In the UK, what’s usually called “malpractice insurance” in the US is known as medical indemnity insurance, or simply indemnity cover. Both describe the same thing: protection for a doctor against the cost of a claim arising from their clinical work.
Indemnity cover pays for legal defence costs and, where a claim succeeds, any compensation awarded. It’s negotiated and, in most cases, handled entirely on the doctor’s behalf, so the individual physician isn’t left to fund their own defence.
In short: NHS work is covered by a state indemnity scheme, but any private or non-NHS work, along with things like GMC hearings or expert witness reports, needs separate cover. Physicians can get that cover either through a traditional medical defence organisation or through a regulated insurance policy, and the GMC requires every licensed doctor to have adequate cover in place at all times.
What Medical Indemnity Insurance Actually Covers
Cover isn’t one single policy that follows a doctor everywhere. What applies depends on who the work is for and where it takes place.
NHS Work
Hospital doctors working for an NHS trust are indemnified through the Clinical Negligence Scheme for Trusts (CNST), run by NHS Resolution. GPs are covered in the same way through the Clinical Negligence Scheme for General Practice (CNSGP), in place since April 2019.
These schemes are comprehensive for clinical negligence claims, but they stop at the edge of NHS clinical work. They don’t cover inquests, GMC proceedings, employment disputes, or anything outside strictly clinical care.
Private Practice and Other Non-NHS Work
Any private or independent practice needs its own indemnity or insurance, even if the work happens on NHS premises. This includes private clinics, cosmetic procedures, occupational health work, and medico-legal reporting.
A doctor who only ever worked for the NHS and never realised their private list wasn’t covered by CNST could find themselves personally exposed to a claim, which is exactly the gap indemnity cover for private work exists to close.
Discretionary Indemnity vs Contractual Insurance
Doctors arranging their own cover generally choose between two different models, and the difference between them matters more than it first appears.
Medical Defence Organisations
The traditional route is membership of a medical defence organisation (MDO), such as the MDU, MPS, or MDDUS. Assistance from an MDO is discretionary rather than contractual, meaning the organisation isn’t legally bound to help with any specific case, though in practice it usually does.
MDOs sit outside FCA regulation, so members don’t get the same statutory protections, such as guaranteed payouts or a right to complain to the Financial Ombudsman, that come with a regulated insurance policy.
FCA-Regulated Insurance Policies
Since the GMC clarified in 2019 that “adequate and appropriate” cover can be either discretionary indemnity or a contractual insurance policy, a growing number of doctors have moved to FCA-regulated products. These are legally binding, meaning the insurer must pay a valid claim under the policy terms.
| Discretionary Indemnity (MDO) | Contractual Insurance | |
|---|---|---|
| Legal obligation to pay | No, decided case by case | Yes, binding under the policy |
| Regulator | Not FCA-regulated | FCA and PRA regulated |
| Traditional providers | MDU, MPS, MDDUS | Various FCA-authorised insurers |
| Complaints route | Internal to the MDO | Financial Ombudsman Service |
How Much Cover a Physician Actually Needs
There’s no single correct figure. The right level of cover depends on a handful of real variables, not a flat rate that applies to every doctor.
What Affects the Level of Cover
Specialty is the biggest factor, higher-risk specialties such as obstetrics, neurosurgery, and cosmetic surgery carry higher premiums than lower-risk fields. Scope of practice, claims history, and whether work is NHS, private, or a mix all affect it too.
Cover for Medico-Legal and Expert Witness Work
Preparing expert reports or giving evidence in court is a distinct professional activity, separate from treating patients, and state schemes like CNST and CNSGP don’t cover it. Doctors who take on this work generally need a specific extension to their MDO membership or insurance policy.
Prof. Sandip Hindocha, the UK’s National Lead Forensic Medical Examiner and a member of the Faculty of Forensic & Legal Medicine, holds indemnity for his medico-legal work through Harley Street Legal separately from his NHS clinical indemnity, in line with this requirement.
What Happens Without Adequate Cover
The GMC has a statutory duty to check that licensed doctors have adequate and appropriate indemnity, and can refuse or remove a licence where that isn’t in place.
This is a registration issue, not just a financial one. A doctor practising without adequate cover risks their ability to practise at all, regardless of whether any claim has actually been made against them.
Frequently Asked Questions
Is medical malpractice insurance the same as medical indemnity insurance? Yes, they describe the same protection. “Malpractice insurance” is the term used in the US, while “medical indemnity insurance” or “indemnity cover” is the standard UK term for the same thing.
Does the NHS cover all of a doctor’s clinical work? No. NHS indemnity schemes like CNST and CNSGP only cover NHS clinical work. Private practice, GMC hearings, inquests, and expert witness work all fall outside that cover and need arranging separately.
Can a doctor choose not to have any indemnity cover? No. The GMC requires every doctor with a licence to practise to have adequate and appropriate cover in place, and can take action against a doctor’s registration if they don’t.
Is discretionary indemnity worse than insurance? Not necessarily worse, but it works differently. Discretionary indemnity relies on the provider’s judgement in each case, while a regulated insurance policy is a binding contract that must pay a valid claim, with a formal complaints route if it doesn’t.
Do expert witnesses need separate indemnity from their clinical cover? Yes. Expert witness and medico-legal work sits outside NHS indemnity schemes and often outside standard clinical cover too, so most doctors doing this work arrange a specific extension for it.
Prof. Hindocha prepares expert reports and independent medical reviews for solicitors, insurers, and courts across the UK. Details of his expert witness services and how to instruct him are on the instruction page.
This article is general information about how medical indemnity and insurance cover works for UK physicians and is not a substitute for advice from an indemnity provider or insurance broker on a specific policy.