Insurance, indemnity and medico-legal support

I’m a PA/AA, what does this mean for me?

As part of your application for registration, and re-entry, you will need to declare that you have in place, or will have in place by the time you begin to practise as a PA/AA in the UK, appropriate and adequate I&I.

The type and level of insurance or indemnity you require depends on factors including where you work, whether you are employed (and, if so by whom and for what services) or self-employed, and the nature of work you do. You must make sure your cover reflects the full scope of your UK PA/AA practice and that you keep it under regular review. Failure to hold appropriate I&I may put your registration at risk.

If you are already practising as a PA or AA in the UK, then you may already have some cover in place through your employer, and we give some examples of this below. Indemnity provided from your employer is likely to only cover you for clinical negligence claims. In order to retain cover in respect of other activities and services (such as non-NHS or private work, inquests, regulatory and disciplinary proceedings, employment and contractual disputes, and non-clinical liabilities) you will need to maintain membership with a medical defence organisation (MDO) or other indemnity provider or insurer.

For further advice on the cover you need, speak to a medical defence organisation or another professional insurance or indemnity provider. Your employer, or the organisation you are contracted to work for, may also be able to help.

When you’re asked about your insurance and indemnity by a patient or someone you’re connected with professionally (such as your employer), you should be able to confirm that you hold adequate and appropriate cover in line with the requirements of Good medical practice.

We don’t hold a record of your insurance and indemnity details but do have regulatory powers to check whether PAs and AAs have adequate and appropriate insurance or indemnity.

We can:

• check that any PA or AA practising in the UK has adequate and appropriate insurance or indemnity cover
• remove registration from a PA or AA if they fail to satisfy us that they have appropriate and adequate insurance or indemnity in respect of their UK practice in place
• refuse to grant registration, or re-entry to the register, to a PA or AA if they can’t assure us that they’ll have the adequate and appropriate insurance or indemnity in place by the time they start practising in the UK.

Insurance and indemnity when you work for an NHS trust or board, or Health and Social Care (HSC) Trust

If you are a PA or AA working for an NHS or HSC body, the organisation you work for will receive indemnity through a clinical negligence scheme.

• In England, indemnity is provided through the Clinical Negligence Scheme for Trusts (CNST), which is administered by NHS Resolution.
• In Wales, indemnity is provided by Welsh Risk Pool Services.
• In Scotland, indemnity is provided by the Clinical Negligence and Other Risks Indemnity Scheme (CNORIS).
• In Northern Ireland each HSC Trust assumes the role, funded by the Department of Health.

This applies even if you are a locum for an NHS or HSC body.

You should also consider whether you need to take out additional professional insurance or indemnity for work that is not covered by NHS or HSC body indemnity and to access personal regulatory and medico-legal support and advice.

If you are treating NHS patients privately, you must check with your NHS or HSC body employer what indemnity is in place.

Insurance and indemnity when you’re carrying out private or independent practice

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.

Many independent healthcare providers will ask you for confirmation of your insurance or indemnity arrangements as part of their pre-employment checks. Some independent healthcare providers provide insurance and indemnity for the work you do for them, but you should always check that it gives you adequate cover for all of your work.

If you’re doing private work as a PA or AA in the UK and hold (or plan to hold) an EU wide insurance policy arranged outside the UK, you must:

• check with your provider to ascertain whether or not your EU insurance or indemnity covers your work in the UK
• make sure that your EU insurance or indemnity is adequate and appropriate, and of sufficient value (at least the same value as a UK policy of insurance or with the same scope as a UK indemnity arrangement) to cover any claims made about your practice in the UK through the UK legal system.

Insurance and indemnity in primary care

In primary care, the insurance and indemnity cover you require is dependent in part on which of the four countries of the UK you are working in. This is because some of the countries have a state indemnity scheme for general practice.

In all cases the indemnity provided by either the state scheme, or your individual GP practice, will only cover you for clinical negligence.

You will need to maintain membership with a medical defence organisation (MDO) or other indemnity provider or insurer to retain cover in respect of activities and services not covered by your state or practice scheme – including non-NHS or private work, inquests, regulatory and disciplinary proceedings, employment and contractual disputes, and non-clinical liabilities.

You must also have appropriate arrangements to cover you for liabilities that arise from your practice as a PA whenever a claim is brought (such as ‘run off’ cover).

You must make sure your cover reflects the full scope of your UK PA/AA practice and that you keep it under regular review. If you are unsure about your current indemnity arrangements, then you should contact your indemnity provider or insurer to check and potentially retain or arrange additional cover if necessary. Please see our guidance on medico-legal assistance and advice, below.

England

If you are working as a PA for General Practice in England, including as a locum PA, carrying out activities connected to delivering NHS primary medical services on behalf of the provider under a primary care contract in England, you will receive indemnity (for claims arising from incidents which took place on or after 1 April 2019) through the Clinical Negligence Scheme for GPs (CNSGP), which is administered by NHS Resolution. This indemnity extends, in certain circumstances, to activities carried out by PAs which are connected to the delivery of other NHS services provided by general practice and known as ‘Ancillary Health Services’.

The Existing Liabilities Scheme for General Practice (ELSGP) may provide PAs with cover for claims relating to NHS clinical negligence that occurred before 1 April 2019. More information about this can be found on the NHS Resolution website.

Wales

If you work as a PA in an NHS Wales primary medical service, including as a locum, you will receive indemnity through a General Medical Practice Indemnity (GMPI) scheme managed by the Legal and Risk Services team at the NHS Wales Shared Services Partnership (NWSSP). This applies for claims arising from incidents which took place on or after 1 April 2019, and you can find more information on the NWSSP’s website.

The Existing Liabilities Scheme may provide PAs with cover for claims relating to NHS clinical negligence that occurred before 1 April 2019. More information about this can be found on the NWSSP’s website.

Scotland

GP practices in Scotland are required to source their own clinical negligence indemnity. If you are a PA working in General Practice in Scotland, then you should speak to the GP practice you are working for to understand if you are covered by the clinical negligence arrangements it has in place.

Northern Ireland

GP practices in Northern Ireland are required to source their own clinical negligence indemnity. If you are a PA working in General Practice in Northern Ireland, you should speak to the GP practice you are working for to understand if you are covered by the clinical negligence arrangements it has in place.

Working for a private or independent GP

If you carry out work as a PA for any private or independent GP practice in any part of the UK, this work will not be covered by a state indemnity scheme. You must arrange adequate and appropriate insurance or indemnity.

I’m a locum

As a locum you should check any contract or arrangement that you enter into to make sure you have adequate and appropriate insurance or indemnity in place.

If you’re working as a locum for an NHS or HSC body, indemnity for the organisation will be provided by a clinical negligence scheme (see information on ‘Insurance and indemnity when you work for an NHS trust or board, or Health and Social Care (HSC) Trust’, above).

If you’re working as a locum PA, in an NHS primary care service in England or Wales you will be covered by the relevant state General Practice scheme (see above for details).

If you are working as a locum PA in an NHS primary care service in Scotland or Northern Ireland, you should speak to the GP practice you are working for to check if you are covered by their practice scheme, or whether you need to arrange your own adequate and appropriate insurance or indemnity.

In all cases the indemnity provided by either the state, or your individual GP practice, will only cover you for clinical negligence. You will need to maintain membership with a medical defence organisation or other indemnity provider or insurer to retain cover in respect of activities and services not covered by your state or practice scheme – including non-NHS or private work, inquests, regulatory and disciplinary proceedings, employment and contractual disputes, and non-clinical liabilities.

You must also have appropriate arrangements to cover you for liabilities that arise from your practice as a PA whenever a claim is brought (such as ‘run off’ cover).

Insurance and indemnity for medico-legal work

If you do medico-legal work (like providing advice, or giving evidence in connection with a legal action, tribunal or hearing) and this work requires you to hold GMC registration, you must take out adequate and appropriate insurance or indemnity.

What do you mean by appropriate and adequate cover?

In our Registration Rules, we define ‘appropriate and adequate cover’ to mean, ‘cover against liabilities that may be incurred by an individual when practising as an associate, which is appropriate and adequate, having regard to the nature and extent of risks of their individual practice’. What constitutes adequate and appropriate is a complex area and you need insurance or indemnity that covers the full scope of your practice.

Medical defence organisations and other organisations in the commercial insurance market can advise you about what level of insurance or indemnity is adequate and appropriate for your practice. To get the best possible advice, you must give them accurate and up to date information about the scope and nature of your practice.

When should I review my insurance or indemnity arrangements?

You should do this at regular intervals and whenever your scope of practice, private practice income or employment or contractual arrangements, change.

The terms of your insurance or the scope of your indemnity protection may require you to tell your provider if certain things happen, such as sanctions being imposed on your registration.

I’ve retired or stopped providing healthcare services – do I still need insurance or indemnity?

Patients who you saw whilst you were working as a PA or AA should not be left without a way of being compensated after you have retired or stopped working.

You must have appropriate arrangements to cover you for liabilities that arise from your practice as a PA or AA whenever a claim is brought.

Providing services in your capacity as a PA or AA in emergencies outside work (Good Samaritan acts)

You are required to have insurance or indemnity that covers the full scope of your practice as a PA or AA. A Good Samaritan act (helping someone in an emergency situation outside of work) falls outside of this requirement. But insurance or indemnity provided by your employer may not cover a Good Samaritan act, so you should check with your medical defence organisation, or insurer, to find out whether you have or need insurance or indemnity for any possible liabilities as a result of a Good Samaritan act.

Providing voluntary services in your capacity as a PA or AA (good neighbour acts)

Good neighbour acts include helping out, in your professional capacity as a PA or AA, at a local sports club or similar planned voluntary work. You’re providing professional PA/AA services whether they are paid or unpaid. If adequate and appropriate insurance or indemnity cover is not given by the organisation for which you are providing this service, you must make your own arrangements to cover yourself.

What is medico-legal advice and assistance – do I need it?

NHS and HSC indemnity schemes, as well as the CNSGP and GMPI schemes, only provide indemnity to NHS or HSC bodies for clinical negligence claims. The same may also apply to indemnity provided by a GP practice or other employer. They won’t give you individual advice and help for other medico-legal matters from your practice as a PA or AA, such as criminal or disciplinary investigations.

And they won’t give you individual advice or assistance if we decide to investigate any concerns that are referred to us about your fitness to practise.

You may find it helpful to arrange medico-legal support to cover you in case you’re involved in an inquest or fatal accident inquiry where your NHS or HSC body, the CNSGP or GMPI, or your GP practice scheme is unable to support you, or an inquiry or if a complaint is made about you, especially if it is investigated further.

I’m a patient – what does this mean for me?

PAs and AAs who are registered with the GMC have a duty to confirm that they hold the right level and type of insurance or indemnity cover.

The type of cover that PAs and AAs have depends on:

• where they work
• whether they are employed or self-employed
• the nature of their work.

We do not keep a record of PA or AAs’ insurance or indemnity arrangements. If you have a question about a PA or AA’s insurance or indemnity, you should ask them.

I’m an employer - what do I need to know about the insurance or indemnity requirements?

PAs and AAs who are registered with the GMC, must have adequate and appropriate insurance or indemnity for their practice as an associate, by the time they begin to practise in the UK. We do not keep a record of the insurance or indemnity arrangements of individual PAs and AAs and there may be circumstances that we need to request this information from you.

The type of insurance and indemnity cover a PA or AA needs to hold depends on their individual circumstances. If you are unclear about whether a particular PA or AA should have insurance or indemnity, you should discuss this with the PA/AA first.

If you’re an NHS or HSC employer

Indemnity for PAs and/or AAs employed by your organisation will be provided by a clinical negligence scheme.

• In England, indemnity is provided through the Clinical Negligence Scheme for Trusts (CNST), which is administered by NHS Resolution.
• In Wales, indemnity is provided by Welsh Risk Pool Services.
• In Scotland, indemnity is provided by the Clinical Negligence and Other Risks Indemnity Scheme, managed by NHS National Services Scotland.
• In Northern Ireland each HSC Trust assumes the role, funded by the Department of Health.

If PAs and/or AAs in your organisation treat patients on a private basis, you should ensure that they check whether this work is covered or whether they need to arrange their own insurance or indemnity.

If you’re a private healthcare provider

You should check with the PAs and/or AAs you employ or contract, if they will be covered by the organisation’s insurance or indemnity policy or if they need to arrange their own personal insurance or indemnity.

If you’re a locum agency

If you place a PA or AA in a non-NHS or non-HSC post, or into a private or independent GP Practice you should make sure that they have adequate and appropriate insurance or indemnity in place. It may be helpful for you to confirm this information with the organisation that the PA or AA will be working for.

The statutory requirement for PAs and AAs to have insurance or indemnity

Good medical practice requires registered doctors, PAs and AAs to have insurance or indemnity in place where necessary. A registered PA or AA must have adequate and appropriate insurance or indemnity in place by the date they begin to practise as a PA or AA in the UK. This is defined as cover against liabilities that may be incurred by an individual when practising as an Associate, which is appropriate and adequate, having regard to the nature and extent of the risks of their individual practice.