Insurance for sessional GPs: the cover you actually need in 2026

When you were salaried or in training, most of this was handled for you. Indemnity sat in the background, sick pay was written into your contract, and a death-in-service lump sum came free with the pension. Go sessional and that safety net quietly disappears - apart from the one piece the GMC can pull your licence over. This is the 2026 picture for a UK sessional GP: what is covered for you automatically, what you have to arrange yourself, and where the gaps are that nobody warns you about. It splits into two halves - professional cover (indemnity and medico-legal protection) and personal cover (your income and your family). Figures are 2026 where they change year to year.

1. Start with the one that's a legal requirement

Indemnity is not optional. The GMC requires every doctor to have "adequate and appropriate insurance or indemnity arrangements in place covering the full scope of your medical practice in the UK," and it must be in place by the time you begin to practise. The GMC can refuse to grant a licence, or remove one, if you can't show you're covered. Indemnity for a GP is really two distinct things that people routinely merge: Clinical negligence cover - pays compensation to a patient who is harmed by negligent care. Medico-legal protection - represents and advises you personally: GMC investigations, inquests, complaints, disciplinary and criminal matters. Since April 2019 the first is largely handled by the state. The second is not, and never will be. You need both, and they come from different places.

1. State-backed clinical negligence cover, nation by nation

Before 2019, GPs carried the full cost of clinical negligence cover themselves, with annual defence-organisation subscriptions running into thousands of pounds. State-backed schemes changed that - but they are not UK-wide, and the differences matter the moment you work across a border. England - CNSGP. The Clinical Negligence Scheme for General Practice, run by NHS Resolution, covers clinical negligence liabilities for NHS primary medical services for incidents on or after 1 April 2019. It is automatic, there is no individual payment, and it explicitly covers locums and salaried GPs as well as partners and other practice staff. Claims about incidents before 1 April 2019 fall under a separate scheme, the Existing Liabilities Scheme for General Practice (ELSGP). Wales - GMPI. General Medical Practice Indemnity, managed by the Legal and Risk Services team at NHS Wales Shared Services Partnership (NWSSP), mirrors CNSGP from the same 1 April 2019 date. The catch for locums: you must be on the All Wales Locum Register, and since December 2020 your shifts need to be booked or recorded through Locum Hub Wales to be covered. Scotland - no state scheme. There is no CNSGP equivalent. GPs rely on a medical defence organisation for clinical negligence cover. The 2018 Scottish GMS contract committed the government to working with the defence organisations on indemnity, but unless and until a scheme actually launches, you arrange your own. Northern Ireland - no state scheme. Same position: GP practice work is not covered by a state scheme, so you must hold your own indemnity. Work you do employed by an HSC trust (some out-of-hours, for example) is covered by the trust's own arrangements - but don't assume that extends to your practice sessions. The practical upshot: locum in England or Wales and your NHS clinical negligence is covered the moment you are working in scope. Locum in Scotland or Northern Ireland and it is not - that cover has to come from your defence organisation.

1. Why you still need an MDO - even in England and Wales

CNSGP and GMPI cover exactly one thing: clinical negligence liability for NHS work. They do not touch the situations that actually keep GPs awake at night. The GMC's own guidance lists what state-backed cover excludes and tells you to hold separate cover for it:

Non-NHS and private work - private sessions, insurance and medical reports, occupational health, aesthetics, sports medicine. GMC fitness-to-practise investigations and other regulatory matters. Coroner's inquests and fatal accident inquiries. Complaints handling and disciplinary proceedings. Employment and contractual disputes, and other non-clinical liabilities. Criminal investigations arising from your practice.

None of that is covered by the state schemes - and none of it comes with personal advice or representation. CNSGP indemnifies the liability; it does not put a medico-legal adviser on the phone at 7pm when you've had a letter. That is what membership of a medical defence organisation (MDO) buys. The three are the MDU (Medical Defence Union), MPS (Medical Protection Society) and MDDUS (Medical and Dental Defence Union of Scotland). So even an England-only NHS locum with no private work is strongly advised to hold personal MDO membership for the regulatory, inquest and complaint work CNSGP was never designed to cover. If you do any private or non-NHS clinical work, it stops being advisable and becomes a professional requirement: that work is entirely uncovered by the state. A few things worth knowing about defence-organisation cover as a sessional GP: Price tracks your scope and workload. MDOs rate on your sessions and the risk of your work; private and aesthetic work pushes premiums up. Get a quote for your actual mix rather than assuming a figure. The subscription is a tax-deductible business expense. Tell them what you actually do. Cover is only "adequate and appropriate" if your MDO has an accurate picture of your scope of practice. Update them whenever it changes. Run-off. A claim can surface years after the work was done. The GMC requires you to have arrangements covering liabilities "whenever a claim is brought." Ask your MDO whether your cover is occurrence-based or whether you would need separate run-off cover when you stop or change your work.

1. The gap nobody arranges until it's too late: your income

Now the personal side, and the gap that catches sessional GPs hardest: as a self-employed locum you get no sick pay at all. Statutory Sick Pay is only for employees - the genuinely self-employed don't qualify. And there is no NHS occupational sick pay, because that belongs to an employment contract you no longer hold. For contrast, a salaried GP on the BMA model contract earns occupational sick pay on a service-based scale: roughly one month's full pay plus two months' half pay in year one, rising to six months full and six months half after five years' service. A locum gets none of that. If you are off for three months, your income is whatever you arranged in advance - and nothing more. That is what income protection is for. The features that matter for a locum: Own occupation definition. It pays out if you can't do your own job as a GP - not only if you can't do any job. It is usually the most expensive definition and the one most likely to actually pay a claim. Deferred period. The wait before payments start - commonly 4, 13 or 26 weeks, or a year. With no sick pay sitting behind you, a shorter deferred period matters far more than it would for an employee, though it costs more. How much. Policies typically replace a percentage of your income - often around half to two-thirds - paid monthly until you can return to work or reach retirement. Tax. Benefits from a personal policy you pay for out of taxed income are normally paid tax-free. MoneyHelper's guide to personal insurance for the self-employed is a sensible, non-salesy place to start before you talk to a broker.

1. Life cover: the death-in-service trap for locums

As an NHS employee you get death-in-service life cover free with the pension. Sessional GPs assume they still have it. Often they don't - or not as much as they think. Here is the mechanism. The NHS Pension Scheme pays a death-in-service lump sum - in the 2015 scheme, twice your relevant earnings - plus an ongoing pension for a spouse or qualifying partner and an allowance for children. But for a locum, the BMA is explicit: you are only covered for death-in-service benefits if you die while actively working and contributing to the scheme. Die on a day when you are not contributing and you drop to the much lower "death in deferment" benefit, based only on the pension you have already built up. For a sessional GP that is a real gap, because pensioning locum work isn't automatic - it depends on you submitting your Form A and Form B for every session. Patchy pensioning, or a quiet few months between contracts, can mean patchy life cover. And the lump sum is based on pensionable pay, which for locums is 90% of your fees, and only the fees you actually pensioned. If anyone depends on your income - a mortgage, a partner, children - the fix is straightforward: a personal term life insurance policy sized to your real obligations, which pays out regardless of whether you happened to be working and contributing that week. Don't assume the NHS lump sum will be there.

1. Critical illness cover (optional, but understand what it is)

Critical illness cover pays a one-off, usually tax-free lump sum if you are diagnosed with one of a specific list of serious conditions - typically heart attack, stroke and certain cancers. It is not income protection: it pays only for listed conditions, and the common reasons GPs take time off - back problems, stress - generally aren't covered. It is usually bought alongside life or income protection rather than instead of them. For most sessional GPs the priorities are income protection (covers most illness, pays an ongoing income) and term life (covers death); critical illness is a top-up if you specifically want a lump sum to clear a mortgage on diagnosis.

1. One label not to get confused by: "locum insurance"

Search "locum insurance" and you will mostly find products aimed at practices, not at you. Practice-side "locum insurance" reimburses a surgery for the cost of hiring a locum when a partner or staff member is off sick or on parental leave. It protects the practice's finances, not the locum's. It does nothing for your income, your indemnity or your life cover - those are the policies in sections 3 to 6, and they are yours to arrange. Your sessional cover checklist

MDO membership (MDU / MPS / MDDUS) - for GMC matters, inquests, complaints, private work and criminal investigations. Needed everywhere; and it is the only clinical negligence cover in Scotland and Northern Ireland. State clinical negligence cover confirmed - CNSGP (England) is automatic; GMPI (Wales) needs the All Wales Locum Register plus Locum Hub Wales. Income protection - own occupation, with the deferred period set for the fact that you have no sick pay. Term life insurance - if anyone depends on your income; don't rely on NHS death-in-service. Critical illness - optional lump-sum top-up. Keep your MDO and insurers updated on your actual scope - and review whenever it changes.

FAQ I only do NHS sessions in England. Do I really need an MDO if CNSGP covers me? CNSGP covers clinical negligence liability, but not GMC investigations, inquests, complaints or disciplinary matters, and it gives you no personal representation or advice. The GMC and the defence organisations both advise keeping personal membership for exactly those situations. Does CNSGP cover my private work? No. Any private or independent practice, anywhere in the UK, sits outside CNSGP and GMPI. You must arrange your own indemnity for it. I'm a locum in Scotland. What is my clinical negligence cover? Your MDO. There is no state-backed scheme in Scotland (or Northern Ireland), so it must come from membership. Do I get any sick pay as a locum? No - not Statutory Sick Pay (that is for employees) and not NHS occupational sick pay (that is a salaried/employed benefit). Income protection is the substitute you arrange yourself. Is my income protection payout taxed? Benefits from a personal policy you fund from taxed income are normally paid tax-free. Won't the NHS pension pay a death-in-service lump sum if I die? Only if you die while actively contributing to the scheme. As a locum that depends on keeping your Form A/B pensioning up to date; on a non-contributing day you fall to the lower death-in-deferment benefit. Personal term life cover closes that gap. Sources

GMC: Insurance, indemnity and medico-legal support for doctors NHS Resolution: Clinical Negligence Scheme for General Practice (CNSGP) NHS Wales Shared Services Partnership: General Medical Practice Indemnity (GMPI) GOV.WALES: General Medical Practice Indemnity - frequently asked questions BMA: State-backed GP indemnity scheme MDDUS: Clinical negligence scheme for general practice Medical Protection (MPS): GP state-backed indemnity questions and answers GOV.UK: Statutory Sick Pay - eligibility Acas: Statutory Sick Pay BMA: Salaried GP handbook BMA: Death in service and your pension BMA: The NHS pension scheme as a sessional GP BMA: Locum GP cover for parental and sickness leave MoneyHelper: What is income protection insurance? MoneyHelper: What is critical illness cover? MoneyHelper: Personal insurance when you're self-employed Drewberry: Income protection for doctors

This is general information, not financial or legal advice. The cover that is "adequate and appropriate" depends on your circumstances - confirm your indemnity position with your medical defence organisation, and take regulated advice before buying any personal protection product.