Indemnity Cover Research Articles

Knowledge, attitude, and practice patterns of Indian ophthalmologists regarding medicolegal issues.

To assess the knowledge, attitude, and practice patterns (KAPP) of Indian ophthalmologists regarding medicolegal issues using an initial survey. An online form was circulated among Indian ophthalmologists of all ages over social media and email by the Young Ophthalmologists Society of India (YOSI) and its medicolegal working group. Anonymous responses were obtained and analyzed for each question. The questionnaire comprised questions about demographic details, KAPP of medicolegal issues including how to deal with medicolegal issues (if faced), medical indemnity insurance, deviation from the recommended minimum sum assured (Rs. 1 crore for Indian ophthalmologists), and legal service providers. A total of 109 responses were obtained. The majority of the respondents were male (60, 55%). More than 50% of respondents (58, 53.2%) were younger than 35 years. More than one-fourth of the respondents were private practitioners (29, 27%), and the majority were of senior consultant designation (45, 41%). Around 80% of respondents (89, 81.6%) were aware of professional indemnity insurance; however, only 54% (n = 59) bought the insurance cover. A majority of the respondents (38, 64.4%) had an indemnity cover of a maximum of Rs. 50 lacs. Only 20% of respondents were aware of the expert body at the state/national level that deals with medicolegal cases. Thirty percent of respondents recommended the ideal cover amount to be more than Rs. 1 crore. The current survey highlights the dismally low rate of awareness of medicolegal issues among ophthalmologists. Specifically, a majority of Indian ophthalmologists surveyed did not have recommended minimum insured cover for professional indemnity insurance. Larger studies are needed to further explore KAPP of Indian ophthalmologists in various medicolegal issues.

Community pharmacist consultation service: survey insights into impact of learning on practice, and barriers and enablers to service implementation

Abstract Introduction Some patients attend NHS services with ‘clinically divertible’ urgent low acuity conditions. The NHS Community Pharmacist Consultation Service (CPCS) enables the referral of such patients and subsequent consultation with a community pharmacist. The Centre for Pharmacy Postgraduate Education (CPPE) offered a learning programme to prepare pharmacists for a more clinical and person-centred approach when delivering the CPCS. Aim To investigate the impact of the CPPE CPCS learning programme on learnt skills and their application in practice, and barriers and enablers to CPCS delivery. Methods A survey was designed to explored participants’ knowledge, confidence and application of taught skills/tools, including clinical history-taking, clinical assessment, record-keeping, Calgary-Cambridge, L(ICE)F (lifestyle, ideas, concerns, expectations, feelings) and SBARD (situation, background, assessment, recommendation, decision) communication tools. Statements on barriers and enablers to CPCS delivery were included. In November/December 2021, CPPE emailed an online survey (one reminder) to CPCS learners who had agreed to be contacted (n=2836). The University of Manchester’s Research Ethics Committee decision tool confirmed that ethics committee approval was not required for this study. Results One-hundred and fifty-nine pharmacists responded (5.6%). Sixty percent were female, all ages were represented, the most populous groups being 55-64 (33.3%) and 45-54 years (27.7%). Ethnicity was broadly representative of community pharmacists: 49.0% white, 38.9% Asian, 8.2% black, and 1.9% Arab. Sixty-eight (43%) of respondents were working in a large multiple community pharmacy, 33.3% (n=53) in an independent pharmacy, and 17.0% (n=27) in a small to medium pharmacy multiple. Knowledge of, and confidence in, taught skills were high and respondents reported applying skills in CPCS consultations and wider practice. There was strong positive correlation between the perceived levels of competence and confidence when delivering CPCS (r=0.966, p=<0.001). The level of competence (r=0.259, p=0.003) and confidence increased (r=0.264, p=0.002) with an increasing number of NHS111 referrals. With regards to specific skills learnt, the highest levels of knowledge were recorded for ‘taking a clinical history’ (86% agreement), ‘clinically assessing a patient’ (84%), ‘using L(ICE)F’ (84%), and ‘completing an accurate and concise clinical record’ (81%). Seventy-three percent of respondents agreed they knew how to use the Calgary Cambridge, whilst only 49% knew how to use SBARD. Barriers to CPCS included lack of GP referrals, staffing levels, workload, and GP attitudes. Enablers included a clear understanding of what was expected, minimal concerns over indemnity cover and privacy, and positive patient attitudes towards pharmacy. Those working in independent pharmacies were more likely than those in multiple pharmacies to report that they were receiving GP referrals (68.5% vs. 49.0%, X2=5.249, p=0.022), that they had enough staff to provide the CPCS (45.3% vs. 26.3%, X2=5.526, p=0.019), and that the local GP considers community pharmacy to be an integral part of the primary healthcare team (54.7% vs. 37.2%, X2=4.214, p=0.040). Employed pharmacists were more likely than locums to report that they had a good relationship with their local general practice (57.5% vs. 37.5%, X2=5.436, p=0.020). Discussion/Conclusion This study demonstrates that CPPE learning contributed to community pharmacists’ extended knowledge and skills in CPCS delivery, which contributes to enhanced provision of urgent care in England. This study identified barriers, both interpersonal and infrastructural, that may hinder service implementation.

Community Pharmacist Consultation Service: A Survey Exploring Factors Facilitating or Hindering Community Pharmacists' Ability to Apply Learnt Skills in Practice.

Background: The NHS Community Pharmacist Consultation Service (CPCS) offers patients requiring urgent care a consultation with a community pharmacist, following referral from general practice or urgent care. The study explored the impact of undertaking a Centre for Pharmacy Postgraduate Education (CPPE) CPCS learning programme, and barriers and enablers to CPCS delivery. Methods: CPPE distributed an online survey to those who had undertaken their CPCS learning. The survey explored participants’ knowledge, confidence and application of taught skills/tools, including clinical history-taking, clinical assessment, record keeping, transfer of care, and Calgary-Cambridge, L(ICE)F and SBARD communication tools. Details on barriers and enablers to CPCS delivery were also included. Results: One-hundred-and-fifty-nine responses were received (response rate 5.6%). Knowledge of, and confidence in, taught skills were high and respondents reported applying skills in CPCS consultations and wider practice. Barriers to CPCS included a lack of general practice referrals, staffing levels, workload, and GP attitudes. Enablers included a clear understanding of what was expected, minimal concerns over indemnity cover and privacy, and positive patient attitudes towards pharmacy. Conclusion: This study demonstrates that community pharmacists can extend their practice and contribute to the enhanced provision of urgent care in England. This study identified barriers, both interpersonal and infrastructural, that may hinder service implementation.

Implementing video group consultations in general practice during COVID-19: a qualitative study

BackgroundGroup consultations have been gaining ground as a novel approach to service delivery. When in-person care was restricted owing to COVID-19, general practice staff began delivering group consultations remotely over video.AimTo examine how multiple interacting influences underpinned implementation and delivery of video group consultations (VGCs).Design and settingQualitative study in general practice in England.Methoda) 32 semi-structured interviews with patients, clinical, and non-clinical staff (from eight GP surgeries in total), NHS policymakers and programme managers, and other stakeholders; b) observation in relevant training and operational meetings; and c) three co-design workshops (21 participants). Thematic analysis was informed by the Planning and Evaluating Remote Consulting Services (PERCS) framework.ResultsIn the first year of the pandemic, VGCs focused on supporting those with long-term conditions or other shared health and social needs. Most patients welcomed clinical and peer input, and the opportunity to access their practice remotely during lockdown. However, not everyone agreed to engage in group-based care or was able to access IT equipment. At practice level, significant work was needed to deliver VGCs, such as setting up the digital infrastructure, gaining team buy-in, developing new patient-facing online facilitation roles, managing background operational processes, protecting online confidentiality, and ensuring professional indemnity cover. Training provided nationally was seen as instrumental in capacity building for VGC implementation.ConclusionSmall scale VGC implementation addressed unmet need during the pandemic. However, embedding VGCs in routine care requires rethinking of operational, infrastructural, and clinical processes. Additional research on costs and benefits at service and patient level is needed.

Pharmacy students can deliver services in general practices: a longitudinal work-based learning model for integrated clinical teaching

Abstract Introduction Collaboration between healthcare providers and higher education institutions enable service delivery using the student workforce.(1) This is significant as access to an appropriately skilled workforce can broaden the delivery of pharmacy services.(1) Pharmacy students may have knowledge and communication skills to be able to contribute to service delivery.(2) However, models that integrate pharmacy students into pharmacy services in general practice are limited. Aim to explore a new model of work-based learning in general practice for pharmacy students. Methods A qualitative design is appropriate and was used for this exploratory study. Thirty-two students were recruited from third year of an MPharm programme at one University to provide services via a Pharmacy Hub for three general practices in England. Each student attended the Hub for one 3-hour session, each fortnight, for 12 weeks between September 2019 and February 2020. Students completed ‘tasks’ using read-only access to patient records on SystmOne and recorded their activity on clinical worksheets. Students and stakeholders from the Hub were invited to take part in an interview covering what students did and what the long-term impact of the initiative might be via email. A convenience sample of fifteen students, four general practitioners, two pharmacists, two pharmacy technicians, one general practice manager, and two receptionists, completed semi-structured interviews. Data was also extracted from a convenience sample of 51/105 clinical worksheets to identify the types of tasks completed by students. Content analysis of transcribed interview data and extracted clinical data was completed by both authors until theoretical data saturation was reached. Institutional ethics approval was received for this study. Results Four themes were identified which included i) what activities students completed, ii) impact of working in general practice on student learning iii) impact on recruitment to general practice and iv) concerns. Concerns had three sub-themes relating to indemnity cover for students, a lack of face-to-face patient contact and repetition of simple tasks. See Table 1 for extracts of data. Clinical worksheets indicated students reviewed repeat medication requests (76%, n= 39) and acute medication requests (12%, n=6), for a wide range of products, such as analgesia, antifungal treatment, statin therapy and H.pylori eradication. Students also answered medication-related queries (12%, n=6) such as identifying the porcine content of medications and how to switch from insulin glargine to insulin levemir. Conclusion Findings suggest pharmacy students can contribute to service delivery in general practice by providing supporting roles. However, models must ensure students have access to progressively more complex tasks to facilitate learning. These findings should prompt further research evaluating the role of the pharmacy student workforce to establish key activities students can be trusted to complete. A strength of the study is the combination of data from qualitative interviews and clinical worksheets which provide rich, contextual data. A weakness of the study is that participant validation was not used to confirm the study findings.

Is the end nigh?

A year after its launch, the results of the Department of Health & Social Care’s (DHSC) consultation on ‘appropriate clinical negligence cover’ are still widely anticipated. In this article, we explore the benefits and disadvantages of regulated and discretionary indemnity cover as understood by the DHSC, the medical defence organisations (MDOs), insurance brokers and underwriters. We also turn to surgeons and clinicians with private practices to ask what they think about the current arrangements. Reforms to medical indemnity insurance forecast the passing of the UK's long-established medical defence and protection organisations.

A trilogy of tragedies - paediatric dental tooth whitening.

Dental tooth whitening is used throughout the United Kingdom for patients who have aesthetic concerns regarding the colour of their teeth. Up until recent months it was also frequently used for paediatric patients with enamel opacities of cosmetic concern and discoloured non-vital anterior teeth. This safe and effective treatment option is now not available to paediatric dental patients due to changes in indemnity cover, and we demonstrate three cases from our department where dental whitening was the most appropriate treatment option. By removing this treatment option for selected paediatric patients, we are concerned that more destructive and less effective treatments may be performed with short- and long-term detriment to their oral health. Furthermore, failure to provide any treatment may negatively affect children's quality of life and psychological well-being.

The accusation no nurse ever wants to face

NHS staff are insured by their employers, but indemnity cover for nurses in independent settings is less clear-cut

Ten years on from an appraisal of litigation against English Health Trusts in otolaryngology: What have we learnt?

NHS Resolution provides indemnity cover for legal claims against the NHS, assists the NHS with risk management and aims to share lessons from claims in order to improve safety. The study aimed to investigate the financial costs of litigation against English Health Trusts in otolaryngology over a 10-year period, to see if any lessons have been learned and identify trends that may lead to a potential reduction in costs and improve patient safety. A Freedom of Information request was made to NHS Resolution for information regarding claims made to otolaryngology departments over the last 10 years. There was a total of 612 successful claims in the 10-year period between 2008/2009 and 2017/2018 with costs of nearly £87 million. Overall, the costs of litigation have increased dramatically, and the main areas for these successful claims can be identified, but restrictions in the detail of information released allows too little insight for improvements to be made to avoid them in future. This continues to be a major problem for healthcare funding and practice.

Consultation on indemnity cover for dentists and staff

Consultation on indemnity cover for dentists and staff

Indemnity cover additional benefit

Indemnity cover additional benefit

Editor’s Choice: Draining costs

The rising cost of doctors’ indemnity cover is now threatening the viability of some health services, doctors warn in BMJ Careers this week (http://bit.ly/1OeQ4fO). Anne Gulland looks at the sharp rise in indemnity fees and hears how these costs might affect the ability of GPs to continue to provide out of hours care to their patients. In addition, a recent news story reports …

Doctors without indemnity cover could have their licence removed, says GMC

Doctors without appropriate insurance or indemnity cover could have their licence to practise removed, the General Medical Council has said. The GMC has proposed changes that would award it new powers to withdraw doctors’ licences if they failed to have appropriate indemnity cover for “liabilities incurred in their practice.”1 Doctors are also at risk of losing their licence if they cannot provide evidence or information that proves that they have such cover in place, the GMC said. “The new regulations …

NHS Litigation Authority

The NHS Litigation Authority is a special health authority – a not for profit arm of the NHS. It provides indemnity cover for legal claims against the NHS, assists with risk management, shares lessons from claims and provides a range of legal and professional services.

College moves to thwart employers who refuse to provide indemnity cover

College moves to thwart employers who refuse to provide indemnity cover

Consultation on indemnity cover

Consultation on indemnity cover

Indemnity cover to become a statutory requirement

Indemnity cover to become a statutory requirement

Indemnity cover rules to be introduced by October

Indemnity cover rules to be introduced by October

Sweetness and Power - Public Policies and the ‘Biofuels Frenzy’

Sweetness and Power - Public Policies and the ‘Biofuels Frenzy’

Medical shadowing programme in paediatrics – initiating a new service

<h3>Aims</h3> Medical shadowing helps applicants to medical school improve their CV and determine their suitability for a medical career. Previously in our tertiary paediatric service shadowing was arranged individually by Consultants. To improve equity of access, adherence to national guidance and quality of shadowing experiences we initiated a new, formal programme. <h3>Methods</h3> Questionnaires are sent to students before and after each placement to determine to what extent our aims and students9 learning objectives are achieved. <h3>Results</h3> Over 8 months 16 students enquired about shadowing. 13 completed the application process. 7 others organised placements outside our programme and were also given questionnaires. 13/20 pre-placement and 10/20 post-placement questionnaires were returned. Male:female ratio was 7:13. 12/13 students self-described as ‘definitely applying for medicine’. 11/12 had had some previous work experience or shadowing (1-3 placements per student). See figures 1 and 2 for additional information. The length of placement was negotiated individually and ranged from 1-5 days (mean 3.8, median 4). 4 students had no formal timetable (all were placements arranged outside our programme). For the activities experienced see table 1. Almost all the different activities were rated as ‘most interesting’ by at least one student. Most highly rated were Paediatric Oncology (5/10 students) and Paediatric Intensive Care (3/10 students). Things which the students did not enjoy included not having a timetable (1 student) or ID badge (2 students). No students reported timetabled activities in this category. None of the students changed their intention to pursue a medical career. No concerns were raised by staff, patients or families regarding the shadowing programme. <h3>Conclusions</h3> Successful medical shadowing can occur in ‘sensitive’ specialties, such as paediatrics. True equity of access requires outreach activities to broaden awareness of programmes amongst students and educational establishments. Informally arranged placements are more likely to fall short of recommended standards. This may leave students and supervising staff vulnerable to complaints and invalidate indemnity cover. To ensure standards are met placements should be organised only through a clearly identified team.