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Getting malpractice insurance sorted is rarely the first thing on a new private practitioner’s mind – but George Maughan, Director of Insurance Services at THEMIS Clinical Defence, argues that the first policy you choose can shape your cover for years to come.
Starting private practice brings plenty of decisions: Where to work, how to attract patients and how to manage the costs of getting established. Arranging medical malpractice insurance can understandably feel like another administrative task before the first clinic.
Yet that first arrangement has implications beyond the opening premium and the certificate required to begin working. For me, the distinction is between having insurance and understanding what it provides.
The practice behind the policy
A clinician purchasing their first policy may already have considerable clinical experience. What is new is the responsibility for understanding their own insurance arrangements.
The GMC requires doctors to have adequate and appropriate insurance or indemnity covering the full scope of their practice. NHS indemnity does not automatically extend to separate private work (Choose and Book can have separate arrangements), and most private facilities operating a privileges-based arrangement require clinicians to have access to £10million indemnity limit.
Consider two consultants with similar projected earnings: one intends to offer consultations only; the other will also undertake procedures across several locations. One has been practicing as a consultant for five years; the other has been a consultant for six months. Their income may look alike, but their activities and profile differ. A meaningful opening conversation therefore extends beyond specialty and anticipated revenue.
How today’s arrangements relate to tomorrow’s claims
There are two separate indemnity distinctions worth understanding. Contractual insurance creates enforceable obligations within the policy’s terms; discretionary indemnity provides assistance at the provider’s discretion. Separately, occurrence-based arrangements generally relate to incidents during the covered period, whereas claims-made protection depends on when claims are made and reported, subject to the wording. These labels describe different aspects of an arrangement which are not routinely explained well enough, and at this point in your career, I have been told from consultants that they were told “not to worry” about these terms so early in their career by indemnity providers.
Because claims can emerge years after treatment, the first year’s work may remain relevant long afterwards. Under a claims-made policy, a retroactive date generally identifies the earliest date of work eligible for cover. When changing providers, continuity depends on you ensuring that you have informed a new provider that you were on a claims made basis, and what your retroactive date is.
Run-off or extended reporting arrangements can provide protection for earlier work after active cover ends. Their duration and qualifying conditions vary, making them relevant even when retirement feels distant.
None of this means someone must remain with their first provider. It does however mean that you must understand the run off, or extended reporting period, available to you under any product a clinician considers.
More than a headline limit
Clinical negligence cover is only part of the picture. Depending on the product, additional protections may include regulatory representation, inquest support, medico-legal assistance or reputational support. These are not automatically included, nor does access to a helpline necessarily mean legal representation is covered. Their scope, limits and conditions matter alongside the main indemnity limit.
More benefits do not automatically make a product appropriate for every clinician. Equally, a comparison that overlooks them is incomplete.
Cost remains a legitimate consideration, particularly when establishing a practice. My observation is that understanding what sits behind the premium is just as important as knowing the figure.
A relationship that develops with the practice
The work planned at inception may change. A consultation-only practice might introduce procedures, expand into another location or add medico-legal work. The GMC identifies changes in scope, income and employment or contractual arrangements as reasons to review indemnity, while policy terms may also require particular developments to be disclosed.
That makes an accessible relationship with the provider valuable beyond the initial application.
At THEMIS, our emphasis is on understanding the clinician’s practice and making insurance discussions approachable. Explaining what is covered, where the boundaries sit and what responsibilities accompany the policy is central to that approach.
The first choice matters not because it must be permanent, but because it establishes a foundation for future decisions.
For general information only. This article is not advice or a recommendation to purchase a particular insurance product. Cover depends on the applicable policy wording, schedule, endorsements, limits, conditions and exclusions.
