RCM MEDICAL MALPRACTICE INSURANCE -
YOUR QUESTIONS ANSWERED

Who is covered?

The RCM medical malpractice insurance applies to those midwives with full membership of the RCM who are in employment providing care to NHS patients and clients. This would include midwives working for the NHS via an agency, those who have contracted with the NHS to provide care and those practising in circumstances in which the NHS owes a duty of care to the patient or client.   

All full members (including teachers with joint agreement membership) who are registered appropriately with the Nursing and Midwifery Council (NMC) are covered by the RCM medical malpractice insurance in connection with employment as a midwife and as a nurse if so qualified, (whether full, part time or occasional) on the condition that the employer accepts liability for the actions of their employees. As the vast majority of midwives are employed by the NHS, they fulfil this criterion. This will also apply to most other midwives in employment, as employers have a legal responsibility for actions undertaken on their behalf. This includes bank midwives, bank nurses, practice nurses, health visitors and midwifery teachers.  The RCM would always advise individuals to check their insurance status with their employer. 

What am I covered for?

The policy covers liability for damages awarded for accidental injury, death or illness, alleged to have been caused by malpractice in the provision of professional midwifery services, and for the loss or damage to property alleged to have been caused in connection with professional services. However, cover only extends to the specific nursing and health visiting duties that you are employed and qualified to undertake. It does not cover other work that you might do, which is not midwifery or nursing practice, such as acting as an expert witness, undertaking social science research etc.

The current limit of insurance is £3M for all claims made against any one individual member. This is the case even where a claim is consequent upon or attributable to one source or original cause and there is more than one member involved, a maximum limit of £3M will apply to the claim. The policy is placed on a "claims made" basis. This means that all claims will be subject to the policy limit, terms and conditions applicable at the time of notification of the claim.

I am a student midwife, am I covered?

As a midwifery student, elective placements offer the opportunity for observation, but you should not engage in direct or hands-on care. The NHS scheme covers you during clinical placements, as long as these take place within in an NHS Trust and you are under the supervision of a practising midwife. If you are undertaking your clinical placements in a setting other than an NHS Trust, such as a GP surgery, you must check the arrangements for insurance cover with the person supervising your placement.  If you are appropriately qualified, medical malpractice insurance extends to your employment as a registered nurse in the NHS whilst you are a student midwife. Please note that the RCM insurance policy cannot cover students undertaking clinical placements overseas as RCM insurance only applies in countries where action can be taken in UK courts. 

Am I covered for independent practice?

The College's policy does not cover independent, self employed or private midwives or midwives working for any employer who declines to accept financial and legal responsibility for the care given on its behalf. This restriction also applies to those working as nurses in similar circumstances.

Am I covered for Samaritan Acts?

The RCM medical malpractice insurance applies to those midwives with full membership of the RCM in circumstances where care is given as Samaritan acts which are unforeseen and uplanned.

I work for a nursing agency, am I covered?

All full members of the RCM (including teachers with joint membership) are covered by the RCM’s medical malpractice insurance whilst giving care to NHS ‘patients and clients’. This cover applies whether the midwife is directly employed by the NHS, has an honorary contract, or is contracted to it through the services of a nursing agency. It will also apply for agency or bank midwives who are undertaking midwifery or nursing duties (for which they are appropriately qualified) in private hospitals or nursing homes where the employer provides cover for vicarious liability for actions undertaken by staff in the institution and this cover is extended to agency staff.

What about practising alternative and complementary therapies?

If you are qualified and competent to practise a complementary therapy and are doing so within the parameters of the NMC Midwives Rules and Standards (2004) and all other relevant NMC guidance, and you are practising this therapy as part of your midwifery or nursing duties you are covered. If, however, you set up in business as a private therapist or work in an alternative health clinic as a therapist, you are not covered.

The RCM would advise all members intending to use these therapies as part of their midwifery practice to refer to the NMC’s position statement on complementary and alternative therapies, which can be found on the NMC website.http://www.nmc-uk.org/aDisplayDocument.aspx?documentID=4023 Occasional practice along the lines of your NHS use of complementary therapies may be covered. Confirmation of cover must be sought in writing from the RCM.

As a midwife teacher employed by a University, am I covered for clinical practice in the trust?

Yes. Under an agreement between the University Vice Chancellors and the NHS, trusts accept legal and financial responsibility for the care given by midwife teachers, even though these teachers are not members of the trusts’ staff. Full details can be found in EL (95) 86 issued by the NHS Executive.

I am a Midwife Sonographer, am I covered for the ultrasound work I do?

If you are a full member, a currently Registered Midwife and a qualified sonographer working for an NHS Trust and are practising within the remit of the professional responsibilities relating to all your qualifications, you are covered if you are practising ultrasound in connection with your midwifery duties and employment as a midwife. However, the scheme does not cover sonography practice that is separate from midwifery duties or employment.

Am I covered for voluntary work?

Yes – as long as you are a full member of the RCM, and are providing care on a voluntary basis as a registered nurse for a recognised organisation that carries the necessary insurance. This includes school trips and scout and guide camps. Confirmation of cover ust be sought in writing from the RCM before embarking on the activity.

I have been asked to accompany a trip or pilgrimage as the designated health professional. Does the RCM policy provide cover?

The RCM’s policy only provides cover for those midwifery and nursing duties (if so qualified), that form part of your employment as a midwife or nurse.  Unfortunately, accompanying trips or pilgrimages as the designated health professional falls outside the remit of the policy and the RCM’s insurance therefore cannot offer cover for such activities.

You will need to discuss with the organisers of the trip what arrangements they have in

place to protect you against liability. 

What about working overseas?

You are generally covered if:

• you are a full member of the RCM;
• you remain registered appropriately in the UK with the NMC whilst practising overseas;
• you are undertaking midwifery practice within the remit of your qualifications and competencies;
• your employer accepts vicarious liability for your actions;
• the country permits "out of country" insurance.

A list of exclusions is available from the RCM Membership Team. However, the policy can only cover you if action against you is taken in a UK Court. You are only covered for nursing duties if you also hold an appropriate nursing qualification in the UK. If you are working for an aid or volunteer agency in a developing country, you will need to discuss with your sponsoring agency what provisions they make to protect you against financial or legal liability. If you are considering working overseas, please contact the RCM to check your insurance status.

 
Can I deliver my friend outside work time?

The RCM has negotiated a clause in the insurance policy to allow midwives to deliver their friends. It covers for:

“planned but occasional midwifery care provided free and gratis, provided outside of work hours, but within the overall sphere of NHS midwifery.”

It is the words “within the overall sphere of NHS midwifery” that are most important. This means the circumstances where a woman who has received NHS care and is booked for an NHS delivery, asks her friend to undertake delivery, either in hospital or at home, even

though this midwife is not formally part of her care team.

In this situation the RCM would expect the midwife involved to inform and seek the support of her manager and supervisor, and of the manager in the area where the birth is to take place, where this is not the midwife’s usual place of employment. The RCM hopes that trusts will take a facilitative approach to such requests by issuing an honorary contract.

In these circumstances the College’s insurance would apply.

Where a midwife employed by one trust seeks permission to practise in another, either in the community or hospital, the situation is slightly more complex. Again, the RCM expects Trusts to adopt a facilitative approach to women’s choice by enabling midwives from other units to access their facilities on occasions. Local arrangements might include a meeting between the supervisor and midwife, or a short period of working in the unit to ensure familiarity with local policies, before the issuing of an honorary contract. In these crcumstances the RCM insurance would apply.

However, Trusts do have the right to refuse to allow a midwife employed elsewhere access to their unit. In this situation the RCM cannot provide insurance cover for the midwife, who would no longer be working within the overall sphere of midwifery practice.


Can I provide aquanatal classes at the local sports centre?

                                     
This depends on whether you are employed by the sports centre and whether the centre or local council is adequately covered. Such centres will already have public liability insurance covering their staff, but may need to check with their own insurers whether this is sufficient to cover medical malpractice cover. If you wish to set up privately as an aquanatal instructor, the College’s insurance cannot cover you.

Am I covered for providing advice or classes in baby massage, infant feeding and parentcraft education?

This depends on the context in which you are undertaking this work.  If you hold appropriate and up-to-date qualifications and provide advice on these topics forms part of your normal employment as a midwife or, if qualified, nurse within an NHS Trust, then the RCM insurance will provide cover.  However, if you wish to provide classes or give advice on a self-employed or independent basis, then the RCM policy cannot provide cover.  If you work for a Sure Start scheme, insurance should be provided for you under the local council’s arrangements. However, you should always check the level of cover that is in place and ensure it is adequate for your practice.

Am I covered to provide parent education classes outside my NHS practice?

The RCM has from December 2008 been able to offer insurance for full members who are NHS midwives in their provision of parent education and associated exercise classes for women outside their employment and in their own time. A charge can be made for attending these classes. 

Insurable activities covered under this category include the provision of information about:

·  physiological and psychosocial changes in pregnancy, labour, and the post-natal period;

·  breastfeeding;

·  healthy diet, lifestyles and gentle exercise*;

·  minor disorders of pregnancy;

·  preparing for birth;

·  choices for birth (including place of birth);

·  practices for coping with pain during labour, including positions during labour and birth and relaxation techniques;

·  caring for the newborn;

·  parenting skills;

·  welcoming the newborn into the family.

*  Antenatal exercise which falls within the scope of midwifery practice and is therefore insurable under this category would include: gentle exercise to help with relaxation and breathing techniques; practice of positions for labour and birth; gentle techniques for stretching; exercises to help improve tone of pelvic floor and with pelvic tilt.

We would also strongly advise that the relationship you have with your clients is solely for the purpose of the exercise classes and NOT for dispensing midwifery advice. Where the woman requires specific midwifery advice, she should be referred to her own midwife.

Exercise Classes Not Included Under the RCM MMI Plan

Please note that the RCM is unable at present to insure the private provision of aquanatal, pilates or yoga exercise classes since these activities fall outside of a midwife’s role upon qualification. Midwives wishing to offer aquanatal, pilates or yoga classes must have the requisite skills, experience and qualifications to do so. We would advise that you obtain MMI cover from the institute with whom you are registered and/or licensed. 

Other Important Considerations

Notifying your Supervisor of Midwives

Please note that any midwifery practice outside your employment would need to be notified to a supervisor of midwives who needs to ensure that the midwife has the requisite skills and knowledge.

Provision of classes in premises that are not the NHS

Please note that this cover does not extend to any public liability claims arising out of the venue for the classes. Midwives should ensure that such insurance is in place.

RCM members who are thinking of providing classes within their own home are advised to inform your household insurers as this may not be included in their normal cover. In situations where you are hiring premises, you need to be aware of the building’s public liability cover. Public liability cover refers to any bodily injury, mental injury, illness, disease or death of any person, or loss of or damage to tangible property of any person in connection with the Insured's professional duties as defined as any full member of The Royal College of Midwives (excluding those engaged in private midwifery practice). 

Tax considerations

The provision of private classes for payment will be regarded as self-employed income and will need to be declared as such on a tax return.

Advertising

Members considering offering private classes need to be aware of the Nursing and Midwifery Council (NMC) guidelines on advertising.  These guidelines can be found at: http://www.nmc-uk.org/aFrameDisplay.aspx?DocumentID=4019.

 
What about my insurance cover if I stop paying full membership subscriptions to the RCM?

If you change your category of membership of the RCM from full membership, or your membership of the College lapses, you are not covered for current practice by the College’s medical malpractice insurance. If you retain Associate membership you will be covered for any past practice whilst you were a paid-up full member of the RCM for the first ten years after ceasing midwifery or nursing practice. (Please also see section on retirement below).

What about when I retire?

When you become eligible (after being an RCM Full member for at least 15 years and reaching the statutory retirement age or retiring due to ill health), you may enter the Retired Membership category and pay a reduced subscription rate. The RCM medical malpractice insurance will then provide cover for claims notified as a result of previous practice whilst you were a paid-up full member of the College, for up to 10 years after you last practised as a midwife, subject to the limits, terms and conditions of the policy at the time of notification. However, you must be a member (full, retired or associate) at the time the claim is notified (i.e. when you first become aware of it and the RCM inform the insurers).

What should I do in the event of an incident?

You must contact the College immediately, if you are aware of any incident that is likely to give rise to a claim against you.

This information is correct as at the date written but may alter in the future. In the event of any query regarding the above, written clarification must be sought from the Membership Team Leader, Royal College of Midwives, 15 Mansfield Street, London W1G 9NH. Email membership@rcm.org.uk