Professional Indemnity Arrangement for NMC Revalidation

The professional indemnity requirement is the easiest of the eight to satisfy and the easiest to misunderstand. Most employed nurses have cover by default through their employer. Agency and self-employed nurses usually have cover through union membership. Genuinely uncovered nursing work is rare, but when it exists the legal exposure is significant.

This chapter covers what the requirement is, who provides cover, and the situations where the default arrangement isn’t enough.

What indemnity actually covers

Professional indemnity cover compensates patients for harm caused by negligent professional practice. If a patient is harmed by an error you made, and the matter is litigated, the indemnity provider pays the compensation and legal costs.

What it does not cover:

• Criminal acts (assault, theft, drug diversion).
• Deliberate wrongdoing.
• Practice outside your registered scope.
• Practice in jurisdictions or specialisms the policy doesn’t extend to.
• Fitness-to-practise costs (the NMC investigation process; your union may cover this separately).

The NMC requires indemnity for the protection of patients, not the protection of the registrant. The requirement is functional: if you harm a patient negligently, the patient must have a route to compensation.

Who provides indemnity for UK nurses

Four main sources:

1. Employers. NHS trusts, GP surgeries, hospices, care homes and most private healthcare employers provide vicarious liability cover for their employees. The cover applies when you’re acting within the scope of your employment. NHS cover is provided through NHS Resolution (formerly the NHS Litigation Authority); private employers usually carry policies with commercial insurers.

2. Unions. RCN and Unison both include professional indemnity in their membership. RCN’s cover is the more commonly used among nurses. The cover travels with you across roles, which makes union cover the standard choice for agency, bank and self-employed nurses.

3. Independent insurers. A small commercial market exists in stand-alone indemnity policies for nurses, mainly used by nurse practitioners with independent clinics and nurse consultants in private practice. Cover varies; check scope carefully.

4. Combinations. Many nurses have multiple overlapping arrangements: NHS cover for substantive work, RCN cover as a backstop, and personal cover for specific independent activity. Overlap is harmless and often sensible.

What the NMC asks

The revalidation form asks you to confirm three things:

• You have an indemnity arrangement in place.
• The arrangement is appropriate for the nursing work you carry out.
• You understand that the arrangement must remain in place while you’re on the register.

You do not submit the policy document or the certificate. The submission is a declaration, not evidence.

If your submission is audited, the audit may ask you to confirm the source of cover and produce evidence: an employment letter confirming the trust’s cover, a union membership confirmation, or a copy of an independent policy schedule.

Common situations and what cover applies

Single-employer NHS nurse. NHS Resolution cover via your employer. Nothing else needed. If you do voluntary clinical work outside the role (NHS Volunteer Responder schemes, hospice volunteering), check whether that’s covered by your employer or the volunteer organisation. Usually it is.

Bank nurse working through trust banks. Cover via each trust you work for. RCN cover recommended as a backstop because trust contracts can be variable.

Agency nurse. Cover usually via the agency, which carries its own insurance for placed nurses. RCN or Unison cover strongly recommended because agency policy quality varies.

Self-employed independent practice nurse (foot care, vaccinations, etc.). Need stand-alone cover. RCN membership covers many self-employed activities but check the schedule. Independent nurse practitioners with their own clinic usually need additional commercial cover.

Nurse consultant in private practice. Stand-alone commercial cover usually needed. Some specialist providers (Medical Defence Union, Medical Protection Society) cover nurses in this role.

Nurse in a non-clinical role. If your registration is dormant or your role doesn’t require it, indemnity isn’t a revalidation issue, but you may also be wondering whether you still need to revalidate. Chapter 3 of this guide covers that.

When the default isn’t enough

The default arrangement (employer plus optional union backstop) doesn’t cover:

• Independent practice activity outside your salaried role.
• Expert witness work for legal cases.
• Clinical work overseas unless the employer is UK-registered.
• Aesthetic or cosmetic procedures, since many union policies exclude these.
• Telehealth services in some private arrangements.

If any of these apply to you, check the small print on your existing cover and consider additional cover. The gap matters more legally than for revalidation purposes. The revalidation declaration is satisfied if cover for your primary nursing work exists. But practising in a gap creates uninsured legal exposure.

What “appropriate” means

The NMC’s word “appropriate” does the work of all the specific exclusions above. Appropriate means:

• The cover applies to the type of nursing work you’re doing.
• The geographic scope matches where you practise.
• The financial limit is realistic for the harms that could arise from your work.

A nurse practitioner with a private clinic carrying only a £25,000 limit isn’t appropriately covered, since the realistic harm from a misdiagnosis far exceeds that. A district nurse with NHS cover plus RCN membership is appropriately covered for typical district nursing.

What the audit looks for

A revalidation audit that picks up indemnity asks for one of:

• An employment letter confirming the indemnity arrangement.
• A union membership letter or certificate.
• A copy of an independent policy schedule.

You don’t need the full policy document, just confirmation that cover is in place for the period of the revalidation cycle.

The next chapter compares RCN, Unison and employer cover head to head: what each one covers, where the gaps sit, and when to carry more than one.