Clinical Indemnity For Neurosurgeons: A Comprehensive Guide

As a neurosurgeon, you will know all too well just how important accuracy in medicine can be. However, mistakes can happen.

Even with the steadiest hand and all the experience in the world, the intricacies of working as a neurosurgeon make patient misdiagnoses, informed consent issues and accidental surgical injuries all unfortunate associated risks1.

That’s why having suitable protection in place is so crucial.

In this guide, we will take you through everything you need to know about clinical indemnity for neurosurgeons, including what it is, the various benefits it can offer, and how to source tailored coverage that specifically protects you in your role as a neurosurgeon.

Why do I need clinical indemnity?

Whether it be performing a craniotomy or deep brain stimulation, without the right level of understanding, concentration and impeccable precision, claims of medical malpractice or negligence can not only affect patient safety2 but also put your professional reputation at risk.

While no good neurosurgeon ever sets out to make a mistake, clinical indemnity is designed to protect you should the worst happen.

If, for example, a patient suffers a stroke from an unintentional injury while performing a craniotomy, having the right type of clinical indemnity policy in place can protect you from any potential claim by this patient. It also provides them with some form of potential compensation that you – or your practice – won’t need to pay out for.

In other words, personal clinical indemnity is there to protect both you and your patients. It helps offer peace of mind, covering any unexpected legal expenses and providing access to a wide variety of medico-legal resources and support.

Is clinical indemnity compulsory for neurosurgeons?

In compliance with The Health Care and Associated Professionals Order 20143, all regulated healthcare professionals are required to have personal indemnity or corporate clinical indemnity coverage.

However, determining the correct type and extent of cover you need will vary depending on where you work, your responsibilities and whether you are employed or self-employed.

If you are employed by the NHS (or HSC in Northern Ireland), you will typically receive coverage through a clinical negligence scheme related to the country you work in the UK:

  • Neurosurgeons in England – coverage is provided by the Clinical Negligence Scheme for Trusts
  • Neurosurgeons in Wales – coverage is provided by the Welsh Risk Pool Services
  • Neurosurgeons in Scotland – coverage is provided by the Clinical Negligence & Other Risks Indemnity Scheme
  • Neurosurgeons in Northern Ireland – coverage is provided by each individual HSC Trust

If you are employed by a trust or board in the NHS or HSC, there is no legal requirement for you to purchase clinical indemnity.

On the other hand, if you work as a consultant in an independent practice, the General Medical Council states that you must have “adequate and appropriate insurance or indemnity in place”.4

What types of clinical indemnity are there?

Clinical indemnity is a complicated area and, unfortunately, there isn’t a one-size-fits-all policy that meets the needs of all neurosurgeons.

Depending on certain factors like your level of experience and the complexity of the surgeries you perform, finding a policy that covers all of your specific needs and responsibilities can be easier said than done.

That’s why, as a first port of call, it’s important to talk to an insurer with specialist experience in the area. Simply get in touch with our team and we’d be happy to discuss your requirements.

Discretionary vs. contractual: what’s the difference?

Most neurosurgeons will be protected by either discretionary or contractual indemnity cover. However, both types of coverage come with their various benefits and drawbacks, which we have broken down in more detail below.

Discretionary indemnity

As its name suggests, discretionary medical indemnity is operated on a discretionary basis. This means that it is down to your provider whether to cover you in the event of a claim or not, with generally no rules available to explain how discretion is used and no guarantee that it’ll pay out when you need it to.

Discretionary cover is typically provided by medical defence organisations (MDOs). When a claim comes in, the MDO will assess it individually before deciding, at their discretion, whether to provide you with financial assistance and legal representation or not.

As discretionary indemnity offered in this way is not regulated by the Financial Conduct Authority (FCA) or Prudential Regulation Authority (PRA), there is no obligation for the MDOs to treat customers fairly or meet strict criteria set by insurance regulators to hold enough capital to meet future claims.

Therefore, if you are considering taking out discretionary indemnity – or have this type of policy already – you might not be protected in the same way you think you are.

Contractual indemnity

Contractual indemnity acts like your normal day-to-day insurance policy, offering a form of protection that operates under a contractual agreement between you and the insurance provider.

Your policy will be tailored around your exact needs and responsibilities, offering specific coverage based on the terms and conditions outlined within the policy itself.

Should a claim ever be made against you that falls within the scope of your policy, having contractual indemnity obligates your provider to offer legal support that protects your reputation and pays out in the event of a successful claim.

There is no risk of a claim being turned down on discretionary grounds – contractual cover is regulated by the FCA and providers must treat you fairly and honour the contractual obligations set out in the policy you have purchased.

Which is better?

While the right choice will vary depending on the specific circumstances involved, contractual indemnity is the only form of guaranteed protection, offering distinct advantages to anyone looking for complete peace of mind.

Plus, in light of the Department of Health and Social Care’s ongoing consultation to investigate appropriate clinical negligence cover for regulated healthcare professionals, as has happened in Australia (where discretionary indemnity can no longer be purchased for medical malpractice), discretionary cover could soon be a thing of the past in the UK after numerous healthcare professionals stated that it was “not fit for purpose”.5

This coincides with the General Medical Council (GMC) also recently publishing updates to their Good Medical Practice for 2024 that not only highlight the need to regularly review your policy but also ensure that your cover is “appropriate” and protects you in the areas you expect6.

Sourcing the right type of indemnity policy

When it comes to finding the right type of clinical indemnity, there are several factors you’ll need to consider – especially in terms of the insurer you decide to go with. Here are some of the key questions you’ll need to seek answers to:

  • Are they clinical indemnity specialists? It’s important to choose a provider that not only understands the challenges the world of healthcare can bring with it but also provides policies specifically to healthcare professionals.
  • What is their claims handling process? Your insurer should have a dedicated team experienced in dealing with medical malpractice claims. They should also be able to provide you with efficient and accessible legal advice throughout the claims process.
  • Do they offer risk management resources? As with neurosurgery, education is power. Therefore, you should opt for an insurer that offers educational materials, training programs and best practice guidelines to help mitigate risk management.

Switch to THEMIS for reliable clinical indemnity

Here at THEMIS, we have already helped neurosurgeons from all over the UK not only save significant sums of money on their indemnity, but also relax knowing that they have a specialist policy. This can then provide them with complete peace of mind and let them focus on what they do best: helping patients without worrying about litigation or discretional risk.

By harnessing the power of artificial intelligence (AI) within our services, we can provide competitive premiums that accurately reflect your complex risk. We can also safeguard your professional and personal reputation by offering clear coverage that can automatically respond to any sudden changes in risk.

To find out more about switching your policy to us, simply contact our team and we’d be happy to answer any queries you might have.

Important Note

This article is intended to raise awareness to clinical risk issues in an effort to reduce incidence recurrence and improve patient safety. This is not intended to be relied upon as advice. Facts have been altered to ensure this case is non-identifiable, albeit clinical learning points remain applicable.