Question in full:

In October the Royal College of Nursing (RCN) revealed it was making changes to its indemnity scheme from January 2012. Our medical defence organisation (MDO) covers our healthcare assistants and practice nurses.

Our nurse practitioners (NPs) were covered by the RCN. We have been informed by our MDO that there would be a discounted charge of £480 per annum for each NP should we wish to add them to our group policy.

This is causing a great deal of anxiety and I would be grateful if you could provide guidance as to whether practices would be obliged to cover and pay for this on behalf of their NPs, if that should be a personal cost or if we simply should not cover at all? Any advice would be welcomed.

Answer:

I am not surprised you are anxious. From the time that the RCN made their statement regarding the withdrawal of their professional indemnity cover, I have seen various articles that go from one end of the spectrum to the other: “It will not affect many practices”, “Nothing is actually changing” and “They will have all the professional cover they need because they will be covered by their GP employer’s indemnity policies”.

At present what we know is that the RCN will no longer provide indemnity cover for practice nurses as part of their membership from 1 January 2012. This in turn means that the medical defence organisations will no longer be able to recover their costs from the RCN indemnity scheme in the event of a nurse being involved in a clinical negligence case made against a practice. Basically this is a commercial decision – it is costing the RCN too much.

You have correctly highlighted the options available to your practice, as follows.

1. No cover at all
All insurance policies can seem to be an absolute waste of money. Only when you need to claim do you realize their true value. In my opinion this is a false economy and could land the practice in financial hot water. Technically the practice, which employs the nurse, is acting as its own insurer as they are vicariously liable for the actions of their employees – not a good place to be.

2. A personal outlay by the nurse
I cannot think of too many advantages apart from the nurse being able to claim the premium that he or she has to pay for the cover as a ‘trading expense’, which they will be able to offset against their income. Running a business is difficult enough without having disquiet among staff.

3. Practice to pay
This to me is the best option. The nurse will be covered by a practice policy and as such the practice will have complete control of the cover that is provided. Yes, there is a cost attached (currently regarded as a practice ‘trading expense’) but this has to be weighed up against unhappy staff.

One last point. What this is all about is ‘vicarious liability’. In simple terms it means that as an employer you have a responsibility for the actions of your staff. The decision of the RCN to remove their indemnity for practice nurses has not created this liability for employers (it was always there), but it has shifted the balance of responsibility more to the employer.

Now the employer must ensure, be it by group cover or an individual’s indemnity, that the nurses they employ have indemnity cover for clinical negligence. Nurses undertaking extended roles are seen as a greater risk exposure for indemnity providers, hence the mention of having to pay extra to cover them. The ‘option’ of simply not covering them at all is not really an option, as the liability the employer holds is still there – it’s just a case of how you close this gap that has been created.