A salaried doctor in one NHS trust has a fairly simple answer to the question of who covers them. A locum who works for three trusts, an agency and a private clinic in the same month does not. Neither does a consultant who sees private patients on Tuesday evenings in an NHS hospital's private wing. The rules differ by employer, by nation and by the type of work. Yet the GMC holds the doctor responsible for getting them right. This guide sets out how locum indemnity works, and who, if anyone, pays for your defence in a GMC investigation.
The duty is yours
Section 44C of the Medical Act 1983 applies to every licensed doctor who practises. It requires them to hold an indemnity arrangement giving appropriate cover against the liabilities of practice. The GMC's guidance says the cover must reach the full scope of your UK practice. It must also be in place before you start. The guidance also asks you to review your arrangements regularly. A review is also due whenever your scope of practice, private practice income or employment arrangements change. For a locum, that last condition arises most months.
Locum work for the NHS
The GMC confirms that an NHS body in England, Wales or Scotland has indemnity through its clinical negligence scheme. So does a Health and Social Care Trust in Northern Ireland. The GMC confirms, too, that this indemnity applies to locums. In Northern Ireland each HSC Trust carries that indemnity itself, funded by the Department of Health. The GMC still asks you to check any contract or arrangement you enter into as a locum. So get the position for your role in writing.
In general practice the position again turns on the nation.
- In England, the Clinical Negligence Scheme for General Practice covers locum GPs working under a GMS, PMS or APMS contract. It applies to incidents on or after 1 April 2019.
- For incidents on or after 1 April 2019, the General Medical Practice Indemnity scheme indemnifies GP work in Wales. A locum GP in Wales must also join the All Wales Locum Register.
- A locum GP in Scotland or Northern Ireland is outside both schemes and must arrange adequate and appropriate cover.
Medical Protection's statement of benefits gives the same advice in its own words. It says state indemnity may apply to a locum for an NHS or HSC body. It advises you to ask the organisation that engages you whether it applies to your particular role. Ask in writing, and keep the answer.
Private and independent practice
The GMC is clear about private or independent practice. If you carry out any, you must arrange adequate and appropriate cover. That holds even if the work takes place on NHS premises. It holds, too, if the work is in addition to your NHS work. Treating NHS patients privately needs a check with your NHS employer about what indemnity is in place. Some independent providers indemnify the doctors who work for them. Many will ask for proof of your own cover as a pre-employment check. Where a provider does offer cover, the GMC advises you to check that it is adequate for all your work.
Private general practice anywhere in the UK falls outside the GP schemes. So does fee-paying work done in an NHS practice. Londonwide LMCs give insurance reports, HGV medicals and medico-legal reports as examples of non-NHS work outside the English scheme. Some doctors write medico-legal reports or give expert evidence. If that work requires a licence, the GMC says you need cover for it too.
None of the state schemes defends you
Every NHS and HSC scheme, and the GP schemes, indemnify the organisation or the practice against clinical negligence claims. NHS Resolution states that the English GP scheme gives no cover for professional regulatory matters. The GMC adds that the NHS schemes will not help you individually with criminal or disciplinary investigations. Nor will they help with a GMC investigation into your fitness to practise. Our article on whether your indemnity covers a GMC investigation looks at this gap in more detail.
For a locum this matters more than for most. A concern about a single shift can lead to a GMC referral and a report from the trust. For a GP, it can also raise a question under the performers list regulations. A different organisation handles each of these.
A checklist for the itinerant doctor
- Keep a list of every organisation you have worked for in the past year. Note the dates, the nation and whether the work was NHS, HSC or private.
- For each, record in writing who provides indemnity for clinical negligence claims and whether that cover extends to locums.
- Hold your own arrangement for advice and representation in regulatory, disciplinary, inquest and criminal matters arising from your practice. You need it because no employer scheme provides it.
- Tell your provider about every type of work you do. That includes private sessions, aesthetic work, medico-legal reports and work outside the UK. Update it when that changes.
- Think about the end of your career. The GMC expects you to have cover for liabilities from your practice whenever a claim is brought. That may mean run-off cover when you stop.
The checklist works the same way for a locum nurse, pharmacist or paramedic: who indemnifies the clinical work, and who pays for representation before the NMC, the GPhC or the HCPC. Our pages for nurses and midwives, pharmacists and HCPC professionals set out what a case before each involves.
If your defence organisation has refused help, our article on what to do when your defence organisation says no sets out the next steps. Where no one will fund your defence, our page on what to do when your insurer or defence organisation will not cover you explains how Eloquia can act for you. Eloquia acts on fixed fees by stage, each stated plus VAT, and the fee includes a specialist barrister from the outset. Our fees and funding page sets out each stage.
If you cannot answer those five points for each organisation, start with the one that engaged you most recently. Then work back.
