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Medical Malpractice Insurance

Medical Malpractice Insurance

Guidance for Members  (Updated 06/2017)

 

For more than 90% of RCM members Medical Malpractice Insurance (MMI) is very straightforward and you are covered for all of the midwifery, nursing or maternity support work you provide as a midwife, student midwife nurse or maternity support worker under contract to the National Health Service (NHS) and other national or local authorities[1] in the United Kingdom, the Isle of Man and the Channel Islands.  This is because these governmental bodies assume the ‘vicarious liability’ for the care services you provide. However as contracts of employment or health care service arrangements become more complex it is important that you understand how the RCM MMI cover applies to you.

If after reading this you are unsure about your cover please contact us at: membership@rcm.org.uk

The RCM provides MMI cover for full midwife and maternity support worker members employed in providing health care services through the NHS or other national or local authorities charged by the United Kingdom Government (including Wales, Northern Ireland and Scotland) to provide health and social services directly, through agencies or through an NHS or national or local authority contract.

It also covers midwife teacher members employed in universities with arrangements with the NHS and student midwife members undertaking clinical and elective placements in the UK. Coverage is also extended on the same basis to national or local authorities in the Isle of Man or the Channel Islands and the British Armed Forces.

In addition some members who operate under the basis described above may be additionally engaged in giving care in other settings including

  1. on an occasional basis and in their own time providing some additional maternity care or related services
  2. undertaking voluntary work either in the UK or overseas,
  3. Undertaking as a student midwife, overseas elective placements.

Whilst the RCM cannot give a blanket extension to our Insurance we can provide cover for these activities in some circumstances, and these are described more fully below.

Medical Malpractice Insurance Benefits – The Key Facts

The main benefits of the RCM MMI are as follows.

  • Insurance cover for all full members who are providing midwifery and nursing care (dependent on your qualification and registration) within the NHS and other local or national authorities; for Maternity Support Worker members and for student midwife members
  • The limit per claim is £5million (for defence costs and damages).  
  • Legal expenses cover of up to £50,000 per claim  
  • Good Samaritan Acts.
  • A member providing unpaid first aid nursing services at a voluntary or charity event
  • Overseas voluntary work/teaching assignments and placements may be insured, depending on the nature of the role and the country where the assignments take place. Advance notice to the RCM is required for cover to be considered (see Key Facts information).
  • Ancillary health care services, such as Antenatal and postnatal education, complementary therapies and exercise classes, including aqua natal classes where provided outside of the NHS on an occasional basis (see Key Facts information).
  • Cover for past liabilities for retired and associate members.

This insurance cover is only available to those who were a member of the RCM at the time of the incident and who have continued to be a member at the point at which any claim is notified.  Lapsing or discontinuing your RCM membership will invalidate your access to this policy.


The RCM have prepared Key facts and Frequently Asked Questions to help clarify arrangements, which can be found on the RCM website at:

www.rcm.org.uk/medical-malpractice-insurance#FAQs.

They are not legally binding and if you are not clear whether you are covered, or remain concerned that you do not fit into any of the categories described here, please email the RCM on membership@rcm.org.uk.

 


 

 

[1] This includes midwives and nurses employed to undertake nursing and midwifery duties in local government or in arms length bodies such as Public Health England.

Medical Malpractice Insurance Benefits

The main benefits of this insurance policy, are as follows.

  • Insurance cover for all members who are providing healthcare services within the NHS. This includes Maternity Support Workers (MSWs) and students midwives, including their electives within the NHS, with no special conditions attached.
  • The limit per claim is £5million. (The total limit in any one year for all RCM members is £10m).
  • Legal expenses cover of up to £25,000 per claim.
  • Good Samaritan Acts.
  • A member providing first aid services at a voluntary event may be covered depending on the nature of the role (see Key Facts information).
  • Overseas voluntary work/teaching assignments and placements may be insured, depending on the nature of the role and the country where the assignments take place. Advance notice to the RCM is required for cover to be considered (see Key Facts information).
  • Antenatal and postnatal education, complementary therapies and exercises including aqua natal classes are covered where provided outside of the NHS on an occasional basis (see Key Facts information).
  • Cover for past liabilities extends to retired and associate members.


These Key Facts and the Frequently Asked Questions have been prepared to help clarify arrangements.

They are not legally binding and if you are not clear whether you are covered, or remain concerned that you do not fit into any of the categories described here, please email the RCM on membership@rcm.org.uk

 


Frequently Asked Questions on the RCM Medical Malpractice  (Professional Indemnity) insurance 

1. What is Medical Malpractice Insurance?

Medical Malpractice Insurance provides cover for claims made as a result of bodily injury to a patient or client arising from an adverse clinical incident alleged to have been caused by a negligent act, error or omission that occurred during your work as an NHS, local or national authority midwife, nurse (if so qualified) or maternity support worker, if these occur within UK territories, including the Isle of man and the Channel Islands.  If as part of your NHS, local or national authority work as a midwife, (and you are practising within the parameters of the NMC Code (www.nmc.org.uk/standards/code/ ) and you are appropriately qualified) you also deliver complementary therapies, undertake ultrasound scanning, antenatal education or exercise classes, you will be covered.

The Insurance Scheme covers both:

  1. The legal costs of defending a claim for damages and
  2. Any damages awarded.

The Policy provides cover up to £5M per claim (the total limit in any one year for all RCM members is £20M), which is the highest cover of any trade union or professional organisation.  

2. Who is covered under the Policy?

  • Full members of the RCM who are directly employed in the NHS or a local or national authority are covered for all of the midwifery and nursing practice undertaken as part of their employment.  
  • Full members who are working for the NHS or a local or national authority through an agency; only with respect to those midwifery or nursing services commissioned by the NHS or a local or national authority.
  • Full members who are working in private companies that are contracted with the NHS or a local or national authority to provide NHS funded or a local or national authority funded care; only with respect to those health care services commissioned by the NHS or a local or national authority and where the NHS or local or national authority is assuming your liability.
  • Full members who are employed as midwife teachers in universities which have a formal agreement with the NHS.
  • Student midwife members undertaking their clinical and elective placements within the NHS and under the supervision of NHS midwives in the UK (If you require evidence of cover, please contact us direct).
  • Student midwife members who are registered nurses undertaking nursing work in the NHS whilst they are student midwives or maternity support worker.
  • Maternity support worker members are covered for work undertaken in the course of NHS employment.
  • All members are also covered for Good Samaritan Acts worldwide. Good Samaritan Acts are defined “as medical, nursing, midwifery and therapeutic care performed at the scene of a medical emergency, accident or disaster where you are present by chance or in response to any general emergency call”.
  • Retired members who are no longer in midwifery or nursing practice continue to be covered for all past liabilities, as long as they were a full member at the time of the incident and have continued to maintain membership in the retired or associate categories of the RCM and their liabilities arise from health care services provided to the NHS or a National or Local Authority.
  • Full members of the RCM who are directly employed by the British Armed forces to provide Health Care Services.

Example for illustrative purposes only

Cathy is a labour ward coordinator at St Saviours NHS Trust.  She is covered.

Gloria is a midwife teacher at University College Scotland, she teaches student midwives in the classroom and in clinical areas at the local hospital which provides her with an honorary contract.  She is covered.

Beatrice is an independent midwife contracting directly with women to provide antenatal and postnatal care.  She is not covered and should make alternative arrangements to purchase appropriate and adequate insurance.

Phyllis works for Public Health England as a screening coordinator.  She is covered.

Amy is employed by City Borough Council as a teenage pregnancy midwife linked to the Children’s Centre.  She is covered.

3. What are the benefits of the insurance policy?

In situations where NHS, national or local authority vicarious liability does not respond, members covered by this policy, benefit from protection against claims for damages relating to alleged or actual bodily injury to a patient or client arising from an adverse clinical incident, up to a limit of £5million per claim.

 4. Extension of cover under the Policy

In addition to NHS provided or funded midwifery and nursing work, RCM members may be involved in other activities inside and outside of work that could give rise to a claim.    In some circumstances the RCM policy will also cover these:

a. A midwife providing unpaid first aid nursing services at a voluntary or charity event in the UK

Example for illustrative purposes only

Jenny is a midwife at Central Hospital Trust.  She wants to help out at her local resident’s association summer fair by being a first-aider.  She has up to date St John Ambulance training and will be doing this on her day off, unpaid.  She is covered.

Moira is a community midwife in Easttown NHS Trust.  She has taken a few days leave to work as the resident midwife at a large music festival.  The organisers are paying for her services and there will be a designated ‘midwifery tent’ on the festival site.   She is not covered and should confirm with the festival organisers that they are providing medical malpractice cover for care given on their behalf.

b. Overseas voluntary work

Overseas voluntary work can be complex in nature, so the Insurance cover does not automatically cover this liability and there is no guarantee that insurance cover will extend to such assignments.  As a general rule if a member anticipates engaging in ANY clinical work overseas, she must ensure that the agency through which the trip is being organised has provided adequate MMI cover meeting the requirements of the jurisdiction.  Where an overseas visit is purely an observational visit or classroom teaching of other midwives, i.e. it contains NO direct clinical care of women; it is more likely that the RCM policy will be able to respond. In the event that a member is volunteering or teaching overseas and requires cover, advance notice is required and any application should provide the following:

  • The country of placement
  • The length of duration of the placement
  • Details of the nursing and or midwifery services being provided and if the services will be observational or hands on
  • Details of the insurance arrangements of the sponsoring organisation

 

Example for illustrative purposes only

Sian is a midwife teacher at Highfield University which is twinned with a college for nurses and midwives in Vietnam.  Sian is going to volunteer at the college for two weeks to assist local midwife teachers prepare their midwife students for their exams by running study skills sessions etc.  She will accompany the midwife teachers into clinical areas to watch them as they support students and provide feedback afterwards.  She is covered.

Julie has taken a career break and has signed up with a major international aid agency to undertake a two year volunteering assignment at a rural health centre in India providing midwifery care to local women.  She is not covered and should confirm that the aid agency has organised all required insurance including travel, health and MMI.

c. Student midwives’ overseas elective placements

Overseas elective placements can be complex in nature so the Insurance cover does not automatically cover this liability and there is no guarantee that insurance cover will extend to such placements.  As a general rule, the RCM policy is unlikely to respond if the placement involves a student midwife undertaking ANY direct clinical care.  It is more likely to respond if the placement is observational only. Therefore in the event that a member is planning an overseas placement and requires cover, advance notice is required and any application should provide the following:

  • The country of placement
  • The length of duration of the placement
  • Details of the nursing and or midwifery services being provided and if the services will be observational or hands on
  • Details of the insurance arrangements of the sponsoring organisation.
  • Clarification from the organisation whether they will indemnify the member.

 

  1. Antenatal and postnatal education, complementary therapies and exercises including aqua natal classes

    RCM members wishing to provide occasional, paid-for services, that compliment main-stream maternity services, outside of their employed work, will be covered provided they are appropriately qualified and competent and practicing within the parameters of the NMC Code and Midwives Rules.  This policy extension is designed to facilitate employed midwives being able to provide limited and occasional related services outside of their employment contract.  It is NOT designed for midwives whose main or significant source of income is in providing independent or private midwifery and maternity-related care.

    The range of activities likely to be covered includes:

     

  • Antenatal and postnatal education
  • Complimentary therapies  
  • Breastfeeding and infant feeding support
  • Antenatal Exercise classes including aquanatal classes
  • Aquanatal classes
  • Advice on Baby care including massage

 

Example for illustrative purposes only

Michelle works 20 hours a week as a core midwife at St James’ Midwife-Led Unit.  She has approached her local swimming pool and wants to provide a weekly, term time aquatnatal class that women will pay to attend.  The swimming pool will collect the money and will make a deduction for their overheads, giving an agreed amount to Michelle.  Michelle has successfully completed an RCM accredited aquanatal teaching programme and is a qualified lifeguard.  She is covered.

Denise is not currently employed.  She is a qualified aquanatal teacher and yoga teacher.  She has set up a website advertising her services, enabling women to book with her for both group classes and bespoke individual sessions.  She is not covered.

 

e. Working in an organisation that is not your Employer

There may be occasions when an RCM member wishes to work in an NHS maternity unity that is not their employer. These will most normally be associated with providing continuity of care across different providers.  In these cases the member must ensure that the NHS organisation they wish to work for will extend vicarious liability to them known as an honorary contract.  

Further RCM guidance can be found in the publication, ‘Facilitating women’s choice of midwife: RCM Guidance: Practical approaches to managing with flexibility’, at: https://www.rcm.org.uk/rcm-publications

f. Extension of Legal Defence Costs

For members whose claim falls outside the scope of this policy, i.e. is NOT covered, we may be able to provide support with legal defence costs only. RCM Members may have the benefit of up to £50,000 in legal defence costs to provide defence in the event of a claim against them for an adverse clinical incident which does not arise from any of the following:

  • A Full Member directly employed and providing Health Care Services in the NHS National or Local Authority
  • A Full Member working for the NHS, National or Local Authority through an agency; only with respect to those health care services commissioned by the NHS or a National or Local Authority.
  • A Full Member providing ancillary health care services
  • A Full Member providing a Good Samaritan Act.

 5. Who is not covered under the Policy?

  • Independent Midwives (except for Good Samaritan Acts)
  • Midwives and Maternity Support Workers who are directly employed by a GP, including practice nurses, because GPs sit outside the NHS indemnity arrangements
  • Midwives and Maternity Support Workers employed in private hospitals or clinics, because these are outside of NHS indemnity arrangements
  • Student midwives’ overseas elective placements unless approved by the insurers of the RCM scheme, as described above
  • Midwives’ overseas voluntary placements, unless approved by the insurers of the RCM scheme, as described above
  • Midwives and maternity support workers working outside of the United Kingdom, The Isle of Man and the Channel Islands (unless they are working for the British Armed Forces)
  • Midwife researchers, academics or others who are undertaking work that is not midwifery practice, such as social research.   
  • Any midwives and maternity support workers undertaking work that is not by definition the provision of professional healthcare services such as acting as an expert witness, drafting or editing clinical papers or books.
  • Midwives who set up a business specifically to offer midwifery classes or therapies.

6. How does the Policy Work?

You must have been an RCM member (in the appropriate membership category) at the time of an incident that gives rise to a claim on the Policy.

 

You must still be a member and in the appropriate category at the time of making a claim on the Policy. This means if you let your membership lapse you will no longer be covered, but if you change category your cover will remain.

 

In the event of your death the Policy will continue to provide cover to the representatives of your estate for any past liabilities as long as those liabilities are covered under the RCM MMI scheme at the time a claim is made.

 

The policy will also respond in the event of a critical injury that prevents you working, as long as you remain a retired member of the RCM

7. What you should do in the event of a claim or incident

You must contact the RCM immediately if you are aware of any claims that has been made against you or any incident that is likely to give rise to a claim against you.

 

[1] This includes midwives and nurses employed to undertake nursing and midwifery duties in local government or in arms length bodies such as Public Health England.