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Guide to the Clinical Negligence and Other Risks Indemnity Scheme (CNORIS)

Published on 28 September 2020

Check who has cover

A list of all members of the Clinical Negligence and Other Risks Indemnity Scheme (CNORIS) is available.

View or download the standard Confirmation of Cover document for 2020 – 2021 to see the list.

On occasion, members may have to demonstrate the extent of the NHS indemnity coverage that they benefit from. Use this document for this purpose.

What’s the scope of CNORIS for professionals?

We’ve put together some guidance and examples of professionals who have cover under the scheme. This is not an exhaustive list.

NHS bodies are liable in law for the negligent acts and omissions of their staff in the course of their NHS employment. Under NHS indemnity, these bodies take direct responsibility for costs and damages arising from clinical and other negligence. This only applies where they – as employers – are vicariously liable for the acts and omissions of staff who are performing NHS functions.

If staff are acting in the course of NHS employment, but aren’t performing NHS functions, the claim isn’t managed by the scheme. One example would be an income generation activity. In these instances, the NHS employer still remains responsible for the acts of staff.

Is activity outwith NHS employment covered?

NHS bodies aren’t responsible for work healthcare professionals complete that’s outwith the scope of their employment. This means that NHS indemnity doesn’t cover any liability arising from such activity.

Private practice activities aren’t protected, even if they are carried out in an NHS hospital.

The medical staff of independent hospitals are responsible for their own medical defence cover. This is subject to the requirements of the private hospital manager. If NHS staff in the training grades work in independent hospitals as part of their NHS training, suitable indemnity arrangements should be formally agreed. They’ll be documented in writing between the health board and the independent hospital.

Are contractors covered – including GPs and GDPs?

The situation is not always entirely clear cut when an NHS body engages a third party contractor to deliver patient care. This is especially true if an independent healthcare provider uses NHS facilities. It’s essential to clearly document the responsibilities of independent contractors. In most cases, independent contractors must bear responsibility for the acts and omissions of staff. They’ll need to obtain appropriate insurance and provide an appropriate indemnity to the NHS body.

Are healthcare professionals opting to work under contracts for services rather than as employees of the NHS covered?

Health boards are vicariously liable for healthcare professionals working under their direction and control. These professionals will be performing services as part of their delivery of NHS patient care.

Any contract of services must clearly establish whether or not a health board will retain liability and manage issues through the NHS indemnity. If not, the healthcare practitioner needs to have appropriate insurance coverage.

Is a hospital doctor doing a GP locum role covered?

This is not the responsibility of the NHS body since it refers to general practice. The hospital doctor and the general practitioners concerned must ensure that there’s appropriate medical defence cover.

Is a GP seeing their own patient in hospital covered?

A GP providing medical care to a patient in hospital as an employee of a health board is covered by NHS indemnity.

Where a NHS body provides facilities for patients who continue to be the clinical responsibility of an independent GP, the GP is responsible. Medical defence cover is appropriate here.

However, where junior medical staff, nurses or other healthcare professionals are involved in the care of a GP's patient in NHS hospitals, they will be doing so as part of their contract with the NHS body. As a result, they’re covered by CNORIS.

Are GP trainees working in general practice covered?

GP registrars are employees of NHS Education for Scotland and the scheme applies in respect of any training activities. However, not all aspects of their work are covered. GP registrars must be members of a recognised medical defence organisation or insurer for these aspects of their roles.

Are independent midwives covered?

Independent midwives are self-employed practitioners. Like all other healthcare professionals working outside the NHS, they’re responsible for making their own indemnity insurance arrangements.

Are locum healthcare professionals covered?

Since locum healthcare professionals carry out the work of colleagues who would be covered by the scheme, NHS bodies remain financially responsible for their acts and omissions. This is true whether locums are "internal" or from an external agency. It also applies equally to a GP acting as a hospital locum, as opposed to providing care to his or her own patient in hospital.

Is on the job training covered for students or those doing work experience?

NHS indemnity applies where students, trainees (including GP trainees), healthcare professionals and others are gaining practice experience, refresher or on the job training. They’ll be under the supervision of NHS employees. For the same reasons, it applies to students gaining experience on NHS premises under the supervision of staff employed by universities/colleges.

To the extent that fault lies with the NHS indemnity member, the indemnity will extend to relieve any external employing organisation that arranged the NHS training. But, the scheme will not protect any external organisation to the extent that the latter body is at fault for the loss.

Are education and research activities covered?

Members' legal liability arising out of clinical research is covered by the scheme.

NHS bodies are vicariously liable for the work done by university/college medical, nursing and healthcare staff, and other research workers in the course of their NHS clinical, teaching or research duties. Other university/college work is excluded.

NHS bodies undertaking sponsor responsibilities in a clinical trial are covered by NHS Indemnity. Location of the trial sites doesn’t matter. Research ethics committee members who provide independent advice to NHS bodies on research proposals are also covered. Health boards appoint these committees. Appropriate contractual arrangements should be put in place with the benefit of indemnities where members are carrying out trials for a commercial sponsor.

The NHS scheme will not indemnify any other organisation involved in research.

NHS bodies need to ensure that they’re informed of clinical trials in which their staff are taking part in their NHS employment. These trials must have approval from the required research ethics committee.

Are volunteers covered?

Where volunteers work under the direction of NHS bodies, they’re covered by NHS indemnity. NHS managers must be aware of all voluntary activities going on in their organisations. Wherever possible, they need to confirm volunteers' indemnity positions in writing.

NHS bodies are not responsible for the liabilities of third party voluntary organisations. Arrangements with these organisations should clearly establish each party's responsibilities in writing.

Legal liability of organisations for the work of staff and volunteers depends on a number of factors. The degree of control exercised by the organisation and the extent to which any activities are central to its functions are two factors. It’s possible for organisations to share responsibility. So, the extent of legal liability will depend on the facts and circumstances in each case.

Where an NHS body is legally liable for the acts and omissions of a volunteer, the NHS indemnity will apply. Agreements with voluntary organisations need to address matters such as health and safety, and insurance to ensure appropriate procedures are in place.

Where fundraising events are arranged by individuals in the community – outwith the control and supervision of the member – then the NHS indemnity is unable to provide cover. This is the case even if the member knows about the event and will benefit from it. Examples include: charity abseiling, sales of food and similar types of activity arranged informally.