Figures show that indemnity fees for scheduled care have risen to approximately £8000 per GP per annum, an increase of more than 50% over the last 6 years. However, this means that for many GPs working full-time, indemnity bills are significantly more – and for GPs providing out-of-hours sessions the amount they pay is even higher. The sharp fall in the personal injury discount rate announced by the Lord Chancellor in February 2017, will mean that settlements for personal injury compensation claims will significantly increase. Without direct government intervention, indemnity premiums could potentially double to protect against these increases, and have catastrophic consequences for the workforce in general practice.
A decade of underfunding and a repeated government failure to prioritise general practice has resulted in a workforce crisis. With financial pressure across primary care already at an all-time high, the unsustainable rise in indemnity costs are forcing GPs to restrict their working hours, limiting their ability to work in urgent care and out of hours settings, and in many cases drive experienced GPs into early retirement.
It is also restricting practices’ ability to recruit new GPs, or other healthcare professionals within localities, and is impacting on the expansion of the multidisciplinary workforce as the financial burden of providing indemnity cover for other healthcare professionals often falls on the practice or individual GP partners. In addition, the significant differential between primary and secondary care indemnity fees is pushing much needed potential future GPs away from a career in general practice.
- Government must ensure a swift roll out of a sustainable long-term, state backed indemnity package for general practice that provides coverage for all GPs and practice staff providing NHS and state commissioned services, including NHS urgent care and out of hours services.
- Ensure parity of indemnity fees between doctors in general practice and secondary care
- Government must commit to providing a winter indemnity package for 2018/19, whilst negotiations for the state backed indemnity scheme are being finalised
Outcome for patients
It is clear that the quality and safety of patient care in general practice in England is under threat from rising workload pressures. A new indemnity system for primary care that is comparable and equitable with secondary care, and removes this huge cost burden from GPs would help reduce these pressures by enticing more GPs to stay in the workforce, thereby making the profession more attractive to future doctors, and in doing so directly impact on and improve patient care.
Next: Manage workload
Saving general practice
With an insufficient workforce, a funding plan that is no longer sustainable, a growth in population and a sea-change in the level of complex cases being presented, urgent steps need to be taken to save general practice.