BMJ 2017;358:j3893 doi: 10.1136/bmj.j3893 (Published 2017 August 15)

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NEWS Patients being put at risk from unfilled out-of-hours shifts, GPs warn Gareth Iacobucci The BMJ

Providers of out-of-hours GP services in England have warned that the rising cost of indemnity cover has left them struggling to fill shifts and is putting the care of patients at risk.

working out of hours. One GP was reported as having to pay £3000 more in cover if the GP were to work 700 rather than 517 hours a year in order to work shifts out of hours.

GP indemnity costs have soared in recent years, with doctors who work out of hours being particularly affected. The Department of Health admitted last month that indemnity costs could rise even further after the decision of the Ministry of Justice to lower the personal injury discount rate for claimants1 and is locked in talks with the BMA on how to mitigate the decision’s effect on GPs.

This provider said, “Our rota currently looks dire, and we have drawn up contingency plans to share with the CCGs [clinical commissioning groups] if we are unable to fulfil all our contracted activities.”

Urgent Health UK, a federation of 23 social enterprises that provide GP out-of-hours services to a population of more than 20 million, has reported a widespread shortage of doctors in England that it blames on the high cost of indemnity fees, with GPs being quoted up to £30 000 (€33 000; £39 000) for annual cover. Simon Abrams, chair of Urgent Health UK and a GP in Liverpool, said that rising indemnity costs was the biggest concern among providers. “All of my colleagues are really struggling to fill shifts. There is huge pressure,” he said. “I am extremely worried that we are getting closer to a situation where an adverse event may occur because of the workforce pressures.” Anonymous feedback from nine out-of-hours providers, obtained by Urgent Health UK for The BMJ, indicates the scale of the problem. One provider reported “a significant drop” over the past couple of months in the number of sessions that doctors were willing to work, with even agencies struggling to source GPs in the current climate. The provider said, “Ten of our GPs have reduced the number of sessions they offer due to increasing indemnity charges, and an additional two GPs have stopped working altogether and removed themselves from the performers list. The total impact of this is that we now have roughly 30 sessions less a week offered by GPs.” Another provider said that the banding system for indemnity cover used by medical defence unions was a barrier to GPs

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To try to fill its rota gaps, the provider said that it had been paying clinicians a contribution towards indemnity of around £4.50 an hour. But it said that it may be forced to stop this because of the risk that the clinicians might be seen as being employed by the organisation. Another provider reported “a permanent risk of shifts not being covered,” with local GPs who want to increase their out-of-hours shifts being quoted “unaffordable” indemnity costs of between £5000 and £6000 for each additional weekly session. The provider called for NHS England to follow Wales’s lead in establishing a clinical negligence risk pool system for out-of-hours working. The BMA’s General Practitioners Committee recently warned that the rising cost of indemnity could lead to the worst ever NHS winter crisis if fewer doctors were able to afford to work.2 Abrams said that additional funding from NHS England to offset high indemnity costs was welcome,3 but that it needed to be diverted to the right places and not just provided in the winter, as was previous extra funding. At the time of publication the Department of Health had not responded to The BMJ’s request for comment. 1 2 3

TheyWorkforYou. General practitioners: insurance. Jul 2017. https://www.theyworkforyou. com/wrans/?id=2017-07-07.3623.h. Rimmer A. Rising indemnity fees could lead to worst ever winter crisis, says new GP leader. BMJ 2017;358:j3682. doi:10.1136/bmj.j3682 pmid:28765123. Rimmer A. £60m scheme will cover GPs’ rising indemnity costs. BMJ 2016;358:i4206. doi:10.1136/bmj.i4206 pmid:27480169.

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Patients being put at risk from unfilled out-of-hours shifts, GPs warn.

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