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Sponsored feature: mind the gap – the introduction of state indemnity

5 April 2019

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Dr Kathryn Leask, medico-legal adviser at the Medical Defence Union, explains why MDU membership remains essential following the introduction of state-backed indemnity
On 1 April this year, state-backed indemnity for primary care work under an NHS contract was introduced in England and Wales, and practice managers may be wondering how this affects the current indemnity from their medical defence organisation.
Here, we answer key questions about the new scheme and explain why membership of the MDU or your own medical defence organisation remains essential.
Q. Is state-backed indemnity enough?

State-backed indemnity, which began on 1 April 2019, only provides indemnity for clinical negligence claims arising from primary care work under an NHS England or Wales contract.
Practice managers and general practice staff will still need expert guidance from the MDU or their own medical defence organisation with issues such as complaints handling, coroners’ inquests, criminal investigations or dealings with the media.
In the last 12 months, the MDU opened over 6,000 case files on behalf of GPs and their staff relating to matters that will not be covered by the new scheme.
The state indemnity scheme will also not cover claims arising from common practice activities such as providing medical reports and certificates and travel clinic services for practice patients.
Any work done by the practice for private patients, occupational health work, family planning or slimming clinics are also not covered by the state scheme, but can be indemnified through MDU membership. 
Q. Will all primary care staff still need access to indemnity?

Practice managers who are part of an MDU Groupcare practice will continue to get free MDU membership and access to medico-legal support alongside state-backed indemnity.
State-backed indemnity means that phlebotomists and healthcare assistants will no longer require individual membership to support them with clinical negligence claims. 
Nurses, pharmacists, paramedics and physicians associates should also have their claims dealt with by the state scheme.
However, they can nevertheless benefit from remaining in MDU membership to get support with handling complaints, representation at registration body disciplinary hearings, coroners’ investigations and criminal investigations related to their clinical practice – and to have access to 24 hour medico-legal advice. 
Practice staff who are MDU members will hear from us individually nearer their membership renewal dates with information on how state-backed indemnity affects their membership. 
Don’t leave your career exposed

The following fictitious case, based on real MDU files, shows the type of incident where practice managers will still need the expert advice their medical defence organisation can provide:
An elderly patient with chronic obstructive pulmonary disease (COPD) contacted his GP practice to request a home visit as he had had a particularly bad night. Unfortunately the new receptionist who answered the call was still unfamiliar with the telephone system and cut him off.
When he called back she told him that he was too late to request a routine home visit and she would need to arrange a call back from the emergency GP.
By the time a GP visited the patient later that day, the patient had deteriorated and the GP arranged for a hospital admission. The patient later recovered but complained about the receptionist’s attitude and failure to apologise.
A family member also posted a complaint on NHS Choices and on a local newspaper’s social media page about the way her father had been treated. The story was picked up by the local media under the headline ‘GP practice slammed after refusing appointment for seriously ill 80-year-old’.
In her role as complaints manager, the practice manager followed the practice’s established complaints procedure by acknowledging the complaint straight away and telling the patient when he could expect a response. She contacted the MDU for support on how to respond to the complaint and how to handle the media interest in the case.
With support from the MDU, the practice manager investigated the complaint by listening to a recording of the call and obtaining statements from the patient, receptionist and GP before reviewing the practice’s telephone and home visit protocols and staff training records.
The incident was discussed at a significant event meeting at the practice. Following this it was agreed that all reception staff should receive telephone skills training. In addition, the practice manager updated the practice’s home visit protocol – in consultation with the GP partners – so that reception staff had more guidance on how to triage calls. 
With the agreement of a senior partner, who was the practice’s responsible person, and support from the MDU, the practice manager wrote to the patient, summarising her investigation into the complaint and the action the practice had taken. She also told him how sorry she was for the distress caused.
Following advice from the MDU’s press office, the practice prepared a statement for the media, explaining that they were unable to comment on individual cases because of their duty of confidentiality.
They also responded to the NHS Choices review explaining that they were sorry to hear about the experience and asking the reviewer to get in touch with them so the matter could be dealt with via their complaints procedure.
The patient later called to say that while he was upset with the treatment he had received initially, he was grateful for the professional way the practice had responded to his concerns.
Find out more about MDU membership following the introduction of state-backed indemnity at