About this consultation
1. We are consulting on changes to the Licence to Practise and Revalidation Regulations 2012 which will:
a) enable the Registrar to ask for information about a doctor’s professional indemnity arrangements
b) enable the Registrar to withdraw a doctor’s licence to practise if they don’t provide the information when requested or if they have failed to obtain, or maintain, an indemnity arrangement which provides appropriate cover
c) confirm the change we have made to the declaration section of new applications for registration with a licence to practise and restoration of a licence to practise, to include a statement about professional insurance and indemnity.
2. This consultation asks for your views on the changes to the regulations.
3. The consultation runs from 15 October 2014 to 10 December 2014.
Why should the consultation matter to you?
4. If you are thinking of applying for registration with a licence to practise for the first time (or restoring your licence to practise) with the GMC – this consultation confirms the change we have made to the declaration section of new applications for registration with a licence to practise and restoration of a licence to practise, to include a statement about professional insurance and indemnity.
5. If you are already registered with a licence to practise – you should already be aware that Good medical practice places a duty on you to have professional indemnity or insurance arrangements in place. The new regulations will give us powers to request information about a doctor’s insurance and indemnity arrangements and to withdraw a doctor’s licence to practise if they don’t provide the information when requested or if they have failed to obtain or maintain an indemnity arrangement which provides appropriate cover.
6. Employers and contractors of doctors’ services – this consultation explains the changes to the Licence to Practise and Revalidation Regulations 2012 relating to professional indemnity arrangements and the impact this will have on doctors who work with you.
Background
10. There is currently no statutory requirement for doctors to have professional indemnity or insurance arrangements in place to provide cover for liabilities incurred in their practice. However, Good medical practice places a professional duty on doctors to do so. Paragraph 63 states ‘You must make sure that you have adequate insurance or indemnity cover so that your patients will not be disadvantaged if they make a claim about the clinical care you have provided in the UK.’ The duties of a doctor set out in Good medical practice apply to all doctors registered with the GMC, whether or not they hold a licence to practise.
11. An independent review group was commissioned by the Department of Health in 2009 to look at the issue of insurance and indemnity. It reported in 2010 and recommended that making insurance or indemnity a statutory condition for access to the profession is the most cost effective and proportionate way of ensuring that all healthcare professionals have adequate insurance or indemnity cover.
12. The report also recommended that there should be a review of all existing legislation in this area and that the relevant legislation should be harmonised across healthcare professional regulators. It also recommended that within that framework it should be for each healthcare regulator to decide how best to exercise its powers.
13. The Department of Health has drafted and Parliament has now passed a new Health Care and Associated Professions (Indemnity Arrangements) Order 2013, which implements the recommendations of the independent review group and creates a new S44C of the Medical Act 1983.
The new S44C of the Medical Act 1983
14. This provides the GMC with powers to make regulations to:
a) request information from or in relation to a licensed doctor or a doctor seeking a licence to practise to demonstrate that they have appropriate cover under an indemnity arrangement*, or will have appropriate cover†, by the time they begin to practise
b) require a doctor to inform us if they cease to have appropriate cover
c) require a doctor to inform us if they have appropriate cover provided by their employer.
15. Additionally the new S44C will enable us to refuse to grant a licence to practise where a doctor fails or refuses to comply with these requirements.
16. In determining our proposed approach, we have taken account of the fact that having adequate indemnity or insurance cover is a long-standing professional duty for doctors. Also, in contrast with some healthcare professions, a large majority of doctors will already have such cover as a result of their employment.
17. We are proposing the following.
- All new applications for registration with a licence to practise and restoration of a licence to practise will include a statement about professional insurance and indemnity. This will be a mandatory tick box as part of the final declaration, and will be a required field in order to submit the application.
- This will require the applicant to declare: ‘I have in place, or will have in place, at the point at which I practise in the UK, insurance or indemnity arrangements appropriate to the areas of my practice’.
18. The new declaration has already been introduced as part of planned operational changes in August 2014. We don’t need to rely on changes to the Licence to Practise and Revalidation Regulations 2012 in order to introduce the declaration. This is because there is already a duty on doctors to have indemnity arrangements in place. Failure to comply with this duty may result in a referral for consideration by the GMC’s Fitness to Practise directorate.
19. The changes to our regulations will reinforce the duty set out in paragraph 63 of Good medical practice and make it a statutory requirement. These proposals mean that:
d) there will be a requirement to include the declaration in the application for a licence in order for it to be complete
e) we will have the power to request information from the practitioner or another party to satisfy ourselves that declarations are accurate or otherwise to determine whether the practitioner has appropriate cover in place
f) we will have the power to require a licensed practitioner to inform us if they have appropriate cover provided under an indemnity arrangement by an employer and to inform us if their indemnity cover ceases
g) we will have the ability to refuse to grant or to withdraw a licence for failure to have appropriate cover or to comply with our requirements to provide the declaration or any further information.
On implementing the proposals we will issue a notification to all registered doctors to remind them of their statutory duty. We do not plan to ask for ongoing declarations or information about indemnity arrangements on a routine basis. However we will include a provision in the regulations to enable us to request evidence or information as and when we require it.
20. We do not currently (and do not propose to) review or endorse specific indemnity providers or arrangements. We currently provide guidance for doctors on insurance and indemnity for doctors here, for patients here and you can find information about medico-legal support here. This guidance will be reviewed as part of the consultation and a revised version will be published when we implement the proposed changes.
Draft amendments to the Licence to Practise and Revalidation Regulations 2012
We are planning to amend the existing licence to practise and revalidation regulations. You can look at the proposed amendments by clicking here. This section describes the main effects of the changes and how they will be applied and asks for your comments on some specific points.
21. Applications for a licence to practise and for restoration of a licence to practise
- We are proposing an amendment to regulation 1(2) to include definitions of ‘indemnity arrangement*’ and ‘appropriate cover†’
- We are proposing amendments to Regulation 3(3) and 4(3) which will provide that an application (both new applications and applications for restoration) must include a statement that the practitioner has in place, or will have in place at the point at which the practitioner practises in the UK, an indemnity arrangement* which provides appropriate cover†.’
This means that all applications for a licence to practise (both new applications and applications for restoration) will include a declaration. The declaration will form part of the online application form (a mandatory tick box as part of the final declaration) which will be a required field in order to submit the application.
Although we will require all applicants to complete the declaration, we do not intend routinely to ask for evidence of insurance and indemnity at the point of registration. However the Registrar will have powers to request evidence of arrangements that are in place or steps taken to make arrangements to provide cover at the point the applicant will begin practising, and to determine whether the arrangements are appropriate. We are likely to exercise those powers only where we become aware of information which may raise concerns about the validity of the original application declaration completed by the doctor.
We do not plan to ask for ongoing declarations on a routine basis.
