Consultants who split their week between NHS sessions and private practice sit at an indemnity boundary that is often misunderstood. NHS work carries an employer-provided scheme; private practice does not. This entry maps the boundary, sets out the two main routes to cover, and highlights the practical considerations that shape the choice.
NHS Resolution (formerly the NHS Litigation Authority; statutory footing under the National Health Service Act 2006) administers the Clinical Negligence Scheme for Trusts (CNST). CNST indemnifies NHS trusts, and by extension the doctors they employ, for clinical negligence claims arising out of NHS treatment. If a consultant is treating an NHS patient in an NHS setting under an NHS contract, the trust and CNST stand behind the claim.
The scope is defined by the work, not the person. A consultant who also runs a private list at a Bupa or Spire hospital, or takes AXA PPP or Vitality-funded referrals into a private clinic, steps outside CNST the moment the patient becomes a private patient. Private work is a personal professional activity, and the consultant carries that indemnity risk personally.
Consultants have two established options for private work: a medical defence organisation (MDO), or a commercial professional indemnity (PI) policy placed with an FCA-authorised insurer. Each has a distinct legal character.
The Medical Protection Society (MPS), the Medical Defence Union (MDU) and the Medical and Dental Defence Union of Scotland (MDDUS) provide indemnity on a discretionary, mutual basis. Membership is annual, subscription-rated by specialty and workload, and the assistance provided in a claim is at the organisation's discretion under its articles. MDOs have long histories of standing behind their members, but the arrangement is not a contract of insurance and does not, in the strict legal sense, give rise to an enforceable indemnity.
The upsides include specialty expertise, medico-legal advice at the case-file stage, GMC assistance, coronial support and pricing that reflects mutual pooling. The downside for some consultants is the discretionary element itself, which they may prefer to convert into a contractual right.
A commercial PI policy issued by an FCA-authorised insurer is a contract. Subject to its terms, conditions, exclusions and limit of indemnity, cover is enforceable in the ordinary way. Premium is rated on turnover, specialty, claims history and the scope of private work declared. Aggregate and any-one-claim limits are stated on the schedule; whether defence costs sit inside or outside the limit is a point the schedule should make explicit.
Consultants who prefer contractual certainty, or who need a specific limit for hospital privileges, may prefer this route.
Some categories of private work attract closer underwriting scrutiny. Regenerative medicine — platelet-rich plasma, stem-cell adjacent therapies, exosome work — may fall inside a policy's standard scope or may need to be declared and endorsed. Cosmetic and aesthetic work, particularly non-surgical procedures outside a hospital setting, is often carved out or sub-limited. Complementary or alternative practice sits outside the ordinary scope of most consultant policies and needs to be disclosed on the proposal form. The GMC's guidance on Good Medical Practice and the associated Duties of a Doctor framework requires practitioners to work within their competence and to maintain appropriate indemnity — so a mismatch between declared and actual practice creates both a policy risk and a regulatory one.
Claims arising from historical private treatment can surface years after the consultation. Run-off cover — an extended reporting period after cessation of practice — is essential and needs to be arranged in advance rather than assumed. MDO members retain assistance under continued membership arrangements; commercial PI insureds should agree run-off terms, typically six years, at or before retirement.
The Department of Health and Social Care's 2018-2019 consultation on state-backed indemnity for general practice led to the Clinical Negligence Scheme for General Practice (CNSGP), which came into force in April 2019 and brought NHS GP work inside NHS Resolution's scope. The same policy direction has been discussed for other categories of clinician, but state-backed indemnity for consultant private practice is not proposed. Private-practice PI therefore remains a matter for the consultant to arrange personally.
A consultant general surgeon works four days a week for an NHS trust and one day a week at a private hospital under practising privileges. The NHS list is covered by CNST through the trust. The private list is not. The consultant weighs MPS membership against a commercial PI policy. Both offer adequate scope for the specialty; the consultant prefers the contractual certainty of a commercial policy and takes out cover with a £5m limit of indemnity to match the private hospital's contractual requirement. Six years ahead of a planned retirement date, the consultant asks Apex Insurance Brokers Limited to arrange run-off through the same insurer, so historical private claims remain covered beyond cessation.
See Apex Insurance Brokers Limited's guides to solicitors' PI, accountants' PI and IFAs' PI for the wider professions framework we work within.
Apex Insurance Brokers Limited is authorised and regulated by the Financial Conduct Authority. Firm reference number 724952. This entry is general information, not advice on any particular policy.