Medical Indemnity in the UK: What International Medical Graduates Need to Know Before You Start Working in the NHS

Guest Blog from MDS (Medical Defence Shield)

If you are planning to start your medical career (or move it to) in the UK, you might know that you need to pass a series of English language and professional assessments, and that you need to register with the General Medical Council (GMC).

But another thing to keep in mind is that on top of proving your professional standards, there might be different administrative requirements from the healthcare system you are used to.

One of such things is the responsibility to hold adequate indemnity or  for your job, and it falls on the healthcare professional to make sure they comply. This is a legal and regulatory requirement essential to be allowed to practice in the UK.

This is stated in the Good Medical Practice, the guide that sets the professional standards for doctors in the UK:

You must make sure you have adequate and appropriate insurance or indemnity arrangements in place covering the full scope of your medical practice in the UK. The cover you need is very much dependent on your circumstances and must be in place by the time you begin to practise.

What are insurance and indemnity? And which one do you require to practise?

Let’s look at the definitions. Insurance is a formal contract, a “policy”, where an insurer agrees to pay up claims up to an agreed amount for a set cost, or “premium”. Insurance is provided by underwriters, and sold by brokers and insurance companies.

Indemnity instead, is a promise to pay for another party's loss. It’s a broader legal principle based on discretion, and not on a binding policy contract.  In healthcare, indemnity is often provided through Medical Defence Organisations (MDOs), but not all MDOs provide it, and their use of discretion might getting a payment more difficult.

In the eye of the GMC, insurance and indemnity are often used interchangeably as the GMC does not make a difference between a proper contract of insurance or a promise to pay, as long as it compensates patients that suffer harm due to clinical negligence, an error, or omission from the healthcare professional.

Most people working in the NHS do not need to worry about this requirement, as the NHS in England, Wales and Scotland automatically provides Clinical Negligence insurance (the kind required by the GMC) to all its employees. In Northern Ireland, Crown Dependencies and Oversea Territories, the provisions are different, and you will need to check if they apply to you.

If you work in a private clinic or hospital, or run your own private practice outside the NHS, even for just a few hours a week, unless in a very small and limited exceptions, you will need to arrange your own insurance or indemnity covering exactly the work you do there, to be able to practise lawfully.

Is the clinical negligence insurance from the NHS enough?

From a legal and regulatory perspective, and if you only work in the NHS, yes it is enough in the eyes of the GMC. However, the NHS insurance schemes only cover compensation for clinical negligence claims.

What NHS indemnity does not cover are the regulatory processes and investigations a healthcare professional might go through because of a negligence claim or following a complaint or incident, which include fitness to practise proceedings, disciplinary proceedings, inquests, criminal investigations, Good Samaritan acts, and anything connected to private practice.

This is where Medical Defence Organisations step in. These are membership organisations that provide specialised medico-legal services to their members.

While not all of them provide indemnity (this is the “promise to pay compensation” discussed in the previous paragraph), they all provide legal assistance when a member is involved in an investigation around their fitness to practise or in most of the scenarios listed above.

Out of the many available to choose from, Medical Defence Shield is the only Medical Defence Organisation in the UK that, as well as the above services, can also offer assistance with day-to-day employment and contractual disputes and other issues experienced at work.

Common pitfalls for IMGs new to the UK

At Medical Defence Shield, we often find that many International Medical Graduates assume NHS cover is sufficient for all their professional needs, and that many delay upgrading their protection. In general, these are the most common mistakes we encountered over the years:

●     Assuming that any cover and entitlement from one’s home-country transfers to the NHS.

●     Delaying membership of a Medical Defence Organisation until something has already happened.

●     Not understanding the difference between MDO Indemnity and insurance (discretionary vs contractual)

●     Not realising they might have gaps in cover when doing additional locum/agency/private work or between posts

What to look for in a Medical Defence Organisation as an IMG

If this is the first time you look for a Medical Defence Organisation, you should make sure it provides at least:

●     Advice and representation for GMC/other regulatory proceedings

●     Advice and representation for investigations into clinical matters at work

●     Legal advice and representation at Coroner’s inquests

●     An advice line to seek help before things escalate or before making a decision you are not sure about

●     Advice and representation for healthcare work you do outside the NHS and or as a locum within the NHS.

And ideally, for complete peace of mind, that:

●     Provides advice and representation for non-clinical internal disciplinaries and investigations (at work) and day-to-day employment support (contractual issues, pay, scope of practice, rotas, etc)

●     Offers occurrence-based cover (if you were a member of the organisation when something happened, you are covered even years after)

●     Covers for non-medical roles if relevant to you (ACPs, PAs, etc.)

●     Offers discounts or special plans for International Medical Graduates (Medical Defence Shield offers 25% off the first year of any membership plan).

●     Has experience dealing with IMGs specific matters.

Appraisal and revalidation

Medical indemnity is only one part of maintaining your professional standing in the UK. Doctors who hold a UK licence to practise will also need to engage with the GMC’s appraisal and revalidation requirements.

For International Medical Graduates, this can sometimes be unfamiliar, particularly if you are not yet connected to a designated body, are working intermittently, undertaking locum work, or are practising partly or wholly outside the UK.

An annual medical appraisal provides an opportunity to review your scope of work, continuing professional development, quality improvement activity, feedback, significant events, complaints, wellbeing and professional development plans. It also helps ensure that you are collecting the appropriate supporting information for revalidation.

Medical Defence Shield members can access discounted independent medical appraisal services through DrAppraisals.com. Dr Appraisals regularly supports IMGs, locum doctors and doctors without a designated body, including those who may have more complex appraisal or revalidation circumstances.

MDS members should check their membership benefits for details of the current Dr Appraisals discount.

FAQ'S

What's the difference between medical indemnity and insurance?

Insurance is a formal contractual policy; indemnity is a discretionary promise to cover losses, usually via an MDO. The GMC treats both the same, as long as patients are compensated for negligence.

Do IMGs need medical indemnity or insurance to work in the NHS?

Yes, it's a GMC requirement. NHS work in England, Wales, and Scotland is automatically covered; Northern Ireland and Crown Dependencies differ. Any private or locum work needs separate cover.

Is the NHS's own insurance cover enough for doctors?

Legally yes, for NHS-only work. But it only covers negligence claims, not fitness-to-practise proceedings, disciplinaries, inquests, or private practice, nor employment matters.

What are Medical Defence Organisations, and do IMGs need one?

MDOs offer medico-legal support beyond what NHS cover provides. IMGs especially benefit, since home-country cover doesn't transfer and MDOs can cover you from day one in the NHS, don’t leave it until it's too late!

Why is Medical Defence Shield (MDS) a strong choice of MDO?

MDS is the only Medical Defence Organisation in the UK that offers both Clinical Defence and Employment Support, including clinical/regulatory defence and contract and workplace dispute. Also, International Medical Graduates on their first NHS placement can apply for their first three months of MDS membership free

Medical indemnity is only one part of maintaining your professional standing in the UK.

Doctors who hold a UK licence to practise will also need to engage with the GMC’s appraisal and revalidation requirements.

For International Medical Graduates, this can sometimes be unfamiliar, particularly if you are not yet connected to a designated body, are working intermittently, undertaking locum work, or are practising partly or wholly outside the UK.

Do MDS members receive any support with medical appraisal?

Yes. Medical Defence Shield members can access discounted independent medical appraisal services through DrAppraisals.com. This may be particularly useful for IMGs, locum doctors and doctors without a designated body who need support meeting their annual appraisal and wider revalidation requirements.