Depending on your niche, your medical indemnity provider may have an interest in your work. This is less likely when your niche is an expansion and deep dive in a counselling or consulting space related to ususal GP practice. For example A&OD support,lactation consultant, ADHD coach, Diabetes support. These niches are an expansion of well understood work any another GP will already provide at a shallower level. You niche down in this area and provide more information and support to the patient but without procedural risks.
The insurer is more likely to be interested the more procedural your work – varicose veins, skin cancer, vasectomy, aesthetic medicine. Here the risks for complications can be high and dramatic – think a surprise pregnancy, a disfiguring facial scar or a local anaestheic overdose. Sometimes there can be a standard of care or defined training course that gives you and your insurer certainty. Sometimes there is no specific course or guideline. Your insurer is going to be reassured with audits demonstrating that your work falls in with expected or published success/complication rates and that you maintain CPD in your area.
For example with my vasectomy work, I have had risk management sessions (outside of any claims) with my insurer where we sat down, reviewed my consent process, forms, workflow and audited complications. I am able to demonstrate CPD in this area. This has improved my confidence in providing this service and my workflows. I know if there ever was a claim, that I am working in this area would not be a surprise to the insurer as it has been fully disclosed and I know I have coverage. I do not know if these risk review meetings have reduced or affected my premiums.
There can also be a middle ground – areas where insurers have come out and said this is fine, this is part of normal practice – for example with provision of MTOP and IUDs.
Avoid underinsurance, incorrect category
As with any insurance, there is one very bad time to find out you are underinsured – when you need to claim! Far better that you keep your insurer abreast of all changes to your practice, current total billings and about any concentration of work. Insurers may have specific rules to follow. For example some insureres place restrictions on the size of skin cancer defects such as less than 15mm on the face, 50mm on the body or might restrict some types of grafts. In researching this I was amused to find I have coverage for post-mortems! Not much chance to practice those thankfully.
So do tell your insurer what your total billings are, they may ask what proportions your work is currently and if proportions will change.
Reduce your niche medical indemnity risks
As you develop your niche more you may see more complex cases or be working on the edge of where specialist colleauges work. Case selection becomes essential here, to know how and when to bow out and refer on. Much of GP procedural work is like this where it is always easier for a solicitor to ask “why didn’t you refer to a specialist plastic surgeon/dermatologist/urologist?” Patients far prefer to see us as they may already know and trust us, we often have better availability and lower prices that specialists. We just can’t let that eagerness to help the patient lead us into taking on unsuitable cases. It is very patient dependant as well. The old ex-shearer in your practice would rather you have a crack at their large BCC, even if you have the text book open on the bedside beside them than trek off to see a plastic surgeon in a glass tower. However the 35year old real estate agent who does all their own tiktok videos may be a great one to refer on.
Have a risk review interview with your insurer, ask then to review your consent form if it is an in-house form. Have clear information for patients, clear expectations for treatment. Be aggressive about supporting any patient with difficulties or complications.