4 out of 5 Surgeons Inadequately Insured

Mind the (Insurance) Gap

Four out of five surgeons unknowingly practice without adequate insurance cover.

Up to 80% of surgeons are unknowingly not adequately covered by their insurance, leaving patients in limbo and prompting the UK’s sole trade union for surgeons and anaesthetists to call for an overhaul of the system.

The GMC requires all doctors and surgeons to have adequate protection in place to allow them to practise in the UK, which theoretically covers both the patient and the practitioner. However, providers are largely unregulated with no external accountability or scrutiny, leaving it to their discretion as to whether they pay out or not. And although practitioners are covered by NHS indemnity, many aren’t aware that this cover does not extend to locum work, ‘Good Samaritan’ acts, or private practice. This means that in the event of a claim, patients will have to resort to suing the surgeon directly and if they do not have the means to pay the compensation out of their own pocket, the patient will be left with nothing.

With 80% of surgeons relying on medical defence organisations (MDO) to provide their insurance, the potential impact on patients is vast. The UK’s sole trade union for surgeons and the surgical team; the Confederation of British Surgery (CBS www.cbsgb.co.uk); is calling for an end to discretionary cover and a shift to contractual cover, which is closely monitored by financial authorities, ensuring it operates with transparency within the parameters of the contract. This type of indemnity cover offers clear guidelines as to how and when payouts will be made, and will make payments within the terms of the contract, holding both parties accountable to its terms. Conversely, discretionary protection is a gamble, leaving payouts to a seemingly random system of chance.

Consultant plastic surgeon and President of the Confederation of British Surgery Mark Henley, says:

“It is a disconcerting truth that the vast majority of surgeons find themselves without adequate indemnity insurance coverage, with many oblivious to its limitations. This not only jeopardises the practitioners but patients in the event of a claim, resulting in arduous legal battles that drain both finances and psychological well-being. Urgent and sweeping change is imperative to dismantle the current landscape plagued by unscrupulous insurance providers.”

The growing complexities and costs associated with private practice have led many surgeons to reconsider how they work. The lack of proportional increases in fees for private operations, combined with the costs of insurance products that may or may not pay out when needed, contributes to the challenges surgeons face in maintaining viable private practices, whilst failing to protect patients.

CASE STUDY

General surgeon Peter Sedman used to operate a private practice, until a failed claim left him with an unaffordable insurance bill.

Peter had been paying £40K a year to an MDO, which appeared as though it would cover him adequately in the event of a claim. With the cost of private operations having remained the same for some years, Peter was worried his practice was no longer viable and so he set about looking for cheaper insurance. He found a company who would insure him for 16K and set up a new policy.

When a grieving wife whose husband had failed to attend follow-up appointments with Peter and who had later tragically died, attempted - unsuccessfully - to sue Peter, he contacted the original MDO insurance company who had covered him at the time of the incident. The MDO refused to help with the 9K cost of a letter to the claimant and Peter was left to pay the bill out of his own pocket. The claim was not viable and the action taken no further as Peter was not at fault.

When Peter’s insurance renewal came up, he was told that, despite the untenable claim, he was high-risk. Peter was shocked to see that his premiums had risen to £130K a year. Peter says:

"When I purchased insurance, I believed I was securing a safety net that would safeguard both myself and my patients in case anything should go wrong. The notion that this coverage was discretionary never crossed my mind. This situation, which appears to be the norm for many of the biggest medical insurance companies, not only puts doctors and surgeons in a position in which they could potentially lose their livelihoods and homes, but also fundamentally does very little to protect patients.

“A surgeon who is essentially unwittingly working without adequate insurance is very unlikely to be able to pay litigation fees out of their own pocket, leaving patients with no compensation.  In the instance of Ian Paterson, the MDU refused to pay out as his actions were criminal rather than negligent. Had it not been for the intervention of other insurers, those he harmed or who tragically died at is hands would have been left without a payout. Crucially, these organisations are not subject to financial conduct regulation. Something needs to change, and it is imperative that it changes soon.”

CBS President Mr Henley concludes;

“Our trade union offers all its members peace of mind through access to bespoke, contractual medical indemnity insurance.”