- Phil Cox
- 2 min read
Prepared by Dr Nimish Shah January 2026
Overview
The LMC have received reports of increasing pressure on GPs to sign prescriptions for remote clinicians—including non-GP specialists—within the Out of Hours (OOH) service. The feedback the LMC have received suggests that the current "Crown Indemnity" assurance may be creating a false sense of security. While it provides financial cover for the Health Board, it does not mitigate the personal professional risk to a GP's registration when signing for a clinical assessment they did not perform.
This briefing note covers:
The distinction between Financial Indemnity and Professional Défense
The specific risks of signing for non-GP specialists (e.g., Paediatricians)
The contractual obligations and the role of the LNC in negotiating these terms
1. The Core Risk: Responsibility vs. Cover
There is a significant distinction between financial protection and professional protection. It is vital that clinicians understand the limits of Health Board cover:
Financial Indemnity (Health Board/Crown Indemnity): This covers the financial cost of a clinical negligence claim (payouts to patients). It does not provide personal legal representation.
Professional Protection (MDOs e.g., MPS, MDU): This provides legal defense for GMC investigations, Coroner’s Inquests, and Disciplinary hearings.
Key takeaway: A GP who signs a prescription based on a remote assessment they did not perform inherits the legal responsibility for that prescription. If the assessment is later found to be flawed, the "signer" remains accountable to the GMC.
2. Specialist-to-GP Prescribing (Paediatrics)
The recent request for GPs and Pharmacists to sign for remote Paediatricians carries a heightened professional risk:
Scope of Practice: GPs are frequently asked to sign for dosages or medications (e.g., weight-based calculations or off-license uses) that sit outside standard primary care guidelines.
GMC Guidance: Good practice in prescribing (2021) states that you must only prescribe if you have sufficient knowledge of the patient’s health and are satisfied that the medication is clinically justified.
3. Contractual & Negotiation Routes
Responsibility is often dictated by the "fine print" of employment:
Individual Contracts: GPs must verify if "remote cross-signing" is a specified duty in their signed OOH contract. If it is a contractual requirement, the GP is obliged to perform it, provided it is clinically safe.
Local Negotiating Committee (LNC) Role: While the LMC represents the profession broadly, the LNC is the formal body responsible for negotiating terms for those on Health Board contracts. Collective disputes regarding these working conditions should be escalated through the LNC.
4. Recommendations for GPs
Seek Individual Advice: Every GP should contact their Medical Defence Organisation (MDO) for a written opinion regarding their specific OOH role and the "line of sight" required for safe signing.
Document Concerns: If signing under protest or due to contractual obligation, ensure the rationale and the remote clinician's details are clearly logged.
Competence First: If a prescription feels clinically unsafe or is outside your competence, you have a professional right (and duty) to decline and suggest an alternative pathway.