This page is used with kind permission by Wessex LMCs

Indemnity Cover (April 2019)

Updated on Tuesday, 18 August 2020, 430 views

RCN Indemnity Information - links below

RCN Indemnity Scheme Information

RCN extends indemnity scheme to protect members providing paid-for travel vaccinations

In April, a new state-backed indemnity scheme for general practice (GP) staff was introduced in England. The Clinical Negligence Scheme for General Practice (CNSGP) is operated by NHS Resolution. It automatically provides cover to nursing staff working in NHS GP services. It includes self-employed workers and covers all clinical negligence claims that arise from an act (or omission to act) on the part of someone providing a GP service that is NHS-funded in England. In Wales, a similar scheme, General Medical Practice Indemnity (GMPI), was introduced at the same time.

Both schemes include travel vaccinations given in GP surgeries except for where vaccinations are paid for by the patient. The RCN is now extending its indemnity scheme to cover this gap.

This means both employed and self-employed RCN members who are providing any paid-for travel vaccinations from GP practices not included in CNSGP in England and GMPI in Wales will be covered by the RCN indemnity scheme.

As an LMC we are getting lots of contact by GP, Nurses & Practice Managers who remain confused about state backed indemnity.

In the past GPs and other clinical staff working in general practice were required to have medical indemnity cover. This cover was largely provided by the three major providers, the Medical Protection Society (MPS), the Medical Defence Union (MDU) and the Medical and Dentist Union of Scotland (MDDUS).

From 1st April 2019, NHS Resolution has been operating a new state-backed indemnity scheme for general practice in England called the Clinical Negligence Scheme for General Practice (CNSGP) and everyone working in general practice will be automatically covered in relation to NHS services.

No payments are required to benefit from the indemnity provided under the scheme and there is no formal membership or other registration requirements for either individuals or practices/organisations.

The indemnity provided under the scheme continues to apply where a GP or other person is no longer practicing or working in general practice at the time a claim is made (which can be many months, sometimes years, after the clinically negligent act or omission occurred).

The new scheme mirrors arrangements in NHS Trusts to bring significant benefits to general practice staff. NHS Resolution can already exercise discretion in relation to that scheme but rarely, if ever, does so. NHS Resolution will work hand in hand with those who find themselves the subject of a claim and only settle cases where compensation is due, while defending the rest. CNSGP is a comprehensive scheme available to all GPs whether in GMS, PMS, APMS and other settings and GPs should be confident they are fully covered just as clinicians in secondary care are

Full details of the scheme, which is being run by NHS resolution, can be found on their website at:

If you are carrying out an activity that consists of, or is in connection with, the provision of primary medical services under a GMS, PMS or APMS contract, any clinical negligence liability incurred by you which arises from that activity is covered under the scheme.

If you are carrying out an activity that is not being delivered under the above contracts, you will be covered by the scheme if the answer to all the following questions is affirmative:

Who is covered?


(Please click on the image below)

Safeguarding Reports 

The BMA have issued the following statement :-

Following further discussions on some of the finer definitions of the scope of CNSGP, we are pleased to announce that it has been agreed with DHSC and NHS Resolution that the compiling of safeguarding reports for NHS patients will now be included within scope. It was initially thought that as these reports can be chargeable under collaborative fees arrangements they should be deemed to be private work and therefore out of scope. However, lobbying from the BMA extended an alternative view of these statutory reports as being reimbursed by the system rather than a private service to patients. This perspective has been accepted by DHSC and NHSR and therefore actions originating from the completion of safeguarding reports after 1st April 2019 will be covered by CNSGP.


What activities are not covered by CNSGP?

CNSGP does not cover all general practice activities.

In addition to retaining the management of existing claims, and being involved in any run off cover, MDOs or other indemnity providers will continue to provide members with advice and support on all non-NHS claims issues. For example, the following circumstances will not fall within CNSGP and so will be dealt with by your MDO or other provider:

You will need to maintain membership with an MDO or other indemnity provider in respect of activities and services not covered by CNSGP.

So CNSGP will cover any clinical negligence liability incurred by your practice team which arises from services delivered on the NHS but it won’t provide the additional advice and guidance/support that the MDOs detail above. It is this that the MDOs are charging you for.

The MDOs have taken a view on assessing risk of a GP needing to use their services based on the types of NHS work that they are undertaking and set their new premiums accordingly. Some MDOs appear to deem minor surgery, implants , out of hours work etc as an additional risk and so are charging a premium on top of their standard rate. Other MDOs are taking a different view. GPs may wish to shop around.

Other Healthcare Professionals (ANPs, Nurses, HCAs, Paramedics etc)

We would encourage practices to clarify with their MDO what cover is included for ancillary staff that is not provided by the CNSGP.  It may be necessary for these individuals (ANP, Nurses, HCAs Paramedic's etc) to obtain cover for professional representation and additional indemnity cover for any private work they are undertaking on behalf of the practice.

Medical Defence Union

The MDU changed it cover last year from an occurrence based cover to claims based cover. This reduced the cost of cover by up to 50%. An Occurrence policy protects you from any covered incident that “occurs” during the policy period, regardless of when a claim is filed. Claims-made policies provide coverage for claims only when BOTH the alleged incident AND the resulting claim happen during the period the policy is in force.

As an LMC we had stated that MDU members would need to purchase 'run off cover' as they have changed from an occurrence based cover to a claims based cover.

The MDU have now clarified that run off is payable in the following circumstances:

if you leave the MDU before the state-backed indemnity scheme is introduced

if the state-backed indemnity scheme is introduced without picking up historic liabilities and you were to leave the MDU before the normal retirement age for your NHS pension scheme.

Otherwise there would be no need for you to purchase run off from us.

Medical Protection Society

(the following statement was written by Dr Mark Sanford-Wood the GPC lead for Indemnity)

The structure offered by the MPS falls into 2 categories:

Professional Protection(GMC representation, complaints advice etc) and

Claims Protection(cover for private work).

Under Professional Protection the website asks if you do any of the following higher risk activities and the answer in many cases will be yes.

This will add about £150 per year to the Professional Protection premium. However when it comes to Claims Protection the question is subtly different and asks if you require MPS indemnity for any of the higher risk activities. Given that CNSGP covers these as long as they are delivered for the NHS the answer in most cases should be no. This seems counter-intuitive to many and answering yes to this question has the effect of producing premiums often over £2,000. This question should be answered in the affirmative only if those activities will be carried out privately.

For most normal GPs the levels of private earning per doctor spread across all doctors in a practice will be considerably under £2,500 per year and the price range for both professional representation and private cover combined should be under £1,000 per year regardless of the MDO you join. It is only where GPs are doing significant amounts of private work requiring private indemnity outside of the CNSGP that costs should be significant.

Important links




NHS Resolution

RCN Indemnity Scheme -

Related guidance...

SGPET Weekly Update - 10 August 2020

NEWS/UPDATE BOARD - This and past updates can be found here How to manage patients with acute and chronic conditions during the...

Clinical Pharmacy Scheme

Details of phase 2 – contains guidance for applicants and black application form PCPA guidance to help practices wanting to employ a...

GP Career Plus pilot areas published

GP Career Plus pilot areas published NHS England has announced 11 areas across the country that will pilot a new scheme to keep hold of...

Childcare costs for doctors to be covered in drive to boost GP numbers

24 July 2020 General practice The NHS has launched a new scheme to encourage hundreds more doctors to return to general practice by...

RCN Foundation Professional Bursary Scheme

RCN Foundation Professional Bursary Scheme Bursaries of up to £5,000 are available for career development activities which focus on: ·...

Student nurses indemnity while they are in GP placements

Please find below a letter from NHS England regarding indemnity cover requirements for student nurses while they are in general practice...

Porter Dodson Staff Handbook and Contracts

Please find below updated contract of employment and staff handbook drafted specifically for Medical Practices. These can be used for...

Occupational Health Services for GPs

Occupational Health Services for GPs Occupational Health Services for GPs (including Needle Stick Injuries) Following the letter from...

Men ACWY for University freshers – missed cohort

A University Practice has highlighted an issue about a missed cohort of Men ACWY patients - namely patients born after 1 Sept 1997 who...

Text/SMS Messaging

Text/SMS Messaging Patients Text or SMS messaging allows practices to contact large numbers of patients within a small time frame. It...