The MYRO Briefing

Do You Really Know What Your Indemnity Covers?

Doctors who hold a licence to practise and are practising medicine in the UK are required by law to have “adequate and appropriate” indemnity or insurance covering the full scope of their practice. It is a condition of holding a licence — and failure to maintain appropriate cover may place a doctor’s registration and licence to practise at risk, including regulatory action. Yet in practice, the arrangements that doctors rely on vary enormously, and each type carries limitations that are poorly understood until something goes wrong.

Section 44C of the Medical Act 1983 requires that a licensed practitioner must have in force an indemnity arrangement providing “appropriate cover… having regard to the nature and extent of the risks of practising as such.” The GMC’s updated Good Medical Practice (2024) reinforces this, requiring doctors to ensure their cover extends to the “full scope” of their practice and to keep it under “regular review.” What the GMC does not do — deliberately — is prescribe a minimum level of cover in pounds. The test is contextual and risk-based, which places the burden squarely on the individual doctor to assess their own position.

Medical Defence Organisations — Discretionary, Not Contractual

The three main MDOs — the Medical Protection Society, the Medical Defence Union and the Medical and Dental Defence Union of Scotland — provide what is technically discretionary indemnity, not insurance. Unlike an insurance policy, which creates a contractual obligation to pay claims that fall within the policy terms, MDO membership provides assistance on a discretionary basis rather than as a contractual entitlement. That distinction can become critical where issues arise around eligibility for support.

MDOs are not insurers, although associated entities may undertake limited FCA-regulated activities. The discretionary nature of assistance is not theoretical: in Hussain v Medical Defence Union (2020), a surgeon’s assistance was withdrawn after under-declared earnings were identified. In 2017, the MDU withdrew support for certain categories of private spinal surgery. Doctors restored to the register after erasure may also find it difficult to obtain discretionary support, depending on the circumstances.

Commercial Insurance — Contractual, But How Much Is Enough?

A doctor who holds their own commercial indemnity policy has a contractual entitlement to cover within the policy terms. These policies are FCA-regulated, with defined policy wording and limits. Cover is typically available in bands — £1 million, £5 million, £10 million per claim — and the doctor selects a level based on their risk profile. The difficulty is that no regulator publishes definitive guidance on what level constitutes “adequate and appropriate.” Policy terms also require careful scrutiny, including exclusions, notification requirements, and conditions affecting the scope of cover.

NHS Indemnity — Narrower Than Most Doctors Realise

Doctors who work in the NHS, or whose organisations carry out NHS work, may be covered by NHS Resolution schemes such as the Clinical Negligence Scheme for Trusts. This covers clinical negligence liabilities arising from NHS work — and is not a comprehensive medico-legal protection scheme.

The gaps are often misunderstood. NHS indemnity does not provide general cover for GMC fitness to practise proceedings, criminal matters, or employer disciplinary processes. It does not extend to private practice, even where this is undertaken on NHS premises. Nor does it cover “Category 2 work” — including reports for courts or third parties, cremation forms, and other non-NHS services — for which separate indemnity arrangements are typically required. Doctors should not assume that representation at inquests or similar proceedings is comprehensively covered, as this may be limited or context-specific.

Company Policies — The Condition Precedent Trap

A significant risk arises where a doctor relies on their employer’s corporate indemnity policy. The scenario is common in the independent sector: a doctor joins a private clinic, is told they are covered by the company’s insurance, and gives it no further thought. The difficulty is that some corporate policies contain conditions requiring individual practitioners to maintain their own separate professional indemnity. These provisions are often found only in the full policy wording, rather than in summary documents. Where such a condition is not met, it may affect the availability of cover when a claim arises.

What Should Doctors Do?

Every doctor should be able to answer four questions about their indemnity position:

1. 1.What type of cover do I have — discretionary indemnity, contractual insurance, NHS indemnity, or employer cover?
2. 2.Does my cover extend to everything I do — including private work, medico-legal work, and any other activity outside my primary employment?
3. 3.What does my cover exclude — and do I have separate arrangements for GMC proceedings, inquests, and criminal matters?
4. 4.If I rely on my employer’s policy, have I reviewed the full policy wording and confirmed whether any additional personal cover is required?

If the answer to any of these is uncertain, the time to resolve it is now — not when a claim arises.

Read the GMC’s guidance on insurance and indemnity →