Clinical Negligence Scheme for Coronavirus frequently asked questions
These frequently asked questions are updated regularly. Here you will find answers to a range of common questions we are often asked about our organisation and the services we deliver.
Arrangements are in place to indemnify healthcare professionals through one of the following state indemnity schemes:
a) The Clinical Negligence Scheme for Trusts (CNST), if they are engaged by an NHS trust to provide NHS services.
b) The Clinical Negligence Scheme for General Practice, if they are engaged by a GP practice to provide NHS services (i.e. a GP practice the main business of which is the provision of NHS primary medical services). This includes salaried GPs, locums, students and trainees, nurses, clinical pharmacists, agency workers and other practice staff.
During the outbreak, existing indemnity arrangements will continue to cover clinical negligence liabilities arising from the vast majority of NHS services, including staff working in a place that is not their ordinary place of work. To ensure there are no gaps in indemnity coverage, the Coronavirus Act 2020 provides additional powers to provide clinical negligence indemnity arising from NHS activities related to the Coronavirus outbreak, where there is no existing indemnity arrangement in place.
It provides cover for services directly related to coronavirus and for any backfill arrangements that may be needed, as a consequence of coronavirus, to sustain the delivery of NHS services.
We do not want indemnity to be a barrier or cause a delay to anyone assisting with the coronavirus response. We expect the vast majority of services will continue to be covered by existing indemnity arrangements. The indemnity provided under the Act provides a complementary indemnity on top of existing arrangements to ensure there are no gaps and provide reassurance to all staff who are asked to assist with the response.
All staff providing NHS services related to the coronavirus outbreak will be covered by this indemnity for clinical negligence where they are not already covered by an existing indemnity arrangement.
Where volunteers are asked by NHS trusts to help deliver NHS services, and a volunteer agreement is in place between the trust and the volunteer or volunteer organisation, then indemnity for clinical negligence will be provided under the Clinical Negligence Scheme for Trusts.
In most cases, returning healthcare professionals will be covered by one of the two existing state schemes: the Clinical Negligence Scheme for Trusts (CNST) if they return to work in an NHS trust; and the Clinical Negligence Scheme for General Practice (CNSGP) if they are engaged by a GP practice providing NHS GP services. However, in the rare instances where these or other indemnity arrangements do not apply, the indemnity provision under the Coronavirus Act will apply.
Yes, providing you are acting in the course of your employment. The key factors to consider are that healthcare professionals should at all times ensure they are competent to carry out any practice requested of them. If you are asked to work for an NHS Trust or GP practice, the existing state indemnity schemes will provide you with cover for clinical negligence arising from your activities. In the unlikely event that you are involved in the novel delivery of NHS services that fall outside the scope of these state schemes, you will be covered by the indemnity provision under the Coronavirus Act.
For details of what roles and working arrangements are in place for doctors please see details on the GMC website here, or the BMA here.
If the epidemic worsens it is likely that healthcare staff will have to work outside their normal field of practice. When deciding the safest and best course of action in the circumstances, healthcare staff should consider factors including what is within their knowledge and skills; the protection and needs of all patients they have a responsibility towards; and minimising the risk of transmission and protecting their own health.
Medical Defence Organisations (MDOs) advise that any doctor faced with clinical duties outside their clinical competence should explain their concerns clearly to someone with responsibility for providing the service to determine the safest way to proceed.
If they have done so and still feel uncomfortable, their MDO can advise them further. The GMC’s Good Medical Practice should be followed.
NMC have provided similar guidelines for Nurses and Midwives here.
The Devolved Administrations have taken an equivalent approach to England. While the existing state indemnity coverage is different in Scotland and Northern Ireland from that in England and Wales, the indemnity powers provided by the Coronavirus Act 2020 are comparable across the four nations. In all four nations staff providing NHS services related to the coronavirus outbreak will have indemnity under the Act, where they are not already covered by an existing indemnity arrangement.
Pharmacists and Pharmacy technicians working for general practice and NHS trusts are covered by state-backed indemnity schemes, and returning professionals engaged by NHS trusts or GP practices will also be covered by these schemes (irrespective of whether the services are provided in a hospital, a clinic, on GP premises, etc.):
The Clinical Negligence Scheme for Trusts (CNST), see link here for details, if they are engaged by an NHS trust to provide the NHS services.
The Clinical Negligence Scheme for General Practice (CNSGP) if they are engaged by a GP practice to provide NHS services (i.e. a GP practice, the main business of which is the provision of NHS primary medical services, see link here for details.
During the outbreak, existing indemnity arrangements will continue to cover clinical negligence liabilities arising from the vast majority of NHS services, including staff working in a place that is not their ordinary place of work. To ensure there are no gaps in indemnity coverage, the Coronavirus Act 2020 provides additional powers to provide clinical negligence indemnity arising from NHS activities related to the Coronavirus outbreak, where there is no existing indemnity arrangement in place. 5
It provides cover for services directly related to coronavirus and for any backfill arrangements that may be needed, as a consequence of coronavirus, to sustain the delivery of NHS services.
This includes any pharmacists that are requested, or volunteer, to assist with the Government’s NHS response to the Coronavirus pandemic.
Pharmacists and Pharmacy technicians are regulated health professionals and must ensure they have adequate indemnity insurance cover, either personally or through their employer. Community pharmacy contractors may also carry indemnity insurance for staff undertaking pharmaceutical services on behalf of the NHS. It is highly unlikely that professionals and staff in community pharmacy will be asked to do anything that is outside of standard NHS pharmaceutical services, so their normal indemnity insurance will cover them. As any new services are developed and introduced, we have committed to keeping the insurers updated so that they can flag any indemnity issues with us.
However, we do not want any indemnity concerns to be a barrier or delay to the response to the coronavirus outbreak. The powers taken in the Coronavirus Act 2020 allow the Secretary of State to provide indemnity for clinical negligence liabilities arising from NHS activities carried out for the purposes of dealing with, or in consequence of, the coronavirus outbreak, where there is no existing indemnity arrangement in place. Under these powers we have made provision for organisations or individuals undertaking NHS activities to respond to the coronavirus to be covered for clinical negligence in these circumstances. This includes those working in community pharmacy delivering pharmaceutical services for the NHS.
We recognise that returning doctors may also want to access medico-legal advice and support, and it is the Government’s intention to ensure this is not a barrier to their return. In Spring 2020, the Medical and Dental Defence Union of Scotland (MDDUS), the Medical Defence Union (MDU), and the Medical Protection Society (MPS) confirmed that they would provide medico-legal advice and support at no cost to their retired members who return to work on the COVID-19 response. For retired MPS and MDDUS members this was automatic. MDU asked retired members to complete a short form.
MDDUS and MPS are currently maintaining this position. MDU has written to its members to say that this no cost cover will be ending on the 30th September. Those MDU members with ongoing clinical commitments are encouraged to contact the MDU membership team to discuss their planned ongoing role and the membership options available to them.
More information for returning members is available via the respective websites of the three medical defence organisations. Please see the following:
We recognise that returning midwives may also want access to medico-legal advice and support, and it is the Government’s intention to ensure this is not a barrier to their return.
The Royal College of Midwives (RCM) has confirmed that it will extend all of the benefits of membership including Medical Malpractice Insurance (MMI) cover to any retired members who join the NMC’s emergency register for the duration of the COVID-19 outbreak.
RCM’s MMI will provide returning midwives with benefits and cover in addition to the vicarious primary liability provided by their NHE Employer, including insurance cover, legal advice and expenses and protection against claims for damages.
The terms and conditions of the RCM’s MMI are set out here.
The Royal College of Nursing has confirmed that if its student or retired members enter on to an emergency register at the NMC during the COVIS-10 outbreak, and if they need legal representation for employment or regulatory issues arising from their time on those registers, RCN will provide that representation even if their membership status remains that of student or retiree. Accordingly, there should be no barrier to them taking on new duties without any need to inform RCN, and they can be confident that the RCN will provide them with the same support as if they had a full membership. Further information can be found here.
The Pharmacists’ Defence Association (PDA) provides indemnity and legal defence costs insurance and individual representation where required to employed and self-employed pharmacists, as part of their standard wider membership offer which is entirely independent of any employer provided scheme. 7
The PDA have launched a new membership category specifically for retirees returning to practice because of the COVID-19 response at a preferential membership fee.
The Guild of Healthcare Pharmacists (GHP) recommend that, if you are a pharmacist returning to assist with the COVID-19 response, you are engaged to carry out your activities under a contractual arrangement with an NHS provider that states that indemnity will be provided for any liabilities arising from your work. The indemnity provided by the NHS provider (primary indemnity) should cover all aspects of your work for the provider. If, however, you need additional cover for anything not covered by the indemnity provided by your employer, your GHP membership with Unite the Union Contingent Medical Malpractice Cover (CMMC) will cover you for this. Unite’s CMMC comes into operation to protect you should your NHS employer’s primary indemnity not provide adequate cover, and provides cover for claims made against you (i.e. those not covered under your primary indemnity), your legal liability to pay compensation and any costs or expenses in respect of accidental personal injury.
For those returning pharmacists who are not GHP members, including registered community, academic and industrial pharmacists, GHP have negotiated a reduced rate for pharmacists to join GHP and provide you with CMMC for as long as you are employed to assist with the COVID-19 response. For further information please click here.
The Pharmacy Insurance Agency (PIA) is the main provider of professional indemnity and legal costs scheme for pharmacy technicians as part of their membership. The PIA has arranged a scheme specifically designed for those pharmacy technicians who are returning from retirement to re-register with the General Pharmaceutical Council (GPhC) to assist with the COVID-19 response. This new scheme is entirely independent of any employer-provided scheme and provides professional indemnity and legal defence costs insurance cover and is being offered at a preferential rate to returning pharmacy technicians.
Vets and veterinary nurses have been asked to assist with the COVID-19 response in a number of areas, primarily maintaining the food supply and supporting the livestock industry. However, vets and veterinary nurses generally have a broad clinical skill base and may, where they are not assisting elsewhere with the COVID-19 response, also be able to assist NHS Trusts in roles which are not reserved by law to licensed doctors or other registered professionals. 8
Vets and veterinary nurses are regulated by the RCVS and there are currently no proposals for emergency registration with other regulatory bodies such as the GMC or NMC.
NHS Trusts should ensure that any vets and veterinary nurses assisting with the COVID-19 response have clear job descriptions to satisfy themselves that they have the skills and competencies required. Where vets and veterinary nurses are working in NHS Trusts, indemnity cover will be provided under CNST for clinical negligence arising from the activities they carry out as they are being engaged to carry out NHS activities on behalf of the Trusts.
Where NHS staff are loaned/seconded to work in care homes or other social care settings to assist the delivery of social care, they should be covered by the indemnity arrangements of the care provider. All care providers are required to have insurance and suitable indemnity arrangements for the services they provide, and the care provider should provide assurance of these arrangements as part of the loan/secondment agreement.
NHS services delivered in a care home or other social care setting would be covered by the usual arrangements. For example, clinical negligence arising from NHS services provided by GPs or community trusts is covered by the Clinical Negligence Scheme for General Practice and the Clinical Negligence Scheme for Trusts, respectively. Scheme rules for CNSGP are given here and for CNST here.
Yes. CCG staff providing infection control training in care homes are covered for this activity by the CCG’s membership of the Liabilities to Third Parties Scheme run by NHS Resolution.
Yes, where you are appropriately trained and competent to undertake this activity, and you are not covered for this activity under your existing indemnity/insurance arrangements, you will be indemnified under the Clinical Negligence Scheme for Coronavirus (CNSC). The CNSC has been established by NHS Resolution to meet liabilities arising from the special healthcare arrangements being put in place in response to the coronavirus outbreak.
Antibody testing undertaken in NHS trusts will be covered under the Clinical Negligence Scheme for Trusts. Further information on the rollout of the antibody testing programme is set out in NHS England and Improvement’s letter on 25 May 2020.
Where possible, existing indemnity arrangements should cover dental nurses, including if you would usually rely on your employer’s indemnity cover rather than purchasing your own. However this cover may not extend to the urgent work that you may carry out for an NHS trust or another dental practice in a different location. If you are carrying out the urgent work for an NHS Trust in a place that is not your usual place of work, you will be covered by the Clinical Negligence Scheme for Trusts. If you are working in a high-street practice that is not your usual place of work and the work is being carried out for the owner of that high-street practice, you should in the first instance discuss with the new practice owner whether you will be covered by their indemnity policy. If this is not possible, the new Clinical Negligence Scheme for Coronavirus will cover you as a backstop.
If you are engaged by an NHS trust or a GP practice which provides NHS primary medical services, you will be indemnified under the Clinical Negligence Scheme for Trusts (CNST) or the Clinical Negligence Scheme for General Practice (CNSGP). NHS England and Improvement has also secured additional capacity through a series of contracts with independent sector hospital providers. Staff working under these contracts will be covered by CNSC.
The CNSC provides indemnity for clinical negligence liabilities arising from NHS activities carried out for the purposes of dealing with, or because of, the coronavirus outbreak. The scheme does not extend to the provision of private healthcare. If you are a healthcare worker practising in the independent sector and treating private patients, you will already have clinical negligence indemnity arrangement in place. If you intend to change your working practice you are advised to contact your indemnifier to ensure you continue to have appropriate indemnity.
Yes, providing you are acting in the course of your employment. The key factors to consider are that healthcare professionals, such as junior doctors, should at all times ensure they are competent to carry out any practice requested of them. During the outbreak, existing indemnity arrangements will continue to cover clinical negligence liabilities arising from the vast majority of NHS services, including staff working in a place that is not their ordinary place of work. In the unlikely event that existing indemnity arrangements do not apply, then the Coronavirus Act 2020 provides additional powers to provide clinical negligence indemnity arising from NHS activities related to the Coronavirus outbreak.
No. The indemnity powers in the Coronavirus Act 2020 will not be used to replace existing indemnity arrangements. The Act allows Government to provide indemnity to sit alongside existing indemnity arrangements to ensure there are no gaps in cover. This provision is designed to act as a ‘safety net’, for clinical negligence indemnity cover to be provided for NHS services related to the Coronavirus response, including any backfill arrangements that may be needed, to ensure the uninterrupted delivery of NHS services, where they are not already covered by existing indemnity arrangements.
Public health consultants returning to work for local authorities should check the cover position with the authority in question. Those returning to work for Public Health England will be covered for any clinical negligence arising from their work under state indemnity arrangements administered by NHS Resolution.
During the pandemic, clinicians including dentists continue to provide care in different ways to minimise the risk of infection. At times this has meant delaying care or providing a different standard of care. It is possible that claims will arise challenging these new practices, for example if a patient feels they were harmed by delays in seeing a dentist in person. As in usual times, dentists are expected to act in line with national protocols and are not liable for outcomes arising as a result of following those protocols. Any claims arising will be handled under the relevant indemnity arrangements as usual.
During the pandemic, dental staff have at times been asked to work at different practices. These staff will not always have their own clinical negligence indemnity arrangements, leaving the practice owner liable for their actions. If the practice owner’s existing indemnity arrangements do not cover staff they host from different practices, CNSC will provide cover for clinical negligence claims against the practice owner for actions of these staff.