The Royal College of Nursing (RCN) does not believe a "significant" number of members will leave as a result of the decision to withdraw indemnity for practice nurses.
While Chris Cox, the RCN's Legal Director, told NiP he "entirely appreciates the anxiety the organisation's policy change has caused", he said the area has been subject to "continual misunderstandings, confusion and ignorance".
When told of NiP readers' bitter disappointment at the news of the RCN's policy change and subsequent threats to leave the organisation as a result, he said he is confident once practice nurses are aware of all the facts, they will recognise why the move was "inevitable" and remain with the RCN.
Cox claimed the move has been falsely portrayed as a change that will affect practice nurses personally.
Under the policy change, the RCN will still provide indemnity cover for practice nurses for work they undertake on a voluntary or self-employed basis and those carrying out 'Good Samaritan' acts.
The responsibility for the provision of indemnity cover for work carried out under a practice nurse's contract of employment will now shift to GPs, said Cox.
"GPs are vicariously liable for the actions of their staff – that is not an option," he said.
"It is up to GPs as employers to communicate with their Medical Defence Organisations (MDOs) to ensure their staff are covered – this is not a conversation that should include practice nurses.
"This change shouldn't in any way place practice nurses at risk."
Cox told NiP there is "no legal or professional obligation" for practice nurses to pay for personal indemnity cover out of his or her own pocket and said the RCN will "assist" its members in resisting pressure from GPs to do so.
Gail Adams, Head of Nursing at Unison, said personal indemnity cover does provide reassurance to practice nurses, which she claims is especially important in the "increasingly litigious society we now live in".
Unison's indemnity cover is contingent upon GPs being vicariously liable for practice nurse's actions and only kicks in once they act "completely outside" of their job description.
She said Unison has no plans to change its policy on indemnity as a result of the RCN's move.
However, she told NiP GPs have been allowed to get away with abdicating from their responsibilities for "too long" and "it is about time we crack this".
"The increase in GP responsibility for indemnity cover may lead to GPs recognising the need for investment in training for practice nurses – as they will understand the danger behind asking a practice nurse to go beyond their competencies at the drop of a hat," said Adams.
Even if the RCN do see a "significant" number of members leave the organisation in a protest move, Cox confirmed the withdrawal of indemnity cover will go ahead and will not be reinstated in the future.
He also told NiP the policy change will not lead to an adjustment in subscription fees for practice nurses as the move serves to "put them in the same boat as all our other members".
Has Chris Cox's comments on the RCN's policy change reassured you enough to stay with the RCN?
Your comments (terms and conditions apply):
“No. The RCN is expensive, more so than GMB or Unison, who seem to offer more with regard to local representation in my area, with good local union representatives who are willing to negotiate and protect members interests. I defected to the GMB some time ago, they are a lot cheaper and their contingency liability insurance is far more comprehensive. The RCN is not really a union, it is more of a professional body which we pay through the nose for; has no bite and tends to roll over when the Government of the day cracks the whip. I do know of some nurses in the past who have had good service; but more often than not have been left wondering what they actually pay their (relatively high) subscriptions for.” – Name and address disclosed
“No, I plan to join unison as the RCN has kept this under wraps!” – Jayne Smith, South Wales
“No, I have already decided the RCN no longer has anything to offer me for the (almost) £17 per month membership. When I phoned RCN Direct I felt patronised by being advised to speak to a legal adviser as I wasn't making "an informed decision", and was told they were not stopping indemnity cover. Fortunately I had read their statement in great detail before coming to my 'uninformed' decision, and I no longer have spare cash for the luxury of RCN membership.” – Janet Webb, Lincoln
"Why is it only practice nurses and not nurses working in the hospital? If GPs are to cover indemnity for practice nurses then why aren't hospitals covering indemnity for hospital based nurses? It is completely unfair. I am a practice nurse who is just completing the final dissertation for Masters level study & I always work within my own professional capabilities. I am very disappointed in the lack of support from the RCN. It is also outrageous that practice nurses are still expected to pay the same annual subscription." – Elaine Clarkson, Merseyside
"No, but the word 'arrogance' springs to mind." – SB, Derbyshire
"I feel a reduction in the monthly subscriptions would lead to more nurses willing to stay with the RCN. I understand they offer more than this cover but this should make a big difference which should be passed on to members." – Barbara Sanders, Coventry
"Not in the least; I am also disgusted that I have had no personal communication about this from the RCN." – Val Relton, Brighton
"No, not really. As a practice nurse, not receiving the same indemnity cover for my work, I think I should pay less than other nurses. Also if I need indemnity cover for 'good samaritan' acts when a non-qualified person does not, should I then decline to become involved should the need arise? Am I bound by the code of practice to stop and help if I do not have indemnity cover? If I am bound to stop and help, and for this require indemnity cover, I think this is punitive to qualified nurses. If we have a duty to stop and help and need cover should this not be paid by NMC who have endowed the qualification? Otherwise being qualified carries a fee with it for just in case scenarios about which we may have no choice.
Any answers would be very welcome." – Janette Neeld, Cambridge
"I am not reassured by these comments and am one of many nurses I know reconsidering my membership of the RCN, I have been a member since I was a student. The indemnity cover was the reason I joined!" – Lisa, Wiltshire
"No, myself and my colleague are still considering leaving, or maybe they will consider a reduced rate for us. I feel aggrieved at paying more than £14 a month (especially in these hard times) when I will be getting little benefit." – S. Grummitt, Notts
"Not really, the RCN does little enough for practice nurses as it is and now they want to do even less!" – Sally, Plymouth
"As a practice nurse who has paid into the RCN for membership since qualifying 10 years ago, I will definitely be canceling my subscription. I am very disappointed and feel let down by the RCN that practice nurses are being discriminated against. The explanation in this article is about GP bashing, The RCN need to take some responsibility for their actions and stop trying to shift the blame to others. MDU will cover for vicarious liability, however if practice nurses are undertaking extended roles such as prescribing, nurse practitioners/clinicians then they will not be covered under this and it will cost approx £480 per year for this cover! There has been no loyalty shown to nurses, who is next to go when the budget is tight again next year?" – Elaine, Skelmersdale
"I have been very disappointed with this move not to include practice nurses. I have been a member since 1996 and a practice nurse for 7yrs. I was not informed by the RCN of these changes I only found out last week reading the independent nurse. Why was I not informed by yourselves of the changes? I think my own GP will cover me as a nurse so I am lucky but I am still thinking about whether I will be staying with the RCN." – Rachel Coulter, Warrington
"No, it is even more annoying. I had cause to use the RCN facility and was helped amazingly by it as on the outside of general practice. It was about bullying. I am scared that it will now be down to GPs or me to move cover. Why don't RCN do the same as Unison and only cover when outside GP cover? Surely leaving practice nurses vulnerable by withdrawing a service is unfair. Will we get reduced rates for the reduced service? I expect not! I am upset and annoyed and feel very let down by this apparent threat. My GPs do cover unnamed staff but I've always relied on my RCN member ship. Shame on you RCN." – Bee, Surrey
"Yes I can understand the reason now, however the issue should have been explained particularly to practice nurses via a letter - you have all our details on file - then this misunderstanding could have been avoided. I feel the RCN is expensive to maintain now NMC registration is annual. The only query/support I requested from the RCN in the past was handled poorly. I do not get the extra interest information I sign up to every year so I am still considering stopping my membership." – Jackie Parsonage, Kingsfold Medical Centre
"Can Chris Cox explain to me what would happen should a patient decide to sue a particular practice nurse as opposed to the general practice or GPs for whom she works; whose indemnity would be called upon? Or can I assume an argument between organisations would ensue?" – Chris, Lothian
"No. I will be leaving in January when my renewal is due." – Carole, Cheshire
"No, I think it's disgraceful! I have paid my fees monthly for 30 years but will be stopping this month. I don't see what I will get for my monthly fee after my "safety net" has gone." – Deborah Watson, Stafford
"No it has certainly not! That is the only reason I pay to the RCN and have done so for the last 28 years. I am appalled that the RCN, once again lets practice nurses down, and I shall most definitely be reconsidering my membership with them." – S. Brown, Preston
"No. I feel very disappointed to be treated this way by the RCN. As a practice nurse not many have NHS bonuses such as Agenda For Change including sickness cover. I have been a member of RCN for nearly 30 years but will aim to remove my membership and apply elsewhere. Our subscriptions have been received by RCN for many years. Yet again RCN does not support practice nurses." – Alyson Thomas, Aberdare, Wales
"No, afraid not. Sorry to cancel my membership but will be joining a union that offers indemnity cover." – Hilary Ford, Moray
"Since becoming aware of the reduction in cover for practice nurses I have been undecided about remaining with RCN. Where do nurse practitioners working in out of hours stand with regards to cover?" – Lyndall McLean, Gloucester
"No." – Diana Perry, Telford
"No, and am disgusted that we will not receive the same cover as other nurses but will be expected to pay the same amount of money. What is the difference between us and all other nurses, we all work for somebody?! I will be leaving and will be canceling both my journal subscriptions also and am surprised the RCN feels losing us will not bother them much." – Michelle James, Northumberland
"No." - Juliet Turner, West Sussex
"Oh how out of touch can the RCN be?!" – Name and address supplied
"I am not convinced. Thankfully, although I work as a practice nurse alongside GPs my employer is in fact CareUK, who have reassured all their nurses that they already provide full indemnity cover. I think the RCN need to formally apologise to their practice nurse members, as most of us did not receive the letter informing us of this. Also, I am aware of one GP employer who didn't even know what vicarious liability was, so how would he be providing cover?" – Margaret Stubbs, Portsmouth
"No, if this is the case then hospitals, nursing homes etc should cover their employees too under their insurance which would result in huge cost saving to RCN and we could all benefit from a reduction ie fees. Why single out practice nurses?" – Kim Wood, Kent
"I feel practice nurse have been let down again. Does the RCN not understand what general practice is like? Some GPs may well support us but not all, it is shameful and I feel let down." – L. Gilbert, Preston
"I have never joined the RCN as I found their representatives were very bias and tend to support the management side of the health service. The representatives were mostly from the hospital senior managers." – Hilda Singh, Enfield
"I feel so let down by the RCN. I have been paying for more than 35yrs and feel ejected by the one organisation that I really relied on. Shame on you RCN. Feeling very vulnerable in the work place now as GPs have to take on yet another 'hidden' cost of employing nurses." – Gale, Telford
"No. Have already left because of the policy change." - Nancy Gourlay, Glasgow
"I stayed with the RCN for the last 30plus years mainly due to their no strike policy and the indemnity cover. If this is not available with practice nurses almost being classed as outside the NHS as far as pay and conditions goes then why stay?" – Diana Salt, Stoke-on-Trent
"As a primary care nurse, I found this article slightly confusing. Am I right in thinking then that Primary Care Nurses no longer have indemnity insurance through the RCN?
Any ideas?" – Ruth, Germany
"His comments have not changed the outcome. Therefore, as an independent/supplementary prescriber my decision to stay with the RCN will depend on how my employer perceives his responsibilities." – Bernadette, Manchester
"I already am covered by MDU by one employer but will need to make sure my other employer will do the same. I also work on a self employed basis so need to keep my RCN subscription." – Julie Baird-Paul, South Tyneside
"I will certainly consider the options very carefully. I imagine there will be some nurses who will have some problems with their GP's - time will tell. I think it was very disappointing not to have been contacted personally about this change and only finding-out about it in the press. I expected better!" – Elaine Hill, Oldham
"I don't see the point of paying the fee" - Lorraine Wlaton, Manchester
"No - I shall now have to pay extensive fees as an independent prescriber to MDU - cannot afford to pay RCN as well. Bitterly disappointed with this entirely financially based decision – no respect for their nursing colleagues." – Julia Rees, Wales
"Not at all. I will be leaving the RCN. I have been a Practice Nurse since 1984 and feel really let down by this change in policy after all these years." – Eleanor Pugh, Oldham
"No" – M. Dempsey, Location not disclosed
"Would consider leaving the RCN. Also found that I was let down terribly by the RCN over an employment issue some years ago. This led to me taking early retirement at that time thus losing out financially. Fortunately, I am re-employed again with my old long term employers but am considering retirement again." – Christine, Location not disclosed
"I have just returned from sick leave to discover that I will no longer be covered for indemnity by the RCN. How very disappointing. I have been nursing for 43 years, 33 of which have been as a practice nurse and have been a member of the RCN for all of that time. I am sure that many practice nurses, like me, initially joined the RCN to gain the security of knowing that we had the support and protection should things go wrong. As practice nurses we have fought long and hard to gain training opportunities and to have a career pathway on par with our hospital based colleagues. It seems that at every turn we are losing confidence, especially in light of this new declaration. I am lucky in my practice that my employers have included me in the MDU but not all practice nurses are as fortunate. I will certainly be leaving the RCN in the near future." – June Wallis, Staffordshire
"Not sufficiently I'm afraid. I feel a lack of trust with the RCN that such a change could be presented as a 'fait accomplis' by post to individual PNs with no apparent consultation with members. I was at the RCN AGM on 26 October when the issue of indemnity cover was the dominant question put forward by members to the RCN Panel. The overwhelming impression was that members felt excluded from having any say in this change. This impression is supported by around 40 responses from all over the UK to the NIP article on 3 Nov 'GPC criticises RCN indemnity withdrawal'. I have done the same as many of those respondents in moving from the RCN to a more supportive nursing body." – Catherine Gleeson, West Yorkshire
"If you withdraw this cover, will our fees go down? And exactly what services will we be getting for our money?" – Diana Parker, Derby
"No - I think it's absolutely disgraceful, I've thought long and hard, I pay a lot of money for my RCN membership and don't feel I'm, getting a good return. £30 a month for a few journals is too much!" – Alison Vermeer, Norwich
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