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.
We are part of NHS Resolution. We support the resolution of performance concerns about individual doctors, dentists and pharmacists.
Our assessment services are aimed at clarifying and understanding the performance of individual practitioners and providing healthcare organisations and practitioners with a sound basis upon which to bring the case towards a resolution. Assessments are not an end point in themselves, but are a valuable tool to support the effective management of cases locally.
Assessments are not an investigation of the incidents which may have led to the referral to us.
The employing/contracting organisation will normally have asked for, and received, advice from us on how to manage the concern with the practitioner. As part of that process they will have been told about the assessments and other interventions available and will have then decided to request an assessment.
Requests for assessment are considered by our Intervention Consideration Group in line with our published policy and a formal decision to approve or decline the request will then be issued. We need the agreement of both the employing/contracting organisation and the practitioner before we can consider such a request.
Clinical Performance Assessment
The Covid-19 pandemic has had an impact on the delivery of these on-site assessments. If we offer one of these assessments then we will work with the parties involved to assess the feasibility of the assessment and the best method of delivery, taking into account the specific circumstances of the case.
The purpose of a Clinical Performance Assessment is to provide an independent view on the clinical performance of the practitioner, identifying both satisfactory practice and any areas of poor practice.
The assessment is intended to provide information to assist the referring organisation in decisions about the next steps in their management of the case.
Local Assessment of Clinical Performance (LACP)
We have introduced LACP’s as a response to the COVID-19 pandemic and the difficulties this has caused to our delivery of Clinical Performance Assessments. We have developed the LACP to facilitate and support NHS organisations in undertaking clinical performance assessments locally during this period.
An LACP is a bespoke tool for use by healthcare organisations to assess aspects of a practitioner’s clinical performance about which there are concerns. When completed, the LACP provides additional assurance to the practitioner’s employer/contractor about the performance of the practitioner in specific clinical domains.
Behavioural Assessment
A Behavioural Assessment provides an independent view on the behavioural characteristics of the practitioner, including any areas which require consideration.
The assessment is intended to provide information to assist the referring organisation in decisions about the next steps in their management of the case.
Clinical Performance Assessment
The assessment is carried out through a clinical assessment visit by a trained team of two clinical assessors and a Senior Assessment and Remediation Manager. It includes:
- Clinical record review: of a sample of patient records.
- Direct observation of practice: the practitioner’s normal clinical work.
- Case-based assessment: exploring clinical reasoning and decision-making about the practitioner’s own cases.
Clinical assessors will have relevant clinical experience in the practitioner’s speciality, be familiar with the standards relating to their clinical specialty and be able to apply them to assess the performance of a peer. We also ensure that they are in good standing with the relevant professional bodies and regulators.
Local Assessment of Clinical Performance
Practitioner Performance Advice drafts a framework for an LACP, based on information about the concerns relating to the clinical performance of a practitioner. It is essential that there is sufficient information to enable us to identify the clinical areas to be assessed and to define clearly the scope of the LACP. Therefore, in most cases, it will be necessary for the practitioner to complete an action plan before the LACP. The objectives in the action plan then form the basis of the LACP. (Practitioner Performance Advice can draft an action plan in these cases, if requested.)
The LACP consists of a range of tools and activities to assess the specific areas of clinical performance. The LACP is normally undertaken by clinicians who were not involved in the implementation of the action plan and are, therefore, independent of that process. The employing/contracting organisation identifies and sources the clinicians who undertake the LACP and who prepare a report with their findings.
Behavioural Assessment
The assessment includes:
- The practitioner completing three online psychometric questionnaires (the Revised NEO Personality Inventory, the Hogan Development Survey and the Motives, Values, Preferences Inventory).
- The practitioner attending an interview with a behavioural assessor (an occupational psychologist), during which the assessor asks a range of questions about the practitioner’s work, including: what they do in their job, which aspects they enjoy most and least, how they approach the different aspects and demands of their role etc. This typically lasts three to four hours. The interview is currently conducted remotely, via videoconference, in two sessions of around two to three hours each. After the first session, the psychologist usually gives initial feedback to the practitioner.
If the request for an assessment is approved then we draw up an ‘agreement to assessment’ which sets out the purpose of the assessment and explains how the assessment will be carried out. It also sets out the responsibilities of Practitioner Performance Advice, the practitioner and the employing/contracting organisation with regard to the assessment.
We will not be able to proceed with the assessment until the agreement to assessment has been signed by both the practitioner and employing/contracting organisation to confirm their commitment to the process.
Please note that if we offer a Local Assessment of Clinical Performance, the agreement to assessment (i.e. to arrange and participate in the assessment) is between the practitioner and their employing/contracting organisation.
Practitioner Performance Advice produces an assessment report which will provide the employing/contracting organisation with clear findings and conclusions about the practitioner’s level of performance (for clinical practice assessments) and with an independent view on the behavioural characteristics of the practitioner, including any areas which require consideration (behavioural assessments).
If a Local Assessment of Clinical Performance has taken place, the local assessors will produce the report. Practitioner Performance Advice is not involved in preparing the report.
We are available to offer advice and recommendations to employing/contracting organisations on next steps after the assessment. This can include asking our Professional Support and Remediation service to prepare an action plan to support a practitioner’s return to safe and effective practice (for Clinical Performance Assessments) and to help consideration of behavioural issues (for Behavioural Assessments).
We recognise that where questions have been raised about a practitioner’s work, this can be a very stressful experience for the individual concerned. We are committed to ensuring the services we offer and the way we deliver our services are sensitive to the impact on the individual about whom questions have been raised.
We always recommend that practitioners access appropriate and timely professional support through their defence organisation or other representative body. We would also encourage practitioners to draw on personal support that is available to them, for example, through friends or family.
The practitioner’s General Practitioner can also be an important source of support.
It also worth remembering that support is available through the healthcare organisation, for example, through its local occupational health and counselling services. More avenues of support may be available locally or accessed through the relevant Royal College.
Our website also contains details of organisations that may be of use to practitioners – please see the link below:
If you have any other questions please contact us on 020 7811 2600 or at nhsr.assessment@nhs.net.
For further information on our assessments, please click on the following links:
Please refer to our Covid-19 Vaccinations NHS Staff Indemnity – FAQs, which are available from our Covid-19 Vaccinations webpage.
The Clinical Negligence Scheme for Trusts (CNST) is a scheme for handling clinical negligence claims against NHS trusts.
Individual member contribution levels are influenced by a range of factors, including the type of trust, the specialties it provides and the number of “whole time equivalent” clinical staff it employs. Claims history is also taken into account meaning that members with fewer, less costly claims pay less in contributions.
When a claim is made against a member of CNST, the NHS body remains the legal defendant. However, NHS Resolution takes over full responsibility for handling the claim and meeting the associated costs.
The CNST covers all clinical claims occurring on or after 1 April 1995. If an NHS Body joined later than this date, then they are covered from the date they join the scheme.
In the first instance you should speak with your MDO. It is important to do this as soon as you become aware of your involvement or potential involvement in an inquest, so they can provide you with as much support as possible. Late notification may limit the extent of assistance that can be provided by your MDO.
NHS Resolution will only become involved if a claim is intimated or likely. If you believe that being involved in an inquest is linked to an incident that could result in a potential claim under the Clinical Negligence Scheme for General Practice or whether a matter should be reported, please contact NHS Resolution by:
1. Email – nhsr.cnsgpnotification@nhs.net
– setting out the basis of your enquiry and we will either respond by email or telephone to discuss the issue further. Do not send any documents via email as they may contain patient sensitive data. Do not include any patient sensitive data in your email.
2. Telephone – call our Claims Helpline 0800 030 6798 at any time; 24 hours a day, 365 day a year to speak to a legal advisor about any clinical negligence claims covered by CNSGP.
For guidance and background NHS Resolution has made three short films providing information on what to expect when called to an inquest. They can be viewed here.
Please refer to our Covid-19 Vaccinations NHS Staff Indemnity – FAQs, which are available from our Covid-19 Vaccinations webpage.
There is no blanket requirement for you to notify NHS Resolution of conditions placed on your licence to practice. We may however request you to provide this information where you are involved in a claim notified to us and these details are reasonably required for the purposes of enabling NHS Resolution to effectively manage the claim on your behalf in accordance with the scheme rules.
In the event details of practice conditions are provided to NHS Resolution where we have not requested this information, we will respond to make it clear that we do not need to be notified and the information will be deleted.
If you are required by your MDO or other indemnifier to report such matters, you should continue to do so.
Yes. The Enhanced Service (ES) Specification – Seasonal influenza vaccination programme 2022/23 – Version 2 has been updated to enable practices to offer their frontline patient-facing staff working in general practice a flu vaccination, effective from 1 September 2022. This covers frontline patient-facing staff who are either registered with the GP practice or not registered with the GP practice (therefore including peer to peer vaccinations), and who elect to receive their vaccination from the GP practice.
As the service is offered and provided under the terms of the seasonal influenza vaccination enhanced service specification and therefore under a primary medical services contract (GMS, PMS, APMS or Schedule 2L provisions under an NHS Standard Contract) the activity falls within the scope of the Clinical Negligence Scheme for General Practice (CNSGP)
For further information regarding the 2022/23 seasonal influenza vaccination programme, please refer to the following guidance published by NHS England:-
Enhanced service specification: seasonal influenza vaccination programme 2022/23: NHS England » Enhanced service specification: seasonal influenza vaccination programme 2022/23
Additional guidance on recording of flu vaccination events: NHS England » Seasonal Influenza Vaccination Programme enhanced service 2022/23: additional guidance on recording of flu vaccination events, payments and collaboration
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.
If the activity consists of, or is in connection with, the provision of primary medical services under a general medical services (GMS), personal medical services (PMS) or alternative provider medical services (APMS) contract, or APMS contract under schedule 2L of NHS Standard Contracts, any clinical negligence liability incurred arising from that activity is covered under the scheme.
If the activity is not being delivered under one of the above contracts, it is covered by the scheme if the answers to all the following questions are affirmative:
- Is it an activity that consists of, or is in connection with, the provision of NHS services?
- Are those NHS services being carried out by or for a provider whose principal activity is to provide NHS primary medical services (i.e. the NHS services are provided as part of general practice) or under a sub-contracting arrangement with such a provider?
- Is the activity in question connected to the diagnosis, care or treatment of a patient?
These claims will not be covered by the CNSGP as they relate to care, treatment or diagnosis before the scheme came into operation. They will need to be reported to your medical defence organisation (MDO) or other indemnity provider. Please note that your indemnity provider will be NHS Resolution where terms have been agreed with MDOs in relation to indemnity provision for their GP members under the Existing Liabilities Scheme for General Practice (ELSGP). The ELSGP currently only covers historical liabilities for those who were members of the Medical and Dental Defence Union of Scotland (MDDUS) and the Medical Protection Society (MPS) at the time of the incident in respect of which a claim is made. For further information on ELSGP and how to make a claim under it, please see here.
The part of the claim referring to the treatment and/or care occurring before 1 April 2019 will be dealt with by the relevant indemnity or insurance provider. Please note that your indemnity provider will be NHS Resolution where terms have been agreed with MDOs in relation to indemnity provision for their GP members under the Existing Liabilities Scheme for General Practice (ELSGP). The ELSGP currently only covers historical liabilities for those who were members of the Medical and Dental Defence Union of Scotland (MDDUS) and the Medical Protection Society (MPS) at the time of the incident in respect of which a claim is made. For further information on ELSGP and how to make a claim under it, please see here. CNSGP will cover the element of the treatment and/or care that occurred after 1 April 2019.
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.
If you are employed by the trust, or your contract with the trust states that the trust accepts liability for your acts/omissions, then you are likely to be covered by the Clinical Negligence Scheme for Trusts (CNST). If the services you provide for the trust are part of the NHS services provided by general practice, then you are likely to be covered by CNSGP.
Any treatment or care you provide to your patients under a GMS, PMS or APMS contract is covered by CNSGP. Any treatment you provide privately (e.g. a patient who pays you for services not provided as part of the NHS) is not covered. It is possible, then, that some of the services you offer to an individual patient are covered by CNSGP and some are not (and therefore you require additional indemnity from another provider for services not covered under CNSGP).
A key challenge for general practice has been to find a solution to the growing cost of indemnity cover. Introducing a state scheme removes the risk of rising indemnity costs from individual GPs and other healthcare practitioners (e.g. nurses and pharmacists) working in general practice. People working in general practice do not need to pay to be covered by CNSGP. CNSGP provides fully comprehensive cover for all claims within its scope.
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.
We have published separate guidance on when and how to report a claim. The guidance can be found here: CNSGP – When and how to report a claim.
Activities not covered by CNSGP include:
- Any healthcare delivered otherwise than through the NHS or local authority funded contracts for NHS public health services. This includes privately funded work undertaken by GPs and other primary care health professionals working in GP practices;
- Other non-NHS activities such as reports and medicals undertaken by GPs for other departmental bodies and insurance work, which falls outside of essential services;
- NHS primary care dentistry and private practice dentistry, other forms of privately-funded primary healthcare, community pharmacy and optometry;
- Medico-legal services (other than those directly relating to clinical negligence claims), such as representation at inquests or in relation to professional regulation matters;
- Claims for breach of confidentiality (due to wrongful disclosure of personal data) causing personal distress only. (See NHS (CNSGP) Regulations Section 5(1)(a) ).
- The following activities, unless they are being delivered under primary medical services contracts or are NHS ancillary health services under CNSGP:
1. Voluntary activities (including Good Samaritan/Good Neighbour acts) and overseas work;
2. Healthcare commissioned and provided by the Ministry of Defence; and GPs engaged by the Department for Work and Pensions (DWP) (except for completion of DWP forms required under a GMS contract which are in scope and therefore covered).
Please refer to the Scheme Scope document for detailed guidance on what falls within and without the scope of CNSGP.
Some primary care practitioners are required to purchase run off cover because they had non-occurrence based indemnity arrangements to cover clinical negligence claims arising from incidents before 1 April 2019. This only applies to primary care practitioners who had a claims-paid or claims-made indemnity arrangement or insurance policy at the time the incident occurred. It does not apply to MPS members or to MDDUS members who had an occurrence-based membership arrangement.
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.
CNSGP provides cover on an occurrence based arrangement only, which means you are covered for any clinical negligence claim arising from an incident that occurred on or after 1 April 2019 – even where you have retired or ceased to work in general practice.
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 and others working in general practice whether in GMS, PMS, APMS and other settings and GPs and general practice staff should be confident they are fully covered just as clinicians in secondary care are.
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.
Any clinical negligence liabilities arising from an act or omission occurring on or after 1 April 2019 are covered automatically by CNSGP. Therefore, you do not need separate cover for these liabilities. You can contact your MDO or indemnity provider to discuss any appropriate rebate of fees already paid.
The arrangements agreed are in respect of the historical NHS clinical negligence liabilities of the Medical Dental Defence Union of Scotland’s (MDDUS) English GP members arising from incidents occurring before 1 April 2019.
NHS Resolution will have oversight of the arrangements which include the MDDUS continuing to handle claims for an interim period.
Please see links to statements published by the Department of Health and Social Care (DHSC) and the MDDUS.
No. The Medical Dental Defence Union of Scotland (MDDUS) will continue to manage the claim on your behalf. You should continue to liaise with the case handler at MDDUS should you have any queries.
If you receive a claim that relates to NHS treatment provided before 1 April 2019 and you are an existing or previous member of the MDDUS and/or the MPS, then you should report the matter to NHS Resolution via: elsgpnotifications@resolution.nhs.uk . If you are not/have not been a member of the MDDUS and/or the MPS, then please liaise with your MDO or other indemnity provider.
In this case you should report the claim to both the Medical Dental Defence Union of Scotland (MDDUS) and NHS Resolution under the Clinical Negligence Scheme for General Practice (CNSGP).
Your medical indemnity provider will manage the part of the case, which relates to treatment and/or care provided prior to 1 April 2019 under the arrangements for historic liabilities now agreed between the Department of Health and Social Care (DHSC) and the MDDUS, whilst CNSGP will cover the element of treatment and/or care that occurred after 1 April 2019.
NHS Resolution is an arm’s length body of the Department of Health and Social Care. Our purpose is to provide expertise to the NHS on resolving concerns fairly, sharing learning for improvement and preserving resources for patient care.
If you have an ongoing case, you should have details of your dedicated case handler who can talk to you about any aspect of your case. NHS Resolution’s GP indemnity team has a wealth of expertise in managing clinical negligence claims across both primary and secondary care. NHS Resolution will instruct lawyers from its approved panel, all of whom are highly skilled and experienced in managing clinical negligence claims. If lawyers have been instructed to manage the claim on your behalf they will be your best first point of contact.
For any general queries, please contact NHS Resolution by:
1. Email – ELSGPnotifications@resolution.nhs.uk
– setting out the basis of your enquiry and we will either respond by email or telephone to discuss the issue further. Do not send any documents via email as they may contain patient sensitive data. Do not include any patient sensitive data in your email.
2. Telephone – call our Claims Helpline 0800 030 6798 at any time; 24 hours a day, 365 day a year to speak to a legal advisor about any clinical negligence claims covered by ELSGP, but not medico-legal matters, which will be handled by your MDO (or any other provider).
NHS Resolution’s aim is to help you to resolve any claim for compensation brought against you by a patient in relation to their clinical care under the NHS as fairly and as quickly as possible. Claims will be investigated thoroughly and compensation will be paid where our investigation confirms that this is due. We will seek your agreement to make admissions of liability, which mirrors our approach across all indemnity schemes operated by NHS Resolution (including the Clinical Negligence Scheme for General Practice and the Clinical Negligence Scheme for Trusts). Where appropriate we will defend the case on your behalf, calling upon the very best expertise to do so. In all cases, we will do all that we can to keep the matter out of formal court proceedings.
In the first instance you should speak with your MDO. It is important to do this as soon as you become aware of your involvement or potential involvement in an inquest, so they can provide you with as much support as possible. Late notification may limit the extent of assistance that can be provided by your MDO.
NHS Resolution will only become involved if a claim is intimated or likely. If you believe that being involved in an inquest is linked to an incident that could result in a potential claim under the Existing Liabilities Scheme for General Practice or whether a matter should be reported, please contact NHS Resolution by:
1. Email – nhsr.elsgpnotifications@nhs.net
– setting out the basis of your enquiry and we will either respond by email or telephone to discuss the issue further. Do not send any documents via email as they may contain patient sensitive data. Do not include any patient sensitive data in your email.
2. Telephone – call our Claims Helpline 0800 030 6798 at any time; 24 hours a day, 365 day a year to speak to a legal advisor about any clinical negligence claims covered by ELSGP and not medico-legal matters that will be handled by your MDO (or any other provider).
For guidance and background NHS Resolution has made three short films providing information on what to expect when called to an inquest. They can be viewed here.
No. The ELSGP (and the CNSGP) provides unlimited and comprehensive clinical negligence cover for the care, diagnosis and treatment of NHS patients. All compensation costs and legal costs will be met by NHS Resolution on your behalf, subject to compliance with scheme rules.
All providers of NHS primary medical services who were members of the MDDUS or MPS at the time that an incident occurred giving rise to an historic liability, and any practice staff working for the MDDUS or MPS member at the time of that incident, are covered under the ELSGP. This includes out of hours providers.
In addition to NHS primary medical services, any other NHS services provided by or for general practice are also covered under ELSGP (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 as “ancillary health services”.
Those providers whose cover is with a medical defence organisation (MDO) other than the MDDUS or the MPS, are not currently covered by ELSGP and should continue to liaise with their MDO.
As above, ELSGP covers all providers of NHS primary medical services (and, in some instances, providers of NHS ancillary healthcare that was provided as part of, or for, general practice) who were members of the MDDUS or MPS at the time that an incident occurred giving rise to an historic liability, and any practice staff working for the MDDUS or MPS member at the time of that incident. This includes out of hours providers.
No other agreements with medical defence organisations or indemnity providers are in place. For now, non-MDDUS and non-MPS members should continue to liaise with their MDO or indemnity provider in the usual way.
The ELSGP is not a membership scheme. Individuals do not need to pay for ELSGP. If you have an ongoing claim that MDDUS is handling and which relates to an incident that occurred during your period of membership with MDDUS, then NHS Resolution, which is administering ELSGP on behalf of the Secretary of State for Health and Social Care from 6 April 2020 will, in the first instance, also be responsible for claims handling.
Some primary care practitioners are required to purchase run off cover because they had non-occurrence based indemnity arrangements to cover clinical negligence claims arising from incidents before 1 April 2019.
This only applies to primary care practitioners who had a claims-paid or claims-made indemnity arrangement or insurance policy at the time the incident occurred. It does not apply to MPS members or to MDDUS members who had an occurrence-based membership arrangement.
A claim is a formal request for compensation as a result of something that has gone wrong in relation to a patient’s healthcare. It should be made in writing and can come directly from the patient or a family member, or from their lawyer or representative.
The claims process is separate from a complaint or other investigation, although the same set of facts can give rise to both. Where a case includes multiple issues, such as an inquest and/or General Medical Council (GMC) proceedings, we will work closely with your medical defence organisation/indemnity provider to ensure that they are managed in a consistent manner.
Irrespective of whether a claim has been brought or is likely, it is extremely important that you are open and transparent with the patient and spend time with them to explain what has happened.
If their care was not as it should have been, you should apologise. An apology is not an admission of liability and should always be offered when something has gone wrong. Our guidance, “Saying Sorry”, is available here.
NHS Resolution’s aim is to help you to resolve any claim for compensation brought against you by a patient in relation to their clinical care under the NHS as fairly and as quickly as possible. Claims will be investigated thoroughly and compensation will be paid where our investigation confirms that this is due. Where that is not the case, we will defend the case on your behalf, calling upon the very best expertise to do so.
If you are an MDDUS member with an existing claim which was being handled by MDDUS prior to 6 April 2020, you do not need to re-notify this to NHS Resolution. The transfer of your claim has been handled directly between NHS Resolution and MDDUS.
If you receive a Letter of Notification or Letter of Claim (which are the two different pre-action documents which commence a claim) it is important that you contact NHS Resolution as early as possible as this will give us the best possible opportunity to protect your position and ensure that deadlines are met. You can find further details here.
It may also be appropriate to notify us of any incidents where a formal claim has not been commenced but is likely to be. Further details on what kind of incidents may be high risk for a claim are here. If you are not sure whether an incident should be reported you can contact NHS Resolution for advice.
Bear in mind NHS Resolution indemnity schemes do not cover any private (non-NHS work), nor activities outside of the scheme scope. If in doubt, you should discuss the particular circumstances or issue with your MDO or other indemnity provider or contact NHS Resolution.
If you have any concerns regarding whether a claim falls within ELSGP or whether a matter should be reported, please contact NHS Resolution by:
1. Email – ELSGPnotifications@resolution.nhs.uk – setting out the basis of your enquiry and we will either respond by email or telephone to discuss the issue further. Do not send any documents via email as they may contain patient sensitive data. Do not include any patient sensitive data in your email.
2. Telephone – call our Claims Helpline 0800 030 6798 at any time; 24 hours a day, 365 day a year to speak to a legal advisor about any clinical negligence claims covered by ELSGP and not medico-legal matters that will be handled by your MDO (or another provider).
It is essential when reporting a claim to NHS Resolution and providing documents that you do so securely to ensure that personal data (including but not restricted to that of a patient) is protected. When reporting a claim to NHS Resolution, complete the Claim Notification Form once it has been sent to you, and, where available, send us the following documents:
1. The section of the patient’s GP records which relates to the period of treatment which is the subject of the claim.
2. Letter of Notification or Letter of Claim or some other request for compensation from the patient or their solicitors;
3. Claim Form, Particulars of Claim – court documents commencing a clinical negligence claim;
4. All correspondence with the patient or their solicitors;
5. All correspondence relating to any complaint that may have been made by the patient;
6. Written comments, witness statements and reports you may have previously prepared, for example in preparation for a complaint response, inquest or regulatory hearing that relates to the relevant incident that is, or may be, the subject of a claim;
7. Any independent expert evidence that may have previously been obtained, for example in preparation for an inquest or regulatory hearing (if provided to you by your MDO);
8. Notes or associated documents from any inquest, including the details of the Coroner’s conclusion (if provided to you by your MDO); and
9. Any Serious Incident Investigation Report or any other report into a patient safety incident.
10. In addition, to the documents listed 2 – 9 above please provide details of any other legal or regulatory process relating to the same incident the subject of this notification to NHS Resolution, previously notified and managed by the MDDUS on your behalf.
The documents listed 2 – 9 above should not be included in a patient’s GP notes and should be kept separately. Where material, such as expert reports or witness statements, has been prepared in order to assist your personal defence in respect of another legal or regulatory process then you should discuss with your MDO or legal team before disclosing it to us.
These claims reporting guidelines will help beneficiaries of the Existing Liabilities Scheme for General Practice know when and how to report a claim.
NHS Resolution does not cover GMC inquiries and representation. You are advised to discuss circumstances with your MDO. If you believe that being reported to the GMC is linked to an incident that could result in a potential claim under the Existing Liabilities Scheme for General Practice or whether a matter should be reported, please contact NHS Resolution by:
1. Email – ELSGPnotifications@resolution.nhs.uk
– setting out the basis of your enquiry and we will either respond by email or telephone to discuss the issue further. Do not send any documents via email as they may contain patient sensitive data. Do not include any patient sensitive data in your email.
2. Telephone – call our Claims Helpline 0800 030 6798 at any time; 24 hours a day, 365 day a year to speak to a legal advisor about any clinical negligence claims covered by ELSGP and not medico-legal matters that will be handled by your MDO (or any other provider).
If you have any concerns regarding whether a claim falls within ELSGP or whether a matter should be reported, please contact NHS Resolution by:
1. Email – ELSGPnotifications@resolution.nhs.uk
– setting out the basis of your enquiry and we will either respond by email or telephone to discuss the issue further. Do not send any documents via email as they may contain patient sensitive data. Do not include any patient sensitive data in your email.
2. Telephone – call our Claims Helpline 0800 030 6798 at any time; 24 hours a day, 365 day a year to speak to a legal advisor about any clinical negligence claims covered by ELSGP and not medico-legal matters that will be handled by your MDO (or any other provider).
In summary, NHS resolution will be responsible for managing any claims for clinical negligence on your behalf. This will include:
- Carrying out investigations, including collation of documents, comments from those involved, preparing statements and obtaining evidence from independent experts;
- Providing advice on process, the legal framework and whether and acceptance of liability will be needed
- Managing the compensation, including an assessment of the value of the claim, whether any other parties should share responsibility and conducting negotiations and arranging for payments to be made
NHS Resolution will not be able to help with inquest and regulatory processes for which you should speak with your MDO.
Yes. For any ongoing cases, NHS Resolution will be in touch with you on how your cases will be managed and what you can expect from us.
For any new cases, shortly after notification, you will be provided with details on what to expect from the claims process and NHS Resolution.
Very little should change. If you have an ongoing claim being managed by the MDDUS in house lawyers then you will be given a new legal team and we explain more below.
If your claim has been handled to date by the MDDUS in house lawyers then you will be provided with a new legal team. This will consist of an NHS Resolution case handler and maybe also lawyers instructed on NHS Resolution’s behalf. NHS Resolution’s GP indemnity team has a wealth of expertise in managing clinical claim negligence claims in both primary and secondary care. NHS Resolution will instruct lawyers from its approved panel, all of whom are highly skilled and experienced in managing clinical negligence claims. NHS Resolution will be in contact to provide contact details by mid-April 2020.
If you are an MDDUS member with an existing claim which has been handled by lawyers outside of MDDUS you will continue to be supported by the same legal team. These lawyers will manage the claim in the same way, with the only change being that they will provide advice to and take instructions from NHS Resolution in place of the MDDUS. You will also be advised who your contact will be at NHS Resolution should you need to contact them, although day to day contact will remain with your lawyers.
NHS Resolution is a Special Health Authority with responsibility for providing indemnity in relation to clinical negligence claims against the NHS in England. Processing and storage of information is in accordance with our responsibilities under the General Data Protection Regulation and the Data Protection Act 2018. To learn more about how NHS Resolution will collect and use claims management data, please see our privacy policy here.
The Risk Pooling Schemes for Trusts (RPST) is the collective name for two separate schemes covering non-clinical risks, the Liabilities to Third Parties Scheme (LTPS) and the Property Expenses Scheme (PES).
The Liabilities to Third Parties Scheme (LTPS) typically covers employers’ and public liability claims from NHS staff, patients and members of the public. These range from straightforward slips and trips to serious workplace manual handling, bullying and stress claims. LTPS covers claims arising from breaches of the Human Rights Act, the Data Protection Act and the Defective Premises Act, as well as defamation, unlawful detention and professional negligence claims.
The Property Expenses Scheme (PES) covers “first party” losses for material damage to buildings and contents from a variety of causes, including fire, theft and water damage. PES also offers business interruption expense cover arising from property damage.
Coverage from both schemes within the RPST began on 1 April 1999. However, if an NHS organisation joined later than this date then they are covered from the day they joined.
The RPST schemes are funded by contributions from members and contributions are calculated on an annual basis using actuarial techniques, including the member’s previous claims experience.
NHS organisations may join either or both schemes with the RPST.
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.
For further information please click here.
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.
For further information please click here.
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.
