Does NHS indemnity cover a GMC investigation? Most doctors assume that their cover will pay for their defence if the General Medical Council opens an investigation. They assume it of the cover they buy and of the cover their employer holds for them. That assumption deserves checking before you need it. The legal duty to hold indemnity and the funding of a regulatory defence are separate things, and the difference matters most when you can least afford a surprise.
What the law requires you to hold
Section 44C of the Medical Act 1983 deals with indemnity. It requires a licensed doctor to have an indemnity arrangement in force that gives appropriate cover. The section defines appropriate cover as cover against liabilities that you may incur in practising. It takes account of the nature and extent of the risks. The arrangement can be an insurance policy, an arrangement for indemnity, or a mix of the two. If you breach the requirement, the GMC can withdraw your licence. It can also treat the breach as misconduct and refer it for investigation.
The GMC repeats the point on its insurance and indemnity page. It says you must have adequate and appropriate cover for the full scope of your practice in the UK. That cover must be in place before you begin to practise. The GMC does not keep a record of your arrangements. Instead it expects you to confirm them when a patient, employer or responsible officer asks.
Read the statutory wording closely. It concerns liabilities, meaning the compensation a patient may recover from you. But it says nothing about the cost of answering an allegation to your regulator. The GMC's own page makes the same distinction. In its words, insurance and indemnity may also give you access to personal regulatory and medico-legal support.
The first gap: state indemnity stops at clinical negligence
If you work for an NHS trust or board, a clinical negligence scheme indemnifies the organisation. In England, for example, the Clinical Negligence Scheme for Trusts does this. The Clinical Negligence Scheme for General Practice covers GPs in England who work under a GMS, PMS or APMS contract. It applies to incidents on or after 1 April 2019. NHS Resolution states plainly that the scheme covers liabilities in clinical negligence only. It gives no cover for non-clinical matters, advice or professional regulatory matters.
The GMC says the same of every NHS scheme. They will not give you individual advice or help with criminal or disciplinary investigations. Nor will they help you if the GMC investigates your fitness to practise. Londonwide LMCs list what sits outside the GP scheme. On that list are inquests, most complaints, GMC investigations, disciplinary proceedings, performers list investigations, employment disputes and criminal investigations. A salaried hospital consultant and a partner in general practice are in the same position here. The state pays the patient. It does not pay for your lawyer.
The second gap: discretionary assistance
Most doctors fill that gap through membership of a medical defence organisation. The two largest describe their model in their own documents. The MDU's member guide says it is not an insurance company. Its Board of Management may provide assistance at its discretion, under the MDU's Memorandum and Articles of Association. The same guide states that the costs of defending a GMC case can be more than £50,000. Medical Protection's statement of benefits says that all benefits of membership are discretionary. Its areas of representation include regulatory matters, disciplinary procedures, criminal allegations arising from clinical practice and inquests.
Discretion is a feature of the model, and both organisations publish examples of matters they are unlikely to assist with. Medical Protection's list includes deliberate, reckless or criminal acts and allegations of fraud. It also includes personal conduct unless it comes before your regulator, and matters that arose before your membership began. These are reasonable lines for a mutual to draw. The practical point for you is that your provider considers each request for help case by case. So you will not know the answer until you ask. If the answer is no, our article on what to do when your defence organisation says no sets out the steps that follow.
The third gap: what an insurance wording says
Some doctors hold a commercial insurance policy in place of, or alongside, membership of a defence organisation. This happens particularly in private practice, and our guide to cover for locums and private practitioners looks at that position. A policy is a contract, and it covers what its wording says. Before you rely on a policy for a regulatory case, read it closely. Find the sections on regulatory proceedings, criminal proceedings, disciplinary hearings and employment disputes. Then read the exclusions and the limit of indemnity for legal costs.
Pay particular attention to two situations. The first is a criminal investigation arising from your practice. The second is a complaint brought by one of your own employees. In both, doctors tend to assume cover without checking whether the policy responds.
What to do this week
None of this requires a crisis to sort out. I would ask you to take four steps while things are quiet.
- Find your membership certificate or policy schedule. Confirm that it reflects your current scope of practice, including any private, aesthetic, medico-legal or locum work.
- Read the published list of matters your provider is unlikely to help with. Then compare it with the work you do.
- If you are a GP in England, remember that the state scheme answers clinical negligence claims only. The GMC expects you to keep separate cover for regulatory and disciplinary matters.
- Note the notification requirement. Every provider expects early notice of anything that may lead to a request for help. Late notice is a common reason for difficulty.
If you are a nurse, dentist, pharmacist or other healthcare professional
The gap exists for other professions too. The GDC's indemnity guidance says the requirement exists so that a harmed patient can obtain compensation, and that a policy may, but need not, cover your legal costs in a fitness to practise case. In general practice the state scheme covers physician associates for clinical negligence claims, not regulatory matters. Check your own policy before you assume a case is covered. See our pages for each profession.
If your provider has refused or limited its help, our page on cover refused or limited explains how Eloquia can act for you instead, on fixed fees by stage, each stated plus VAT and including a specialist barrister from the outset.
If a GMC letter has already arrived and you are unsure where you stand, write to your provider. Ask whether it will assist, and on what terms. Keep a copy of the reply. Whatever the answer, the deadlines in the GMC's letter keep running. The first response you send often shapes everything that follows.
Sources
- GMC: Insurance, indemnity and medico-legal support for doctors
- Medical Act 1983, section 44C (indemnity arrangements)
- NHS Resolution: Clinical Negligence Scheme for General Practice
- Londonwide LMCs: CNSGP, what is in, what is out
- Medical Protection: UK medical membership statement of benefits
- MDU member guide: introduction (not an insurance company, assistance at the Board of Management's discretion), Medical Defence Union
- MDU member guide: defending you (the costs of defending a GMC case can be more than £50,000), Medical Defence Union
- GDC: Indemnity guidance
