Friday 17 May 2019

Indemnity in General Practice AGAIN

Back in March there were a number of queries on forums  about the Clinical Negligence Scheme for General Practice (CNSGP) in relation to the private vaccines we may give in General Practice (yellow fever, rabies, meningititis ACWY for travel purposes, tick borne encephalitits and Japanese encephalitis PLUS malaria chemoprophylaxis prescriptions.

The history

From 1st April 2019 NHS Resolution started operating a new state-backed indemnity scheme for general practice in England called the Clinical Negligence Scheme for General Practice (CNSGP).

The website describes what is and isn't covered.

It appeared at the time from enquiries to different medical defence organisations that the private travel vaccines weren't covered.  HOWEVER IT SEEMS THIS TURNS OUT NOT TO BE TRUE!

NHS Resolution have now posted a document dated MAY 2019 called the Scheme Scope document or found directly here.  It's a very useful document so please read.  

It says Travel vaccinations are covered by the CNSGP as long as these vaccinations are delivered under a GMS/PMS/APMS contract or under a sub-contract for the GMS/PMS/APMS services.  In practice, most travel vaccinations will be provided by general practice under a GMS/PMS/APMS contract. The costs of some are reimbursed to the GP practice in the usual manner under the GP contract terms but the costs of some travel vaccinations may not be reimbursable under the contract. For such vaccinations, legislation permits general practice to charge patients directly. This is still an NHS charge and an NHS service so is covered by the CNSGP. 

I think the reference to link to this would be Schedule 5 of the GMS contract from 2004 where it says 'The contractor may demand or accept a fee or other remuneration' then look at section
(g) which says 'for treatment consisting of an immunisation for which no remuneration is payable by the Primary Care Trust and which is requested in connection with travel abroad'.

This new Scheme Scope document doesn't mention malaria chemoprophylaxis but again in the Schedule 5 as above, if you look at section (l) it says  'for prescribing or providing drugs or medicines for malaria chemoprophylaxis'.

What I would say is this has been extremely confusing but I hope this is resolved now!  I've left the rest of the original blog below for information but it's still important you check out you have insurance for your nursing activities outside your NHS care as described on the NHS Resolution website - linked above!




I am currently covered for my work in a GP practice by their group practice policy (because there are a number of GPs using it, the organisation provide additional cover for their practice nurses at no extra cost), BUT making enquiries to this company I was informed that because of the new NHS scheme and that the premiums paid by GPs will be lower, there will be a charge for nurses to be added on to an indemnity policy in the future.  I was told this was approximately £525 if working up to 24 hours a week and £695 if working up to 40 hours per week.  I understand that this will happen when your policy is due up.  

Some years ago now the RCN stopped providing indemnity to practice nurses employed by GPs.  I remained in the RCN though, not only for the professional side, but their indemnity covered me for my self employed work, and other voluntary roles - see the RCN scheme. The information on their website is very helpful about this new development - see here.   Interesting to read on there that “The RCN has heard from members and non-members alike that some GP employers have told them that  they will no longer be purchasing indemnity cover from their medical defence organisations (MDOs). As a result, the MDO will no longer provide them with support for their other legal issues like employment advice, NMC referrals, inquests and many other potential legal issues - please go to the article to read more.  

My understanding is that the principles around vicarious liability for employees remain unchanged. It is not appropriate for a GP employer to try to shift that responsibility onto their employees, so if you're employed in a GP practice you should not be required to purchase your own cover because of these changes. Your employer should take responsibility for professional indemnity cover.  You will need this in addition to the Clinical Negligence Scheme for General Practice 


Monday 6 May 2019

MMR and travel

I did a blog on MMR and travel back in December 2017.  Measles risk continues not only now in Europe but in other parts of the world as well.  The latest measles data is published on the World Health Organization website here which also provides links to other information including the measles fact sheet.

Look at the latest information on measles from NaTHNaC on TravelHealthPro in relation to your travellers.

The Vaccination of individuals with uncertain or incomplete immunisation status flowchart published by Public Health England (most recent edition November 2017) has excellent guidance regarding your course of action if doses are missed, and one of the statements is ' Two doses of MMR should be given irrespective of history of measles, mumps or rubella infection and/or age'.

Dealing with people born before 1970 has historically caused a greater quandary, but while the Green Book acknowledges this cohort are more likely to have had all three natural infections and are less likely to be susceptible, it states MMR vaccine should be offered to those who request it or if they are considered to be at risk of high exposure (see page 219).

The December 2017 issue of Vaccine Update clarified that ImmForm stock can be used - the exact wording says Central MMR vaccine stock (ordered from Immform) can be used to catch-up anyone of any age – this also covers opportunistic catch-up prompted by travel.   Moreover, it says an item of service fee can be claimed manually via the CQRS MMR programme for each dose of MMR administered to patients aged 16 years or over. This includes patients born before 1970 who have no history of measles or MMR vaccination.  See page 5 of the Vaccine Update issue 273.


There was further excellent information on MMR in the July 2018 Vaccine Update (Issue no. 281) which asked if 'you were up to date with your MMR' on page 5. And the CQC wrote mythbuster no. 37 on Immunisation of healthcare staff which includes MMR.  The relevant information is as follows: Measles, mumps and rubella (MMR) is particularly important to avoid transmission to vulnerable groups. Evidence of satisfactory immunity to MMR is either:

  • a positive antibody test to measles and rubella or
  • having two doses of the MMR vaccine.
Public Health England have published new leaflets about MMR available in English, Polish, Romanian and Somali.   Order hard copy from here