Overview
The Clinical Negligence Scheme for Trusts (CNST) provides indemnity for those working in NHS trusts. The Clinical Negligence Scheme for General Practice (CNSGP) provides indemnity for GPs and others working in NHS general practice. NHS Resolution administers both schemes and more details can be found at resolution.nhs.uk. Some healthcare professionals also have indemnity cover from Medical Defence Organisations or commercial insurers.
https://resolution.nhs.uk/resources/clinical-negligence-scheme-for-trusts-cnst-rules/
In short, the CNSGP covers clinical negligence/medical malpractice, however it is recommended that all clinicians have their own indemnity cover (top up cover) for fitness to practice elements such as inquests, GMC hearings, disciplinary investigations or advice and support.
Am I covered?
https://resolution.nhs.uk/wp-content/uploads/2019/09/CNSGP-Scheme-scope-table.pdf
Clinical Negligence Scheme for General Practice (CNSGP)
On 1st April 2019, NHS Resolution launched a new state backed indemnity scheme for general practice in England called the Clinical Negligence Scheme for General Practice (CNSGP). The scheme covers clinical negligence liabilities arising in general practice in relation to incidents that occurred on or after 1 April 2019. CNSGP provides a fully comprehensive indemnity for all claims within its scope.
This removed the need for GPs (and practice staff) to arrange and fund their own clinical negligence cover.
All GPs and their staff will automatically be covered by the schemes if they are providing NHS services. No individual payments from GPs or their staff are required.
All providers of NHS primary medical services are covered under CNSGP, including out of hours providers. It covers for medical malpractice, however the recommendation is to have a top up cover to cover the fitness to practice elements not covered by the CNSGP.
The only ongoing costs for GPs and other healthcare professionals working in general practice relate to any indemnity arrangement to ensure you are adequately protected for those activities which are not covered under CNSGP, and any run off cover that is required in relation to incidents that occurred prior to 1 April 2019.
1. Who and what are covered by CNSGP?
All providers of NHS primary medical services are covered under CNSGP, including out of hours providers. The scheme extends to all GPs and others working for general practice who are carrying out activities in connection with the delivery of primary medical services – including salaried GPs, locums, students and trainees, nurses, clinical pharmacists, agency workers and other practice staff.
In addition to NHS primary medical services, any other NHS services provided by general practice are also covered under CNSGP (namely, NHS activities carried out by or for a provider whose principal activity is to provide NHS primary medical services). These ‘other’ NHS services are referred to in the regulations that establish CNSGP[1] as “ancillary health services”. This means general practices are covered for all of their NHS services, including local authority commissioned public health services.
The place at which activities are carried out, the status of the person carrying out the activity, the form of the entity responsible for the provision of the NHS services in question and the individual circumstances of the patient concerned are not relevant to the scope of CNSGP. The question is whether the services provided are NHS primary medical services, and where they are not NHS primary medical services, whether they are NHS services provided by general practice [namely, by a provider whose principal activity is to provide NHS primary medical services]. This means that different kinds of organisations are covered under the scheme for activities they carry out which are in scope of the scheme.
Claims made against GP practices or other organisations providing NHS primary medical services or ancillary health services are covered under the scheme. This includes claims made in respect of liabilities that arise as a consequence of the acts or omissions of employees and others engaged to carry out activities connected to the provision of such services.
This scheme scope table outlines types of work carried out by general practice staff and whether or not it is covered by CNSGP.
The scheme applies to any liability in tort (civil wrongdoings which include clinical negligence) that arises as a consequence of a breach of a duty of care owed by a GP contractor[2] or GP sub-contractor[3] to a third party in connection with the provision of primary medical services or ancillary health services where –
(a) An act, or omission, on the part of the GP contractor/sub-contractor (or any employee or other person engaged by them) results in personal injury or loss to the third party;
(b) The act, or omission, is in connection with the diagnosis of an illness or the provision of care or treatment to the third party; and
(c) The act or omission occurs on or after 1 April 2019.
[1] The National Health Service (Clinical Negligence Scheme for General Practice) Regulations 2019.
[2] A GP contractor is a person or organisation who holds a general medical services (GMS), personal medical services (PMS) or alternative provider medical services (APMS) contract or agreement made under Part 4 of the National Health Service Act 2006 – i.e. GP contracts.
[3] A GP sub-contractor is a person or organisation that provides primary medical services under a sub-contract with a GP contractor (i.e. a primary medical services sub-contractor. It also includes a person providing ancillary health services under a sub-contract with a GP contractor or a primary medical services sub-contractor
- Am I covered if I have a mixed practice – some of my work is NHS work and some of it is private?
All activities relating to the diagnosis of an illness or the provision of care or treatment and carried out under a general medical services (GMS), primary medical services (PMS) or alternative provider medical services (APMS) contract are covered by CNSGP. If the provision of primary medical services under such contracts is your principal activity, all of your NHS work is covered, as the activities fall within scope of the scheme.
Any activities relating to your private practice are not covered and you need to purchase suitable indemnity or insurance to cover such work.
3. How do I become a member of CNSGP and what does it cost?
You don’t need to do anything or to become a member. From 1 April 2019, all GPs and others working in general practice are automatically covered under CNSGP for liabilities arising from the provision of NHS primary medical services and ancillary health services as part of the NHS for England. You do not need to pay a subscription. The costs of the scheme are met centrally.
The only ongoing costs for GPs and other healthcare professionals working in general practice relate to any indemnity arrangement to ensure you are adequately protected for those activities which are not covered under CNSGP, and any run off cover that is required in relation to incidents that occurred prior to 1 April 2019. Please familiarise yourself with the terms of the Existing Liabilities Scheme for General Practice (ELSGP), which came into effect on 6 April 2020, when considering whether or not to purchase run-off cover.
4. Do I still need to purchase run-off cover from my MDO or insurer?
General practice staff who, for any period of time before 1 April 2019, held claims-paid or claims-made indemnity arrangements or insurance policies may need to purchase run-off or extended reporting period cover separately themselves, unless the terms of their cover specify any defined circumstances where this would not be required or they are covered under the Existing Liabilities Scheme for General Practice (ELSGP). If you are unsure of your current indemnity arrangements then you should contact your existing indemnity provider.
5. What role does my MDO/insurer have with CNSGP now in place?
In addition to retaining the management of existing claims, and being involved in any run-off cover, MDOs or other indemnity providers continue to provide their members with advice and support on all non-NHS claims issues. For example, the following circumstances do not fall within CNSGP and so will be dealt with by your MDO or other provider:
§ Non-NHS work;
§ NHS Dentistry;
§ Community pharmacy;
§ NHS Optometry;
§ Complaints (unless there is also a claim for compensation arising out of alleged clinical negligence);
§ Inquests (unless there is also a claim for compensation arising out of alleged clinical negligence, in which case NHS Resolution will work closely with your MDO or other provider when dealing with the claim for compensation);
§ Regulatory and disciplinary proceedings;
§ Employment and contractual disputes;
§ Non-clinical liabilities such as defamation.
You will need to maintain membership with an MDO or other indemnity provider in respect of activities and services not covered by CNSGP.
6. Will the Government be offering run off cover?
General practice staff who, for any period of time before 1 April 2019, held claims-paid or claims-made indemnity arrangements or insurance policies will need to purchase run-off or extended reporting period cover separately themselves to ensure that they are covered for incidents arising during the period they held such cover, unless the terms of their cover specify any defined circumstances where this would not be required. If you are unsure of your current indemnity arrangements then you should contact your existing indemnity provider.
Who do I contact about a claim after 1 April 2019?
If all of the care resulting in the claim was provided after 1 April 2019 then you should contact NHS Resolution in England or NHS Wales Shared Partnership - Legal & Risk Services.
For all other matters (medico-legal advice, complaints, GMC investigations, Coroner’s inquiries, police investigations etc) and for claims where the care in question was provided before 1 April 2019 you should contact the MDU as you did before.