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.
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.
All providers of NHS primary medical services will be covered under CNSGP, including out of hours providers. The scheme will extend 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 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 as “ancillary health services”. This means general practices will be 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 will be 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 will be 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 or GP sub-contractor 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.
 The National Health Service (Clinical Negligence Scheme for General Practice) Regulations 2019.
 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.
 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 will be covered by the scheme if the answer to all the following questions is affirmative:
Is it an activity that consists of, or is in connection with, the provision of NHS services?
Are those NHS services being provided by a person or organisation whose principal activities are to provide primary medical services (i.e. the NHS services are provided as part of general practice) or under a sub-contracting arrangement with such a person?
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.
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. 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 will be covered as the activities will fall within scope of the scheme.
Any activities relating to your private practice will not be covered and you will 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 CNST (Clinical Negligence Scheme for trusts). 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 will be covered by CNSGP. Any treatment you provide privately (e.g. a patient who pays you for services not provided as part of the NHS) will not be covered. It is possible, then, that some of the services you offer to an individual patient will be covered by CNSGP and some will not (and therefore you will 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 become a member. From 1 April 2019, all GPs and others working in general practice will automatically be 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 will be met centrally.
The only ongoing costs for GPs and other healthcare professionals working in general practice will 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.
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;
- The following activities, unless they are being delivered under primary medical services contracts or are NHS ancillary health services under CNSGP:
- Voluntary activities (including Good Samaritan/Good Neighbour acts) and overseas work;
- 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).
General practice staff who, for any period of time before 1st 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, 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.
In addition to retaining the management of existing claims, and being involved in any run off cover, MDOs or other indemnity providers will continue to provide their members with advice and support on all non-NHS claims issues. For example, the following circumstances will not fall within CNSGP and so will be dealt with by your MDO or other provider:
- 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 will be 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 practice 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 will be covered automatically by CNSGP. Therefore, you will 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 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.