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<\/a>The crisis in general practice is all too visible. Increasingly, we hear reports of practices being unable to recruit GPs, leading to some having to close their lists to new registrations in order to safely manage their existing patients. Other practices are closing altogether and handing back their contracts. These are the results of a decade of underfunding and a failure to prioritise general practice, which are clear for all to see.<\/span><\/p>\nHowever, what has largely been a hidden problem to most outside general practice has now come into full view. <\/span>GPs have had to cope with rapidly rising indemnity costs for many years. They now reach an average cost of around \u00a38000, after a more than 50% rise in costs between 2010 and 2016<\/a><\/span>. As this includes many doctors who are working less than full time, the average figure for a GP working nine sessions a week is significantly more, and for GPs doing out-of-hours sessions, the amount they pay is even higher. It\u2019s as if they have had to pay a personal tax for the privilege of choosing to be a GP, and year on year that growing tax bill has become increasingly unsustainable. \u00a0<\/span><\/p>\n The situation reached critical in February this year when the Lord Chancellor announced a revision to the personal injury discount rate from 2.5% to -0.75%<\/a>, which would have left medical defence organisations with no option but to significantly increase subscriptions. <\/span><\/p>\n Indemnity costs for GPs were already playing a major part in the recruitment and retention crisis we face. The substantial difference between primary and secondary care indemnity fees is a major consideration for anyone thinking about their future career options. Younger doctors are put off from becoming GPs and older ones are looking for the exit door. Even doctors in the middle of their careers wonder whether it\u2019s worth continuing when they receive their annual indemnity bill.<\/span><\/p>\n The situation is even worse for GPs doing out-of-hours and urgent care work. They’ve faced an average 20% increase in costs every year from 2010-16<\/a>. Delivering care in this riskier environment means that indemnity cover is even higher, and as a result GPs who are prepared to work during the night and at weekends are discouraged from doing so. This leaves many organisations struggling to fill rotas and patients put at risk as the services that remain are stretched too thinly.<\/span><\/p>\n As practices struggle to recruit GPs, many are turning to other healthcare professionals to work alongside them, such as pharmacists and physiotherapists. However, once again, indemnity fees are all too often thwarting these changes because the current system is designed around GPs bearing all the indemnity responsibilities and therefore all the costs. <\/span><\/p>\n All of these problems were happening before the discount rate changes, but the prospect of a doubling (or more) of indemnity rates led even the medical defence organisations to call for radical change. The current system is broken and needs fixing urgently.<\/span><\/p>\n