MDU, MPS, MDDUS: what actually differs for locum GPs

CNSGP covers NHS clinical negligence for GPs from April 2019. Discretionary indemnity from the Medical Defence Union (MDU), Medical Protection Society (MPS), or Medical and Dental Defence Union of Scotland (MDDUS) covers everything else. For a locum GP, everything else is a lot: private work, GMC proceedings, coroner's inquests, inquiries, good-Samaritan acts, complaints, and press representation. The choice between the three is about service and fit more than about headline fees.

Cost

All three organisations quote individually, and we are not going to print a range for you, because the number that matters is the one they quote you. Get a quote from each. What moves it:

• Session count per week
• Whether you do any private GP work alongside NHS
• Whether you do any aesthetic work (generally excluded or surcharged)
• Years qualified (newly qualified GPs pay less)
• Which nation you practise in

Quotes for the same GP can differ by hundreds of pounds between the three, in either direction, and the ordering changes with the profile. Anyone who tells you which one is cheapest without seeing your session pattern is guessing.

What discretion actually means

None of these bodies guarantee cover. They have discretion to refuse a claim if, for example, you did not act in good faith. In practice, refusals for genuine locum work are very rare, but "discretionary" is not the same as an insurance contract, which is why the FCA regulates some defence products as insurance but not all.

MDU offers insurance-backed products for some risks alongside discretionary cover. MPS and MDDUS are discretionary across their offering. The distinction matters for:

• Certainty: an insurance contract has enforceable terms
• Cover persistence: discretion can be withdrawn
• Historical claims: what happens if you cancel or switch

Ask specifically which of your risks are insurance-backed and which are discretionary when you renew.

Service quality

This is where GPs vary most in their loyalty.

Responsiveness. How quickly do they get back on an out-of-hours query? Try asking each one a trivial question before joining; the response time and tone tell you plenty.

Named case handlers. When a complaint lands, do you get a named barrister or a case-handling pool? Named handlers build familiarity with your case; pools lose time at every handover.

GMC experience. Most locum GPs never face a GMC case. When one happens, it is weeks of your life. Ask directly: how many GMC cases do you handle annually; who represents me; how many go to tribunal.

CPD and education. All three offer member CPD. Content varies. Some GPs move between them every few years partly for the education.

Quirks worth knowing

• Run-off cover after you retire or leave practice: terms vary. Discretionary organisations commit to cover historical work but with discretion; retirement-specific products differ.
• International work: cover for overseas sessions varies, and the terms change. Ask each organisation directly about the specific country and the specific work, and get the answer in writing before you travel.
• Aesthetic and cosmetic work: all three scrutinise this carefully. Surcharges or exclusions common. Get the confirmation in writing before you start the service.
• Telemedicine: all three cover UK-to-UK consultations. Consultations to patients outside the UK are a separate conversation.

CNSGP, what it does and does not cover

CNSGP (Clinical Negligence Scheme for General Practice, run by NHS Resolution) covers NHS clinical negligence for GPs and their practice team from 1 April 2019. It is automatic, you do not apply, and free.

What it does not cover:

• Private work, including aesthetic, insurance-medical, and occupational-health
• GMC investigations and referrals
• Complaints handling
• Coroner's inquests
• Disciplinary or employment issues
• Good-Samaritan acts off duty

So CNSGP is necessary but not sufficient. You still need discretionary indemnity for everything else.

Choosing

Most locum GPs make the decision on recommendation from colleagues plus one of these:

1. A bad experience with one organisation's response time
2. A specific private-practice risk that one organisation handles better
3. A material fee difference for cover they judge to be equivalent

None of the three offers a free trial: a year's membership is a year's subscription, paid for. If you are unhappy after a year you can move, and switching is not complicated as long as you notify both organisations of the overlap and confirm continuity of cover. Just do not think of the first year as a trial.

What not to do

• Do not cancel existing cover before the new one confirms. Even a day's gap in run-off cover can matter if a historical claim surfaces.
• Do not assume employer indemnity extends to locum work. It rarely does.
• Do not let a quote become "confirmed cover" in your head. You have cover when you have a membership number and a certificate, not before.

Sessional stores your indemnity certificate alongside your other professional documents and sends a reminder 30 days before expiry. See our documents guide.

For information only, not regulated advice. Check with a qualified accountant or adviser.