Information for GPs working in Out of Hours regarding General Medical Practice Indemnity (GMPI) cover

The Scheme for General Medical Practice Indemnity (GMPI) is a discretionary state-backed scheme that covers clinical negligence claims for incidents occurring on or after 1 April 2019.

The indemnity coverage differs significantly depending on how the GP is engaged:

1. Out of hours services (OOH) provided via contractual arrangements between a Health Board and an independent provider/sub-contractor, are captured by the scheme for GMPI. This includes any locum or agency staff who are engaged via such independent provider/sub-contractor. However, all locum doctors who are engaged by an independent provider sub-contractor (other than those doing locum work solely in their own GP practice) are required to join the All Wales Locum Register, to have access to the scheme for GMPI

2. Any employees, locum, agency or bank workers who are directly engaged by a Health Board are captured by standard NHS indemnity arrangements. (this is not GMPI) 

So you need to be quite clear as to your employment status and if it qualifies for section one then you are covered under the GMPI and need to be on the whole Wales register but don't have to document every Out Of Hours shift.

So for peace of mind individuals should get clarity about their contractual status with the health board and then contact their indemnity provider to see if they are covered.

The other burning question is all the guidance talks about Out Of Hours services and again clarification would need to be gained from GMPI regarding NHS111 which operates in hours.

Dr Nimish Shah

OOH Remote Prescribing Risks

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.

Home visits to undertake influenza vaccinations as part of the 2025-26 influenza vaccination requirements

Regarding provision of home visits for flu vaccinations and the recent direction of patients from the immunisation team.

We understand the significant capacity pressures the practice is currently facing, particularly when managing "opportunistic" vaccination alongside routine care. However, we have reviewed the 2025-26 PCCS:I Service Specification, and we must clarify the practice's obligations to ensure you remain compliant with the contract you have signed.

Contractual Requirements and Equality

Under the service specification for Immunisations and Vaccinations, the practice is responsible for delivering the service to its eligible registered population. Specifically, regarding accessibility, the specification (page 25, sections s–u) states:

• Accessibility: Services must be accessible, appropriate, and sensitive to the needs of all persons.

• Equality Act 2010: Eligible persons must not experience "particular difficulty" in accessing the service due to protected characteristics, specifically disability.

• Home Visiting: If a patient has a disability or clinical condition that prevents them from attending the surgery, the practice is required to provide a reasonable adjustment to ensure they are not excluded. In this context, that adjustment may be a home visit.

Determining Eligibility for Home Visits

While the immunisation team may be directing patients to you, the practice retains the clinical responsibility to determine if a home visit is strictly necessary.

A home visit should be reserved for those who are truly housebound due to illness or disability. If a patient is physically able to attend the surgery (or does so for other appointments), the practice is within its rights to insist they attend a clinic. However, if a disability truly prevents them from attending, the PCCS:I framework requires the practice to facilitate the vaccination at their place of residence.

You could as per section (u) of the specification, if capacity makes this impossible, you should engage with the Local Health Board to discuss how they can support your equality plan for under-served or housebound groups.

Failure to provide these visits for eligible disabled patients could be viewed as a breach of both the PCCS:I specification and the Equality Act 2010.

We hope this clarifies the guidance but ultimately it is up to the practice that they do not discriminate against a patient who has a true disability that prevents them from leaving their house.

Your practice may wish to take this into consideration in deciding on whether to participate in next year's influenza campaign.