CNSGP Frequently Asked Questions

Frequently Asked Questions

1. What is the Clinical Negligence Scheme for General Practice (CNSGP) ‘State backed scheme’?

The Clinical Negligence Scheme for General Practice (CNSGP) is a state backed indemnity scheme covering NHS services provided by general practice. It is restricted to GP Practices in England and Wales and covers certain clinical negligence liabilities arising in general practice that occur on or after 1 April 2019.

CNSGP covers all staff providing NHS services in general practice.

2. When was the CNSGP launched?

The CNSGP State Backed indemnity scheme was launched on April 1^st, 2019.

3. Why was the CNSGP launched by the government?

The PDA has been told by the Department of Health and Social Care that the CNSGP was launched for a number of reasons, but primarily as a result of the increasingly expensive costs of GP Defence Association membership that the government was ultimately having to fund through funding contributions that it was making to GPs. The arrival of the State backed scheme will mean that the NHS will no longer have to fund the full defence association benefit; it will no longer pay for the wider medico-legal defence and it is anticipated that this will drive considerable savings for the NHS.

4. Will the State Backed Scheme provide me with defence benefits that are the same as PDA membership?

No.

The State Backed Scheme (known as the Clinical Negligence Scheme for General Practice; CNSGP) has not been designed to replace defence association membership and is restricted to providing clinical negligence cover. It will be limited in scope as the cover it provides is restricted to certain activities. Fundamentally, it is not designed to defend the reputation of practitioners but is designed instead to settle compensation claims for patients. It differs from the PDAs approach comprehensively in many ways. For example, the PDAs benefits are provided by dint of three things;

1. An insurance contract with specified limits of cover which protects the member because it is regulated by the Financial Conduct Authority.
2. PDA defence association benefits which are discretionary, but which provides protection in the 85% of cases where insurance is not relevant or is not activated at all. For example, helping pharmacists prepare for an interview by an GPhC inspector, or assisting a pharmacist with responses to the media.
3. PDA Union membership, this provides statutory protection to pharmacists by allowing PDA Union representatives access to the workplace in the event of a workplace disciplinary investigation or interview.

Placed alongside each other, these three benefits provide the most comprehensive defence and support package available and this places the pharmacist and the pharmacist’s reputation at the very centre of its thinking.

5. If you rely upon the CNSGP scheme there are some important differences that you need to be aware of and what is excluded?

The CNSGP is operated by NHS Resolution which is a public body and this has important implications for the style and the support that pharmacists can expect if they rely upon it.  In effect, CNSGP has a duty to act in the public interest and therefore, it may report a pharmacist involved in an incident to a regulator or to those managing the NHS performers list. The PDA is not a public interest body, it will instead always put the members interests at the forefront of its thinking and try wherever it can to advise a member to act in a way which avoids the necessity of any action being taken by a regulator or any other authority. If a regulator is involved, the PDA will seek to defend the pharmacist in such an eventuality, whereas the CNSGP does not.

Click here to view a copy of the CNSGP Scheme Rules and statement on Public duty reporting

The State Backed Scheme is not provided by a regulated contract of insurance instead it will respond to civil claims for compensation at the discretion of the Secretary of State.

it will not provide cover to pharmacists in the event of the following;

The CNSGP Exclusions which are covered by the PDA

• GPhC inquiries and representation
• Employment disciplinary proceedings
• CQC investigations
• CCG, Health Board and NHS England investigations (to include performers list management)
• Coroners (or other inquest) investigations and representation
• Criminal proceedings
• Complaints from patients
• Health Ombudsman complaints
• Breach of confidentiality
• Ex-Gratia payments
• Defamation, Libel and slander claims
• Breach of Data Protection regulations
• Public Liability claims

Activities excluded by CNSGP which are covered by the PDA

• Claims that arose from incidents occurring prior to April 1st 2019 (Covered by The PDA ‘Run Off‘ Scheme)
• Non-NHS work (Not covered by The PDA ‘wrap around’ scheme but covered by the Full comprehensive GP practice based PDA member scheme)
• Portfolio career pharmacy work in other sectors of the profession such as in community pharmacy (Covered by the PDA ‘wrap around’ scheme and the Full comprehensive GP practice based PDA member scheme)

This list is not exhaustive 

In the experience of the PDA, the list of perils excluded from the CNSGP, are the risks that pharmacists are much more likely to face.

6. Why does the government recommend continued membership of the Defence Association?

When PDA representatives met with the Department of Health and Social Care (DHSC) officials, they were clearly aware of the shortcomings of the State Backed Scheme, not just for the practitioners but also for patients who may decide to refer a pharmacist to the GPhC and expect that their complaint is handled expeditiously by the regulator. It is recognised that at certain stages in their career, it is likely that a pharmacist will be called to account for something that they have done or not done. The NHS recognises that in such situations, a healthcare professional operating without medico legal protection is not a sensible or attractive proposition.

DHSC have made clear that they expect pharmacists to maintain their membership of the PDA even though they may be covered for their indemnity exposure by the State Backed Scheme. Click here to see what the DHSC has said. 

In a Q & A fact sheet published by the NHS one of the questions is;

Do I need to maintain membership with my current MDO/indemnity provider after 1 April 2019?

Yes. You will need to maintain membership with an MDO or other indemnity provider in respect of activities and services not covered by [The State Backed Scheme]

7. Will the existence of the CNSGP affect my premium?

Your premium may be affected depending on which level of cover you choose. The PDA will offer three levels of cover to members.

7.a Comprehensive PDA GP practice-based membership. This is the original and fully comprehensive GP Practice membership scheme from the PDA. It provides a choice of £5 million or £10 million limit of protection, not just for GP Practice based work but also for any pharmacy portfolio career work in another sector of pharmacy. Not only is it entirely independent of the CNSGP, but it provides cover for many of the matters and activities excluded by the CNSGP. Prices for this membership scheme start from £925.

7.b CNSGP ’wrap around’ GP Practice membership. This scheme has been designed for those pharmacists who commenced work in a GP practice after April 1^st, 2019. It works alongside the CNSGP in England and Wales and because of this, it costs much less. It provides medico legal protection and all the additional PDA member benefits plus some clinical negligence cover capped at £250,000. This means that it can primarily take charge of any claims and ensure that the pharmacists’ reputation is protected. Any more expensive claims would be passed to the CNSGP. It simultaneously provides cover for non-GP practice pharmacy portfolio career work for example in community, hospital or primary care pharmacy and in this regard, it offers a choice of £5million or £10million cover. Prices for this membership scheme start from £249.

7.c CNSGP ’wrap around’ GP Practice membership with ‘Run Off’. This scheme has been designed for those pharmacists who commenced work in a GP practice prior to April 1^st2019 as they will need ‘Run Off’ It provides ‘Run Off’ cover to protect pharmacists from incidents which may have occurred prior to April 1^st, 2019 but for which claims have emerged subsequently. The CNSGP does not provide cover for these historical risks. It provides medico legal protection and all the additional member benefits plus some clinical negligence cover capped at £250,000. This means that it can primarily take charge of any claims and ensure that the pharmacists’ reputation is protected. Any more expensive claims would be passed to the CNSGP. Prices for this membership scheme start from £559.

 8. What is Run Off cover and why is it needed by GP Practice based pharmacists?

When the PDAs GP Practice based members scheme was launched in 2016, it allowed pharmacists to enjoy Professional indemnity and Legal Defence costs insurance from the first day that they started to work as a GP practice based pharmacist under one of the new NHS led GP Practice based scheme pilots. This meant that any incidents that may have occurred whilst working in a GP practice which emerged after the members joined the PDA (historical risks) would have been covered under the PDAs scheme.

The government has taken an entirely different approach; its CNSGP, which was established on April 1^st, 2019 in England and Wales, will not provide any historical risks protection and this means that unless pharmacists take the precaution of either maintaining their full PDA membership, or purchasing ‘Run Off’ cover, those who choose to rely on the CNSGP will be exposed to claims that may be made against them from an emerging historical risk. The approach taken by the NHS has required the PDA to fundamentally change the way it approaches its indemnity arrangements.

9. What has the government said about the need for ‘Run Off’?

Click here to read the letter received by the PDA from the Department of Health and Social Care

10. What is the risk of a claim from a historical incident?

Liability risks of claims from historical incidents do exist and they can emerge several years after the incidents have occurred. Technically under UK law, a child who is injured through negligence at birth can instigate their claim against the person who was negligent for up to three years after they reach the age of 18. So, in the worst-case scenario the theoretical risk for indemnity claims from historical liabilities exists for 21 years. This is why many healthcare professionals maintain their ‘Run Off’ cover for 21 years, this involves purchasing a ‘Run off’ insurance policy each year, typically for reducing premiums over time. However, it is worth exploring the theoretical risk in the pharmacy context before deciding how best to proceed; a process recently undertaken by the PDA. It is necessary to consider the experience of the PDA’s claims handling team, that of underwriters in claims from episodes involving wider healthcare errors and especially those affecting children and that of experts involved in handling claims against children. The common practical view is that such claims are typically settled with the court’s supervision and with parental involvement as soon as possible and delays are generally not planned. Claimants and their families do not to wish to wait for decades to start to argue for and receive their compensation. They know that doing so runs the risk of memories fading, their circumstances changing or their will to claim dissipating and even the possibility that the parties who committed the error may no longer be available to be held to account.

Quite understandably, they prefer instead to secure their compensation as soon as possible.

Consequently, in the event of an incident, notification of a claim is generally lodged with the healthcare professionals involved in any incident promptly and the claimants may then decide to wait for a long period of time to assess the full scope of any harm caused before they issue proceedings. In some cases, however, patients may not become aware that they were subjected to an error until some considerable time after the error has occurred. It may be that their condition has deteriorated over time, or they inexplicably end up in hospital and a subsequent evaluation discovers the historical error. In such circumstances, a claim may only materialise some considerable time after an error has occurred perhaps even several years later. In some cases, handled by the PDA, early notifications of claims to come never materialise, in others, in the most serious cases and in the event of non-contested claims, a compensation payment may be made ‘on account’ to allow the injured party to invest in any adjustments that may be needed e.g. additional nursing care or home modifications, pending a full and final settlement to be agreed some time in the future.

The practical effect of this is that in most cases any pharmacist who may be on the receiving end of a claim is likely to know that this is going to happen reasonably promptly or at least within the first few years and will be able to notify their insurers straight away. However, there is also the risk that this may not always be the case and that decades go by before a claim is notified and then made; this however, is not a scenario experienced by the PDA, nor its underwriters.

This explains why some people purchase ‘Run Off’ cover for a period of 21 years, but it also explains why the cost of premiums for such cover reduces substantially after the first two or three years. By the fifth year, the likelihood of any claims emerging from episodes older than five years becomes so much smaller that the cost of ‘Run off’ becomes a very small and affordable fraction of the cost of a full annual indemnity insurance policy.

11. The government has asked the PDA to arrange ‘Run Off’ cover for GP practice-based pharmacists, how has the PDA responded?

Because of the way the CNSGP was set up, the government has asked the PDA to establish ‘Run Off’ cover for GP practice based pharmacists who worked in this role prior to April 1^st 2019, to protect the public from any errors and pharmacists from any historical claims that may emerge from an incident that occurred prior to that date.

The PDA believes that the responsibility of historical risks liability should lie with the CNSGP, as it was the government who changed the dynamics of indemnity provision. Nevertheless, the PDA has had to put in place ‘Run Off’ arrangements for members as otherwise, they would be exposed to claims from any emerging historical risks. The PDA is keen to ensure that members pay no more than is necessary and that is why it is offering members a choice of ‘Run Off’ arrangements.

Option 1

The first option, is for members to maintain their current comprehensive GP practice based scheme, this will provide them with full indemnity cover for claims that emerge from incidents which occurred after the date that they initially commenced their first GP Practice based indemnity scheme with the PDA (the initial retro-active date). It will also cover them for any incidents that occur during the current and future years of their policy, even though the CNSGP is also in place. This approach is one that has been taken by at least one of the Medical Defence Unions. In such a scenario, ‘Run Off’ cover is actually not needed as pharmacists will have maintained their original cover. It is recognised by the PDA however, that this will not be the most cost-effective option for members.

Option 2

The second option is for members to purchase a Traditional ‘Run Off’ insurance policy.

Option 3

The third option is a more cost-effective approach; the PDAs newly arranged ‘members of scheme’ for ‘Run Off’. This is a group scheme; an option which can work because it is operated as a combination with a new style of PDA membership; the CNSGP ‘wrap around’ scheme. The resultant cost of this ‘members of scheme’ is much lower than maintaining their original full GP Practice based membership and is also much more cost effective than would be a Traditional ‘Run Off’ scheme joined by GPs.

Because ‘Run Off’ arrangements are difficult to establish and they have been made a requirement by the NHS, the PDAs ‘members of scheme’ for ‘Run off’ is available both to historical members of the PDA and also to those previously not in PDA membership, although the pharmacists previously not with a PDA GP Practice based scheme would need to pay higher premiums as they would previously not have contributed to the GP Practice based indemnity fund.

12. What is Traditional Run Off cover?

The Traditional ‘Run Off’ insurance scheme is designed to provide an individual pharmacist with their very own £5 or £10million level of indemnity protection per claim per year for any claims that emerge from any previous historical liabilities. Under a Traditional ‘Run Off’ scheme, if ten members have a claim for £5million, then £50million would be provided to settle the claims. The ‘Run Off’ premiums paid, and the insurance provided does not provide protection for any current work, it only provides cover for claims being made from any historical liabilities that may emerge from work undertaken prior to April 1^st, 2019.

As such the risks of claims emerging over time recedes and the premiums reduce accordingly. Because each pharmacist carries their own full tier of £5 or £10 million protection however, the premiums are still relatively high.

The Traditional ‘Run Off’ does not provide any legal defence costs cover for medico-legal issues and this is why it is automatically provided alongside the ‘wrap around’ scheme described at point 7c.

In combination, this means that any of the medico-legal protection for historical and current claims, as well as indemnity benefits for current portfolio career work and even some of the current GP practice work is delivered by dint of a second ‘wrap around’ policy.

13. What is the PDAs ‘members of scheme’ for ‘Run Off’ – and how does it work?

The PDA has taken an innovative approach to the launch of the CNSGP and part of this is a ‘members of scheme’ for its ‘Run Off’ solution.

As an alternative to continuing on with the cost of the historical PDA scheme for GP Practice based pharmacists as a ‘Run Off’ solution, or the more Traditional ‘Run Off’ arrangement providing £5 or £10million of cover per member per claim, the PDA has established a ‘members of scheme’ for ‘Run Off’. A standalone fund of £30million per year set aside for the pharmacists in the ‘members of scheme’ and an individual claims limit of £10 million per claim. The ‘Run Off’ premiums paid, and the insurance provided does not provide protection for any current work, it only provides cover for claims being made from any historical liabilities that may emerge from work undertaken prior to April 1^st, 2019.

This scheme although much less costly than Traditional ‘Run Off’ is limited by its financial cap, but nevertheless it is provided as an option.

Theoretically, this means that in a real crisis scenario, where more than £30 million of claims occurs in one year, then the scheme would expire leaving no further cover available. As a ‘Run Off’ figure of £30million, the risk of a claim, which is lower than with regular ongoing risk, for the small number of pharmacists involved in GP practice based work prior to April 1^st 2019, is deemed appropriate by both the PDA and its underwriters and they have extensive experience of primary care claims with other professions. However, there is clearly a mathematical possibility that many claims will emerge and that the £30million pot will expire leaving those pharmacists left in the scheme with no further cover available. This represents a risk but one that the PDA believes can be managed because if there is evidence that there are significant claims from historical incidents coming through after the launch of this scheme, then the PDA would move swiftly to notify all remaining members of the scheme and seek to make any necessary changes to the ‘Run Off’ arrangements as a matter of urgency.

After extensive research, the PDA believes that such a scheme represents a proportionate approach to the issue of a diminishing risk of claims from historical incidents and the relatively small number of individuals involved in the risky areas of GP practice-based work such as diagnosis prior to April 1^st 2019. The PDA has sought to balance this risk against the benefit of keeping costs to members to a minimum. The ‘members of scheme’ does not provide any legal defence costs cover for medico-legal issues and this is why it is automatically provided alongside the ‘wrap around’ scheme described at point 7c.

In combination, this means that any of the medico-legal protection for historical and current claims, as well as indemnity benefits for current portfolio career work and even some of the current GP practice work is delivered by dint of a second ‘wrap around’ policy.

14. What is the cost of the various new schemes (both with and without ‘Run Off’) arranged by the PDA on behalf of members?

1. CNSGP ‘wrap around’ scheme without ‘Run Off’ cover from £249
2. CNSGP ‘wrap around’ scheme with ‘members of’ for ‘Run Off’ From £559 (£249 for ‘wrap around’ element and £310 for ‘Run Off’ in year 1, reducing thereafter)
3. CNSGP ‘wrap around’ scheme with Traditional ‘Run Off’ From £764 (£249 for ‘wrap around’ element and £515 for ‘Run Off’ in year 1, reducing thereafter)
4. Fully Comprehensive GP Practice scheme from £925

For those pharmacists not previously in PDA membership;

5. CNSGP ‘wrap around’ scheme with ‘members of’ for ‘Run Off’ From £882 (£249 for ‘wrap around’ element and £633 for ‘Run Off’ in year 1, reducing thereafter)

Please note these membership fees are all based on a basic GP Practice based pharmacist.

The membership premiums will vary depending on IP qualifications, experience and the different risks and responsibilities which accompany that. Please enter your level of experience and responsibility on the application section to establish your respective membership fee.

15. How much would the ‘Run Off’ costs be expected to reduce by in year 2, 3 and beyond?

Typically, as the risk of a historical claim being made recedes, so does the ‘Run Off’ premium. However, since the premiums of the many pay for the claims of the few, if lots of historical claims started to emerge then these ‘Run Off’ costs would likely not reduce and may even increase; although as described in 13. this is not anticipated. On the assumption that the ‘Run Off’ scheme operates as expected, the ‘Run Off’ premium element is likely to be 20% lower than the first year premium in year 2, 40% lower in year 3, 70% lower in year 4 and 85% lower in year 5.

16. Who should pay for the ‘Run Off’ cover?

 In its discussions with the DHSC, the PDA has been keen to establish that the government should bear the full cost of this ‘Run Off’ arrangement as it is they who changed the indemnity dynamics. Securing clarity and some sense of fairness around the ‘Run Off’ issue has taken several months and this has caused delays in launching the new PDA post CNSGP indemnity arrangements. In the end, a conclusion of sorts has been reached, but it is not a satisfactory one. The government have ultimately accepted the principle that they will need to take some responsibility for the ‘Run Off’ costs in GP practice and they have now ringfenced finances to fund the cost of ‘Run Off’ cover for GP practices to ensure that all historical risks liabilities in GP practices are covered. However, they have used the GP contractual framework to pay these funds. This means that GP practices will receive these funds and pharmacists and all the other healthcare professionals will have to approach the GP practices direct to ask that they pass the funds over to them to fund their ‘Run Off’ costs. We are worried about the practical arrangements; for those pharmacists working for just one practice, especially if this is a supportive practice, this may be a feasible proposition (indeed, member surveys have shown that GPs have been prepared to contribute towards the cost of their indemnity), but for those (the majority) typically working for several practices simultaneously, this prospect will be a more difficult one for pharmacists to secure. This is the reason why the PDA is now pushing to be recognised in national contractual and remuneration discussions with the government in the future and this is why union recognition at the employer organisations is now being pursued by the PDA.

Members are urged to download the NHSE letter which describes the contractual payment to GP Practices to fund ‘Run Off’ costs and use it to support their requests for funding to GPs. Click her to download the NHSE letter

17. What does the PDA recommend?

Irrespective of when they started their GP Practice based work, the Comprehensive PDA GP practice-based membership is the best policy should pharmacists wish to see their defence strategy controlled exclusively on their behalf by the PDA and not be in any way reliant on the CNSGP. Most importantly, the CNSGP which is operated by NHS Resolution a public body, means that it has a duty to act in the public interest and as a consequence, it may report a pharmacist involved in an incident to a regulator or to those managing the NHS performers list. The PDA is not a public interest body, it will instead always put the members interests at the forefront of its thinking and try wherever it can to advise a member to act in a way which avoids the necessity of any action being taken by a regulator or any other authority. If a regulator is involved, the PDA will seek to defend the pharmacist in such an eventuality, whereas the CNSGP does not.

This is a solution also recommended to GPs by the largest Medical Defence Union. It ensures that their representation is kept entirely independent from their employer, and their employer’s interests and that the protection that is required in all and varied work situations can be relied upon. It also ensures that any wider defence strategy is thought through right at the start of any defence activity. Although the premiums are very cost effective compared to that paid by GPs and nurses, it is recognised that some pharmacists will find the annual premiums (£900-£1,700) prohibitive. Many pharmacists, especially those who find themselves working in a GP practice where Defence Association membership is the cultural norm have persuaded their GP practices to pay for their higher premiums for the more superior cover as a work-related benefit. The other added advantage for those pharmacists who commenced their work in GP practice prior to April 1^st, 2019, is that they would not need to take out any ‘Run Off’ cover as their indemnity protection would be ongoing.

For those who commenced general practice work on or after 1^st April 2019 and wish to retain important PDA member benefits including initial support for clinical negligence claims from the PDA, but are happy for NHS Resolution to handle larger claims, the CNSGP ’wrap around’ GP Practice membership scheme would be the most appropriate. Ultimately, although it determines the initial defence strategy because it handles the proceedings, it does not provide exclusive control of any more expensive claims as once the costs of those compensation claims reach £250,000, they would have to be handled by NHS Resolution under the CNSGP. Within this framework however, the ‘wrap around’ scheme has been designed to enable the PDA to design the overall defence strategy, to connect and set into train all the wider medico- legal defence considerations and proceed with the defence of the pharmacist’s reputation. It is expected that in the event that a high value claim has to be passed to  NHS Resolution, any environmental issues that may need to be mentioned so as to defend a pharmacist (which the GPhC may ultimately seek to rely on) will have been identified, any other healthcare professionals that may have to be cited as being responsible for any part of the claim will have already been drawn in to the proceedings and any expert witness reports which would be supportive of the pharmacist would have been secured. As such, whilst it is a compromise, the ‘wrap around’ scheme has been designed to deliver much of what is required for the defence of a pharmacist’s reputation.

For pharmacists wanting to rely on the CNSGP for larger claims, but who were working in general practice prior to 1^st April 2019, The State backed CNSGP wrap around GP membership with ‘Run Off’ cover will be required to ensure that any liabilities connected to general practice work prior to 1^st April 2019 are adequately covered. This will also be in line with DHSC requirements for all clinicians covered by the CNSGP.

Those pharmacists who may wish to enjoy their own £10million claims limit and not be a part of the ‘members of scheme’ for ‘Run Off’ arrangements as they are concerned about large claims coming through, might consider remaining on the Full and Comprehensive PDA GP Practice membership scheme for two to three years, by which point the likelihood of a claim from historical risk would be far smaller and then transfer over to the ‘members of scheme’. At that point the performance of the ‘members of scheme’ will be evident. Alternatively, they should consider the CNSGP ‘wrap around’ GP practice membership scheme with the Traditional ‘Run Off’ as this will guarantee a £5 or £10million limit of cover in the event of numerous claims from historical liabilities coming through the system.

18. Why shouldn’t I rely exclusively on CNSGP?

As noted elsewhere, the DHSC has recommended continued membership of a defence organisation. For those who remain unconvinced, we provide some further information to consider.

Whilst on the face of it, a State Backed Scheme might look financially attractive, especially for pharmacists who previously paid for their PDA membership premiums themselves, a closer look at this consideration is recommended. Firstly, not all GP practice-based activities are covered by the State backed scheme. Secondly, the State Backed scheme does not move with the pharmacists as they move into other pharmacy sectors as part of their portfolio career. Sole reliance upon the State Backed indemnity scheme would leave pharmacists with no protection for those areas of risk that they are much more likely to be exposed to; Regulatory proceedings, employment disciplinary proceedings, coroners’ inquests, complaints etc. Most importantly, the CNSGP which is operated by NHS Resolution a public body, means that it has a duty to act in the public interest and as a consequence, it may report a pharmacist involved in an incident to a regulator or to those managing the NHS performers list; this represents a significant conflict for pharmacists who seek to rely solely on the CNSGP. Healthcare professionals operating in a modern society are likely at certain stages in their career, to be called to account for their actions in a formal procedure. In handling many thousands of cases each year, the PDA has learned that the entire defence effort must be connected all the way through the process and at every stage of the proceedings. The State Backed Scheme is not set up for this purpose. Comments made by State backed scheme lawyers in any compensation settlement will likely be kept by claimants and used as evidence in a subsequent GPhC hearing, employment disciplinary or other inquest. It is crucial that the defence efforts are operated centrally by the same organisation that will defend the pharmacist in a wide range of potential hearings, this needs to be an organisation whose primary objective is to defend the reputation of its members.

19. Will the new CNSGP ‘wrap around’ scheme, when combined with the NHS provided CNSGP, provide me with the same amount of cover as the fully comprehensive PDA GP Practice based membership scheme?

No.

The CNSGP ‘wrap around’ scheme is designed to enable those PDA members who have opted to rely upon the CNSGP to still be able to fall back upon the PDA to arrange and operate the initial defence strategy. This puts the interests of members at the heart of the defence effort in the event of a claim. It also provides the wider Legal Defence Costs cover (for things like Regulatory or criminal proceedings and any employment disputes) that would accompany an investigation into an incident or a claim, which the CNSGP explicitly does not. Finally, it provides protection for portfolio pharmacy career work undertaken in other non-GP practice settings which the CNSGP does not. As such, the ‘wrap around’ scheme does not provide the same amount of cover as the fully comprehensive PDA GP Practice based scheme.

See comparison table

The ‘wrap around’ scheme is built using three components.

The first component mirrors the indemnity cover provided by the CNSGP for work in a GP practice by providing an independent £250,000 layer of professional indemnity (as well as £250,000 of public liability cover) allowing the initial defence strategy to be organised by the PDA. It provides pharmacists with protection for the same activities that would be covered by the CNSGP, it also excludes the activities excluded by CNSGP, these being non-NHS work in a GP practice.

The second component provides £5 or £10million of professional indemnity and public liability cover allowing pharmacists to undertake non-GP practice-based pharmacy portfolio career work career work for example in care homes, community pharmacies or hospital pharmacies as this is excluded by CNSGP.

The third component provides £500,000 of Legal Defence costs insurance which protects pharmacists from a wide range of professional regulatory, employment and even criminal consequences of their activities, all of which are excluded by CNSGP.

Because the CNSGP ‘wrap around’ scheme was built upon the foundation of the CNSGP (so that costs could be kept to a minimum) and the fully comprehensive PDA GP Practice based membership scheme was designed to cover pharmacists for all and any activities that may be undertaken in a GP practice and beyond there are certain differences between the two schemes.

The most important differences, between the fully comprehensive PDA GP Practice based membership scheme and the CNSGP ‘wrap around’ scheme are;

The ‘wrap around’ scheme will only provide up to £250,000 professional indemnity for work undertaken in a GP practice and this is because the CNSGP is available to be relied upon in the event of expensive claims. Whereas the fully comprehensive PDA GP Practice based membership scheme will provide £5 or £10million of cover, which means that members will not need to rely upon the CNSGP to defend any aspect of claims.

The fully comprehensive PDA GP Practice based membership scheme will provide £5 or £10million of indemnity for breach of confidentiality, libel and slander, defamation and public liability claims in both a GP practice as well as in non-GP practice-based pharmacy portfolio career work. Whereas the ‘wrap around’ scheme will provide £5 or £10million of indemnity for breach of confidentiality, libel and slander, defamation and public liability claims only in non-GP practice-based pharmacy portfolio career activities whilst providing a £250,000 limit in a GP practice.

Another important difference, is that because the CNSGP will not cover any non-NHS work in a GP practice, neither will the ‘wrap around’ scheme, whereas the fully comprehensive PDA GP Practice based membership scheme will.

20. Can I take out the ‘Run Off’ cover on its own without any additional ‘wrap around’ cover

No.

The PDAs ‘Run Off’ solution has taken a long time to negotiate with underwriters, it is cover that is difficult to arrange especially for the small number of pharmacists potentially involved. After some considerable delay, the PDA has been able to arrange a ‘Run Off’ scheme because numerous important aspects of the defence service provided in the event of a claim are not actually covered by the ‘Run Off’ cover as such (such as the regulatory, criminal and employment implications of a claim) they are covered instead by the PDA ‘wrap around’ element. This makes the proposition more attractive to ‘Run Off’ underwriters as their risks are lower and it makes the ‘Run Off’ far less costly for members.

However, because of this, the ‘Run Off’ cover on its own would not have been fit for purpose and explains why it is not available on its own. As well as the lower costs involved, we believe that the practical effect of this more innovative joined up approach is highly beneficial because it enables PDA personnel to design the wider interconnected defence strategy which encompasses all of these wider issues which are necessary to properly defend the reputation of a pharmacist. Had the PDA not taken such an approach, the costs of ‘Run off’ would have been very much higher and likely not have been possible to establish at all.

Beyond these factors, the PDA has also agreed two ‘Run off’ schemes for pharmacists, the focus of which has been to keep costs to members to a minimum. One of these is even suitable for previously non-PDA members who have been unable to secure any ‘Run Off’ cover from their existing insurers.