Do I need additional/different indemnity to practice as a private GP?

The legal requirement

Section 44C of the Medical Act 1983 requires every doctor with a licence to practise to have an indemnity arrangement that gives “appropriate cover” for their practice. Appropriate means appropriate to “the nature and extent of the risks” of the work. Cover that suits your NHS sessions does not automatically suit private work, which may involve different patients, settings, prescribing and procedures.

The GMC adds that your cover must be in place by the time you start practising, must cover the full scope of your practice, and must cover liabilities whenever a claim is brought, which can mean run-off cover when you stop.

What the NHS scheme covers, and what it does not

Since 1 April 2019, NHS Resolution has run the Clinical Negligence Scheme for General Practice (CNSGP) in England. It covers clinical negligence claims arising from NHS primary medical services delivered under GMS, PMS and APMS contracts, for incidents on or after that date. It covers the whole practice team, and nobody pays a subscription for it.

NHS Resolution is explicit about private work: “Any treatment you provide privately (e.g. a patient who pays you for services not provided as part of the NHS) is not covered.” Medical Protection’s guidance gives examples of work outside the state scheme, including:

• private clinic work and private online consultations
• private prescriptions
• reports, insurance forms and cremation forms
• paid travel vaccinations
• HGV and taxi medicals

CNSGP also does not cover regulatory and disciplinary matters, such as GMC investigations, or representation at inquests. NHS Resolution recommends that GPs keep cover from a medical defence organisation (MDO) or other indemnity provider for everything outside the scheme.

Across the UK

Nation	NHS GP scheme	Private work
England	CNSGP (NHS Resolution), from 1 April 2019	Not covered
Wales	General Medical Practice Indemnity (GMPI), from 1 April 2019	Not covered. Welsh Government guidance says GPs doing private work must take out their own indemnity.
Scotland	No equivalent state-backed scheme for GP contractors. The NHS scheme (CNORIS) covers health boards, not independent contractor GPs.	Arrange with your MDO
Northern Ireland	No state-backed scheme like England’s. The Department of Health has given practices dedicated funding towards indemnity costs as an interim measure.	Arrange with your MDO

What to do before you start

Speak to your indemnity provider before you do any private work, not after. The three large MDOs (MDU, Medical Protection and MDDUS) each handle private work differently. Some include certain fee-paying work in GP membership, and others offer it as an addition. Ask your own provider and get the answer in writing.

Be ready to tell them:

1. Your services. General consultations, medicals, screening, minor surgery, aesthetics, prescribing for specific conditions (for example weight management or menopause) and anything procedural. Each can change the risk and the cost.
2. How you will consult. Face to face, video, telephone or asynchronous online. Remote-only services and cross-border patients raise particular questions.
3. Your hours. Most providers price private work partly on sessions or hours a week.
4. Your setting and structure. Whether you will be employed or engaged by a clinic, work under practising privileges, or run your own service as a sole trader, partnership or company.
5. Where your patients are. Most UK cover is for UK practice. Seeing patients abroad, even by video, needs checking.

Then review your cover whenever you add a service, increase your sessions or change structure.

If you work for a clinic, or employ others

If a private clinic or online provider engages you, ask whether it has its own cover for the organisation and whether it expects you to hold personal cover as well. Most expect personal cover. Check that both policies together cover the work you will actually do.

If you set up your own service and take on other GPs, nurses or healthcare assistants, decide early whether each clinician brings their own cover or whether you arrange cover for the practice. Your organisation can also be named in claims, not only the individual clinician. Several MDOs offer corporate or group products for this.

Claims-made and occurrence-based cover

Occurrence-based cover responds to incidents that happened while you were a member, whenever the claim arrives. Claims-made cover responds to claims made while the policy is in force, so you may need run-off cover when you stop. This matters if you change provider or retire. See claims-made vs occurrence-based cover.

Costs

Private indemnity is now a real cost of private work because the NHS no longer covers GP clinical negligence for the NHS work that used to share the subscription. Costs depend on the factors above, so get quotes from more than one provider. See the costs of indemnity for private GPs and where to get private GP indemnity.

Do and don’t

• Do decide your services and structure first, then speak to your provider.
• Do keep written confirmation of what is covered.
• Don’t assume your NHS arrangements stretch to private work.
• Don’t start a new service, such as aesthetics or online prescribing, before your provider has confirmed cover for it.