The introduction of the Clinical Negligence Scheme for General Practice (CNSGP) in 2019 was supposed to simplify GP indemnity. In many ways it did — NHS-funded clinical negligence cover for GP practices, paid for centrally, removing the need for individual GPs to fund their own indemnity for core NHS work.
But the picture is more nuanced than "the state covers you now." Understanding what CNSGP covers, what it doesn't, and when you still need separate indemnity from an MDO (Medical Defence Organisation) is essential for every working GP — and getting it wrong can leave you personally exposed.
What CNSGP covers
CNSGP covers clinical negligence claims arising from NHS primary medical services provided by GP practices in England. This means:
- Consultations, examinations, and treatments provided under the GMS, PMS, or APMS contract
- Work done by GPs, nurses, pharmacists, and other practice staff within their NHS roles
- Out-of-hours work if it's provided under an NHS contract (e.g., through a commissioned OOH provider)
The cover is occurrence-based (it covers incidents that happen during the period of cover, regardless of when the claim is made) and is funded centrally by NHS Resolution. Practices don't pay premiums — it's included in the baseline funding.
For a salaried GP doing purely NHS work within a practice, CNSGP generally provides comprehensive clinical negligence cover for their day-to-day role.
What CNSGP does not cover
This is where GPs get caught out:
Private work. Any clinical work outside the NHS contract — private consultations, insurance medicals, occupational health, cosmetic procedures, medicolegal reports — is not covered by CNSGP. If you do any private work, you need separate indemnity.
Work outside England. CNSGP is England-only. GPs working in Scotland, Wales, or Northern Ireland have different arrangements and typically still need MDO membership for clinical negligence cover.
Non-clinical complaints and regulatory proceedings. CNSGP covers clinical negligence claims (i.e., legal proceedings alleging harm). It does not cover: GMC fitness-to-practise proceedings, CQC investigations, inquests (coroner's court), criminal investigations, disciplinary proceedings, or complaints to the Parliamentary and Health Service Ombudsman. For representation and support in these situations, you need MDO membership.
Good Samaritan acts. If you provide emergency medical care outside your NHS role (roadside accident, collapsed passenger on a plane), this is not covered by CNSGP. MDOs typically cover this under their membership terms.
Locum-specific considerations. Locum GPs are covered by CNSGP while working in a practice under its NHS contract — but the cover attaches to the practice, not the individual. If a claim arises after you've left and the practice can't be reached (closed, dissolved), there can be ambiguity about cover. Most locum GPs maintain MDO membership as a safety net.
MDU vs MPS vs others: what's the difference?
The two dominant Medical Defence Organisations for GPs are the Medical Defence Union (MDU) and the Medical Protection Society (MPS). Both are mutual organisations (not insurers — an important legal distinction) that provide:
- Advisory support for complaints, GMC referrals, and inquests
- Legal representation for regulatory proceedings
- Clinical negligence cover for private work (as a benefit of membership, not a contractual guarantee — this is the key difference from insurance)
- Indemnity for Good Samaritan acts
- Access to confidential advisory helplines
The critical point: MDO membership is discretionary assistance, not insurance. Both MDU and MPS reserve the right to decline assistance on a case-by-case basis. In practice, they almost always provide support to members in good standing, but the legal structure means there is no contractual guarantee of cover. This distinction has caused controversy but remains the operating model.
Cost: Annual subscriptions vary by role, sessions, and scope of practice. For a GP doing NHS work only (where CNSGP covers clinical negligence), MDO subscriptions are significantly reduced compared to pre-CNSGP levels — typically £1,000–3,000/year depending on membership tier and whether private work is included. For GPs with significant private work, subscriptions can be substantially higher.
Other providers: Smaller providers like MDDUS (Medical and Dental Defence Union of Scotland — also available in England), Medical Protection (a separate entity from MPS), and specialist insurance-backed products exist. Some GPs have moved to insurance-based indemnity products that offer contractual cover rather than discretionary assistance. These are regulated by the FCA and offer legal certainty, but may have policy exclusions that MDO membership wouldn't.
What you actually need by role
Salaried GP (NHS only): CNSGP covers your clinical negligence. MDO membership is strongly recommended for GMC, complaint, and inquest support. Cost is modest.
GP Partner (NHS only): Same as salaried, plus you carry business liability. CNSGP covers clinical negligence. MDO membership covers the regulatory and complaint dimensions. Consider whether your partnership agreement addresses indemnity obligations clearly.
Locum GP (NHS only): CNSGP covers you while working in NHS practices. MDO membership provides continuity of cover, advisory services, and a safety net for any ambiguity about retrospective cover. Essentially non-negotiable for locums.
GP doing private work: CNSGP does not cover this. You need either MDO membership with private work cover, or a separate insurance-backed indemnity product. Check the scope carefully — some MDO tiers exclude specific private activities (cosmetic, occupational health, medicolegal).
GP doing OOH: If the OOH work is under an NHS contract, CNSGP covers clinical negligence. If it's private (e.g., deputising for a private OOH company), you need separate cover. Clarify the contractual basis with the provider before starting.
Portfolio GP: Your indemnity needs are the sum of your activities. Map each role (NHS clinical, private clinical, educational, medicolegal) and ensure each is covered. This often means MDO membership at a tier that covers diverse activities.
The practical advice
Check your cover annually. Your working pattern changes, your indemnity should change with it. Don't assume that because you were covered last year, you're covered for what you're doing this year.
Keep records of your NHS work. If a claim arises years later, being able to demonstrate you were working under an NHS contract at the time ensures CNSGP applies.
Don't drop MDO membership entirely just because CNSGP covers clinical negligence. The advisory and regulatory support services are the most valuable part of membership — and you never know when you'll need them until you do.
If you're unsure about your cover for a specific activity, call your MDO before you do it, not after something goes wrong.
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