The traditional setting of a GP Practice has been for some time not the only place that GPs are employed to carry out their vocation. Whether it is in Out of Hours practice, telemedicine or triaging patients in a secondary care setting, GPs are providing their services to a much wider audience.

In addition to the day job, there has always been the ethical issue of providing care in an emergency outside of the safety of a clinical environment.

In April, the new Clinical Negligence Scheme for General Practice (CNSGP) was set up to provide indemnity for healthcare practitioners delivering primary care, but how this works practically for providers of emergency care, depends on a number of factors.

Background

As ever, the starting point is to consider what is covered under CNSGP.

CNSGP covers clinical negligence liabilities arising in general practice in relation to incidents that occur on or after 1 April 2019. CNSGP will provide a fully comprehensive indemnity for all claims within its scope and all employees of the organisation to deliver the care commissioned under:

  1. A Primary Care Contract (GMS, PMS, or APMS contract or as enhanced primary care elements under Schedule 2L of the NHS Standard Contract) or its direct sub-contract; or
  2. As an ancillary health service, as defined under the scheme rules.

The key principle is that it is the contract, not the nature of the role or location which is important to establishing whether cover is provided.

Below we consider how indemnity is provided in the alternative clinical settings to that of a GP Practice and how cover is provided in respect of Good Samaritan acts and Emergency care.

NHS 111, OOH and Integrated Urgent Care

NHS 111

NHS 111 services that are provided by general practice will be covered if provided under a Primary Care Contract (GMS/PMS/APMS).

If not provided under a Primary Care Contract, the service may still be covered provided that the organisations main activity is to provide primary medical services, as an ancillary health service as defined by the scheme.

NHS 111 services not provided by general practice would normally be covered under the Clinical Negligence Scheme for Trusts (CNST).

OOH Care

If the out of hours work is carried out pursuant to a Primary Care Contract the activity will be covered by CNSGP. Often the service will be delivered under an APMS contract.

The Out of Hours period is from 6.30pm to 8am on weekdays and 24 hours a day at weekends and on bank holidays.

Integrated Urgent Care

A GP Practice providing primary care services in an urgent care centre, as an enhanced primary care element under Schedule 2L of ythe NHS Standard Contract will be covered by CNSGP.

NHS Trusts holding APMS contracts would also be covered as would a GP practicesub-contracted to deliver the urgent care services.

In all three scenarios all those carrying out activities in connection with the provision of NHS services for general practice under a Primary Care Contract, direct subcontract ot as an ancillary health service will be covered by CNSGP. This includes GPs, nurses, other healthcare professionals and non-clinical staff. The location at which the service is delivered is irrelevant.

Secondary care settings and CNST

A GP working in secondary care setting may potentially be covered by either the CNSGP scheme or the Clinical Negligence Scheme for Trusts (CNST).

Those delivering care under a Primary Care Contract will be covered by CNSGP. This could include GPs working in emergency departments, minor injuries departments, urgent care centres or NHS walk in centres.

The A&E and minor injuries services at the Trust may also be covered by the Trust’s membership of CNST. If there appears to be overlap, it is unwise to assume that you will be covered by one scheme if not covered by the other and a check should be made.

Emergency Care and Good Samaritan acts

Whether emergency treatment provided to an individual iscovered by CNSGP will depend on the circumstance and the setting. The general rule is that the provision of medical services outside of a Primary Care Contract or subcontract is not covered.

Therefore, care provided to a passer-by when off duty would not be covered. Indemnity for Good Samaritan acts is usually covered within defence organisation membership, but this should be checked.

However, emergency treatment provided to a person, within a GP’s practice areawill be covered as under the terms of a Primary Care Contract (GMS, PMS, APMS or subc-ontract) medical services must be provided to any person, including registered patients and temporary residents, in an emergency situation; limited to within core hours and within the practice area.

Additional cover required

CNSGP only covers clinical negligence liabilities. It does not provide cover for regulatory or disciplinary investigations, inquests, criminal prosecutions and private work. For these areas and any clinical negligence liabilities falling outside the scope of CNSGP practitioners will need to maintain membership with an MDO or other indemnity provider.

How we can help

Capsticks is an NHS Resolution CNSGP panel firm with a dedicated team of lawyers that has experience of handling claims against GPs and other practice staff, as well as inquests, regulatory investigations and disciplinary investigations. We also provide a range of business services to the wider GP sector. For further information on this article or any other issue concerning CNSGP, please contact Majid Hassan, Joanna Bower or Angus Hetherington.