are two broad categories of legal issues that can arise from your work as a locum doctor:
Clinical negligence claims
In this case, the hospital where you are working is sued by a patient or their family for alleged negligence because of potential errors that were made during the patient’s care. This is a legal matter which is settled financially out of court or resolved in court.
As a locum doctor you are very unlikely to be personally named in the legal proceedings, although this does happen from time to time.
These are sometimes referred to as ‘non-claims’ and include a range of issues which fall short of a full court case, and do not involved compensation claims, but can be serious situations. Common examples include:
● Patient complaints
● Inquests (and Fatal Accident Inquiries if you're working in Scotland)
● GMC referrals
● Disciplinary investigations
● Good Samaritan acts
● General ethical questions
These are still very serious situations that could have an impact on your fitness to practice and certainly cause stress should they arise.
What protection does the NHS give me as a locum doctor against clinical negligence claims? Does it matter if I am locuming with the staff bank or an agency?
If your locum role is within the NHS, the NHS provides an indemnity to protect its employees against clinical negligence claims.
This applies whether you are working in a substantive, bank or agency locum role. There is no difference between shifts booked via a locum agency or directly with the Trust’s staff bank: as long as the work is in an NHS-setting, you will be protected.
This means that, as regards clinical negligence claims, you are adequately covered as long as your work as a locum doctor is entirely within the NHS.
For GP locums working in Scotland and Northern Ireland, it would be important to establish whether claims indemnity is required for this GP work. This is not provided by the NHS for most posts.
For reference, in England the indemnity is provided through schemes called the Clinical Negligence Scheme for Trusts and the Clinical Negligence Scheme for GPs, with similar schemes in Scotland, Wales and Northern Ireland.
What happens if there is a clinical negligence case against the Trust relating to a patient I cared for?
You are likely to be asked to provide a statement, effectively as a witness, to help the parties involved understand the series of events which took place.
This may be your only involvement with the case. This is especially true for junior doctors who were not the most senior clinician on the team at the time of events.
If you are a member of a medical defence organisation (which we explain below), they can support you with advice through this process and help with drafting your statement.
What about locuming in the private sector or doing other non-NHS work?
For non-NHS roles, you must get your own cover in place against clinical negligence claims.
The GMC Guidance states: “If you carry out any private or independent practice, you must arrange adequate and appropriate insurance or indemnity (even if this work takes place on NHS or HSC body premises). This applies even if the work is in addition to work you do for an NHS or HSC body.”
Will the NHS support me with medico-legal issues?
The NHS provides only very limited support for doctors on medico-legal issues. Unfortunately this means that should a GMC referral occur, for example, you might find that your Trust’s legal department is not forthcoming with support or advice even though the events took place whilst you were working for them.
Therefore, it's important to carefully consider whether you want to get additional protection to ensure you are fully protected should any of these issues arise in your role.
This is where a medical indemnity (sometimes called professional indemnity for doctors) or insurance policy can be useful…
What is medical indemnity? What's the difference between indemnity and insurance?
Medical indemnity is a promise to pay for the costs of claims or defending you against professional challenges.
The most common model is for doctors to join a medical defence organisation (MDO).
MDOs are mutual membership organisations that provide indemnity and support for their members. MDOs aren’t insurance companies, and provide protection on a discretionary basis. They were established and are run to look after their members, using their discretion to support doctors.
Doctors who want this indemnity and support become members of an MDO, and pay an annual subscription fee to join.
An alternative to MDO membership is to buy an insurance policy from insurers, who, are increasingly offering insurance policies to doctors.
These policies are similar to home or car insurance. Insurance contracts set out specific situations in which they will cover the costs of precise scenarios related to both legal claims (if needed) and the other professional challenges explained above. Therefore should one of these situations arise, you can refer to the insurance policy to cover any losses you suffer.
What support do I get when I join a medical defence organisation?
Medical defence organisations offer a full service of advice and support to their members.
They have expert advisers who you can contact via a telephone advice line, where they will give you support and guidance to help you through your circumstances.
You can also speak directly to fellow medics who have specific qualifications in medical law. They offer expert advice, including for emergency situations, that can arise at any time of the day or night.
If a situation requires legal representation, your MDO will also have a team of in-house and external legal advisers who can provide additional support.
Is it compulsory to get medical indemnity or an insurance policy in place?
If you are working exclusively within an NHS setting where NHS indemnity applies, it is optional whether to get additional protection. You can rely on the ‘basic’ protection from your NHS Trust for clinical negligence claims alone. This means that you would be without support should any of the medico-legal issues set out above should arise.
This is more likely to be a good option for you if, through your work as a locum, you feel like you are being exposed to different clinical settings, different working environments, new colleagues and therefore more uncertainty than in a substantive or training post. Or if you simply value the comfort of knowing that there is additional support available should you need it.
If you are working outside the NHS, the GMC guidance requires you to have ‘adequate protection’ in place, as explained above.
What determines how much I pay for a membership to a medical defence organisation?
The cost of membership to a medical defence organisation is determined predominantly by the nature and seniority of the role you are undertaking. This reflects the level of your responsibility in that role, and therefore the level of risk that the MDO is assuming in providing you with cover.
Other factors might relate to any additional indemnity you need (particularly any private practice or supplementary roles that you need cover for). Most MDOs will also vary the charges depending on your previous history of claims or other history.
Pricing for junior doctors in locum roles is relatively standardised, reflecting that they will be working under the supervision of a consultant (whether directly or remotely). This compares to other roles, such as locum GPs who are often charged based on how many sessions they undertake and whether this is out-of-hours practice.
When you speak to an MDO about membership, they will ask you for information about:
● The role or roles you will be working in, including your clinical responsibilities and support
● Your CV (potentially)
● Your GMC registration
● Any previous claims or case history with other organisations
It can take some time to obtain a case history from previous providers, so this should be sought as early as possible.
What is the ballpark cost of a membership?
This can vary significantly based on the factors outlined above.
To give you an indication of what you might pay, we’ve taken the example of an F3 doctor working ad hoc locum shifts for NHS trusts through locum agencies.
In those circumstances, you could expect a membership to cost in the region of £80 to £125 per annum.
Any private work performed outside the NHS would attract an additional cost, as would any unusual or extenuating circumstances.
When do I need my insurance/indemnity to be in place?
Arrangements ought to be in place before your clinical work starts.
Remember, for non-NHS work it is mandatory to have cover in place and this must be in place before you start working. Typically, private healthcare providers will ask you for confirmation of your insurance or indemnity arrangements as part of their pre-employment checks before you start work in any case.
How do I choose a medical defence organisation?
If you decide to opt for the support that medical defence organisation membership can provide, the next consideration is which MDO to pick.
The best thing to do is shop around and make inquiries of multiple organisations, so that you can find the best fit for you and the best price.
Regardless of who you choose, it’s best to start making inquiries early so that you can make sure you have all the information needed to hand and everything in place before you start your role.
Messly & MDDUS
At Messly, we want to help locum doctors easily find good quality indemnity cover from a reputable provider.
We did some ‘secret shopping’ and spoke to doctors, and were most impressed with MDDUS. They are one of the larger MDOs, with over 54,000 members, and they offer wide-ranging medical expertise, competitive pricing and have a ‘doctors for doctors’ personal care ethos that can support you in times of need. They also have other health and wellbeing benefits for doctors.
They have offered a £50 discount to locum doctors who join them using a voucher code from Messly. We’re confident that with this discount, F3 doctors in particular will struggle to get a cheaper medical indemnity anywhere else.
To learn more about MDDUS and to redeem your code, click here.
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