Clinical Negligence Scheme for General Practice 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.
Please refer to our Covid-19 Vaccinations NHS Staff Indemnity – FAQs, which are available from our Covid-19 Vaccinations webpage.
For the 2021/22 flu vaccination season only, the seasonal influenza vaccination programme enhanced service specification has been updated to enable practices to vaccinate primary care contractors (primary medical services, pharmaceutical services, primary dental services or general ophthalmic services) and their frontline 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)
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.
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.
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.
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.
