Doctors and indemnity: GMC requirements and the role of the MDU and MPS
Reviewed by Apex Insurance Brokers · Last reviewed 2026-08-05
Clinical indemnity is not optional paperwork — it is a condition of holding a licence to practise medicine in the UK. But the arrangements differ sharply depending on whether you work for the NHS, in private practice, or both. This guide explains what the General Medical Council (GMC) actually requires, how the state schemes fit alongside the medical defence organisations, and why doctors who also run a business must not confuse clinical indemnity with commercial professional indemnity (PI).
What the GMC requires
Since 2015 it has been a statutory requirement for doctors with a licence to practise to hold indemnity or insurance. The obligation was introduced through amendments to the Medical Act 1983 and the associated indemnity arrangements legislation, and is reflected in the GMC’s guidance in Good medical practice.
The standard the GMC sets is that cover must be ‘adequate and appropriate’ for the full range of work you do. Note what this is — and is not:
- It is not a single fixed minimum figure set by the GMC. The regulator does not publish a flat £X limit that applies to every doctor.
- ‘Adequate’ relates to the likely scale and value of claims arising from your work — a high-risk surgical or obstetric practice needs materially more cover than low-risk work.
- ‘Appropriate’ means the arrangement must actually respond to the type of work you do — the right scope, the right specialties, and cover that will be available when a claim eventually surfaces.
You are responsible for making sure your cover is in place and remains adequate as your practice changes. If you take on new procedures, a new specialty, or private patients for the first time, your existing arrangement may no longer be appropriate. Always check the GMC’s current published guidance for the wording in force, as regulatory guidance is periodically updated.
NHS work: the state-backed schemes
Most doctors doing NHS work do not buy their own clinical indemnity for that work — it is provided through state-backed schemes administered by NHS Resolution (in England):
- Clinical Negligence Scheme for Trusts (CNST) — covers clinical negligence liabilities for NHS trust employees, including hospital doctors carrying out their NHS duties.
- Clinical Negligence Scheme for General Practice (CNSGP) — introduced in April 2019, this covers clinical negligence liabilities arising from NHS GP work in England.
The devolved nations run their own equivalents — for example general medical practice indemnity in Wales and separate arrangements in Scotland and Northern Ireland. The key point: these schemes generally cover NHS clinical negligence only. They typically do not extend to private practice, to GMC fitness-to-practise investigations, disciplinary matters, inquests, or Good Samaritan acts. That gap is exactly why doctors still hold membership of a defence organisation even when the bulk of their clinical work is NHS.
Private work: the role of the MDU and MPS
For private clinical work — and for the medico-legal support the NHS schemes do not provide — doctors traditionally turn to a medical defence organisation (MDO). The best known are:
- Medical Defence Union (MDU)
- Medical Protection Society (MPS)
- Medical and Dental Defence Union of Scotland (MDDUS)
Historically, the core benefit these bodies offer is discretionary indemnity: the organisation has a discretion over whether to assist with a claim, rather than a contractual promise to pay under an insurance policy. In practice they also provide medico-legal advice, representation at GMC investigations and inquests, and help with complaints — support that goes well beyond a pure negligence payout. Some MDOs now also offer, or partner to offer, insurance-backed products that provide a contractual right to indemnity. When choosing, it is worth understanding which type of arrangement you are being offered.
| Feature | Discretionary indemnity (traditional MDO) | Insurance-backed cover |
|---|---|---|
| Right to be paid | At the organisation’s discretion | Contractual, per the policy terms |
| Regulation | Not a contract of insurance | FCA-regulated insurance contract |
| Wider support | Advice, GMC cases, inquests, complaints | Varies by policy — check the wording |
| Basis | Often occurrence-style; check terms | Often claims-made; check terms |
Whichever route you take, the doctor remains responsible for ensuring the overall arrangement meets the GMC standard. Talk to a broker about your private-practice cover if you are unsure whether your current arrangement is adequate and appropriate.
Keep clinical indemnity separate from commercial PI
This is where doctors most often get caught out. Clinical negligence indemnity protects you against claims arising from patient care. It is a different thing from the commercial professional indemnity insurance a business needs.
If you operate a private clinic through a limited company, provide medico-legal reports, sit on advisory boards, act as an expert witness, or offer consultancy and training, those activities can create liabilities that clinical indemnity was never designed to cover. A company or partnership may also need cover such as:
- Professional indemnity (PI) for advice, reports and non-treatment services provided by the business.
- Public liability for injury or damage on the premises (a patient slipping in the waiting room, for example).
- Employers’ liability, which is legally required if you employ staff such as receptionists or nurses.
- Management liability or directors’ cover for those running the corporate entity.
Commercial PI limits are usually expressed as generic options such as £1m, £2m or £5m per claim, chosen against the value of the work and any contractual requirements. Do not assume your MDO membership fills these gaps — check exactly what each arrangement responds to, and make sure the boundary between your clinical indemnity and your business insurance is clear and complete.
Running a private clinic or consultancy alongside your clinical work? Make sure the commercial side is properly covered.
Get a PI quote →A practical checklist
- Confirm which of your activities are NHS (state-scheme covered) and which are private (not).
- Hold appropriate clinical indemnity — via an MDO or insurer — for all private clinical work and for medico-legal support.
- Understand whether your indemnity is discretionary or contractual, and on what basis it responds.
- Separately arrange commercial PI and any business insurance for your company or consultancy work.
- Review cover whenever your scope of practice changes, and check the GMC’s current published guidance.
Common questions
Does the GMC set a minimum indemnity figure for doctors?
No. The GMC requires cover that is ‘adequate and appropriate’ for your scope of work rather than a single fixed monetary minimum. What counts as adequate depends on the risk and likely claim value of what you do. Check the GMC’s current guidance for the wording in force.
If all my work is NHS, do I still need my own indemnity?
The state schemes generally cover NHS clinical negligence only. Many doctors still keep MDO membership because those schemes typically do not cover GMC investigations, inquests, disciplinary matters, complaints or Good Samaritan acts — and never cover private work.
Is my MDU or MPS membership the same as professional indemnity insurance for my clinic?
No. Clinical indemnity covers patient-care claims. A private clinic operating as a business may also need commercial PI, public liability and employers’ liability. These are distinct products and should be arranged separately.
Apex Insurance Brokers Limited is authorised and regulated by the Financial Conduct Authority (FRN 724952). This guide is general information, not advice on a specific policy or a substitute for your policy wording.