The changes announced recently to the RCN’s indemnity scheme have provoked much debate online, in the press, and at the recent ANP annual conference. There appears to be confusion about whether practice nurses in extended roles, such as prescribing, will now need their own indemnity insurance and, if so, who will pay for it.
The RCN has updated its information in response to questions since the announcement. The statement stresses that nothing has changed for individual nurses. Indemnity for charitable or Good Samaritan work is still included in the RCN subscription. The change means that if an RCN member employed by a GP practice is found to be at fault in a clinical negligence action, medical defence organizations such as the Medical Defence Union (MDU),Â the Medical Protection Society (MPS) and the Medical and Dental Defence Union of Scotland (MDDUS) will no longer be able to try to recover some or all of the costs from the RCN.
The RCN says that the change only affects the medical defence organisations, that GP practices should have group indemnity cover and accept vicarious liability for all staff, and that nurses employed by GP practices (not a partner or self-employed) do not need personal cover.
The MPS has provided some information about this on its website where it says that it is, ‘unlikely that GP members would be granted assistance from MPS’ for negligence claims ‘against nurses working in extended roles’ and that practices are therefore strongly advised to ensure that ‘these nurses have and maintain their own indemnity arrangements’.Â Wessex Local Medical Committees, for example, echoes this, saying practice nurses ‘may want to get their own insurance’ in case of actions against them that do not ‘fall under vicarious liability’ and that ‘this may be even more relevant for nurse prescribers’. The MDU has told the ANP that it was surprised to hear of the change, and that it is planning to meet with the RCN. It says, ‘It may well be that nurses as professionals in their own right will need membership of the MDU to secure their peace of mind for their exposure to liabilities arising from their work as regulated healthcare professionals’ and adds that nurse practitioners and nurses in an extended role can obtain personal membership including indemnity insurance.
The RCN says that it is a ‘myth’ that independent prescribers need personal cover and that employers should not be asking nurses to undertake any duties not covered by the defence organisation. The BMJ has reported that practices will have to upgrade to practice-wide cover, at some expense, but that these schemes may not cover nurses working in extended roles, such as prescribers, quoting Dr Vautrey, deputy chair of the BMA’s General Practitioners Committee. The report says that in these cases practices may have to pay for personal insurance for their nurses, given the RCN advice to its members.
In the ‘Standards of proficiency for nurse and midwife prescribers’, the NMC recommends, that ‘every nurse/midwife prescriber should ensure that she has professional indemnity insurance by means of a professional organisation or trade union body. …Registrants are strongly advised to contact their professional body, to ensure that their indemnity insurance covers them for the scope of their prescribing practice.’