Working on instructions · POH-GGZ · escalating to the GP
Professional indemnity insurance (BAV) for a self-employed practice nurse (POH)
A POH (practice nurse in general practice) works under the GP's responsibility, but as a self-employed professional you are liable for your own conduct. In a claim it is almost always about the moment when you should have escalated.
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Deze pagina in het Nederlands: Beroepsaansprakelijkheidsverzekering voor een zelfstandige POH.
The calculator and the quote form below are in Dutch. Prefer to do this in English? Email info@finassverzekert. nl or call 072 - 509 24 56 and we will take it from there.
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- An adviser checks whether the cover suits your activities
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A premium indication, not personal advice. Prefer to talk it through? Call 072 - 509 24 56.
In brief
The GP is the lead clinician and the patient claims against the practice in the first instance. That does not mean you are out of range. Under Article 6:171 of the Dutch Civil Code the practice as principal can be liable for your mistake, after which it tries to recover that loss from you. Many contracts for services set out that right of recovery in so many words, together with an obligation to be insured yourself. You are not an insured person on the practice's policy unless that is recorded in writing.
Your work is care, so the standard in Article 7:453 of the Dutch Civil Codeapplies: the care of a good care provider in line with the professional standard. In POH-somatiek (somatic practice nursing) it is about following up abnormal values — blood sugar out of control, sharply raised blood pressure, deteriorating kidney function — and about medication you titrate according to protocol. In POH-GGZ (mental health practice nursing) it is about assessing suicide risk and about whether you consulted the GP or the crisis service in time. Those claims include injury, so a policy that only covers financial loss is too narrow; see the liability insurance for care and welfare.
If you carry out reserved procedures such as giving injections, there must be an instruction from the doctor and you must be competent within the meaning of Articles 35 and 36 of the Dutch Individual Healthcare Professions Act (Wet BIG). If the instruction or demonstrable competence is missing, you face an incident alone. You can read more about cover for self-employed professionals at professional indemnity for self-employed professionals.
This page deals with one situation. The full overview is on Compare professional indemnity insurance (BAV).
Where things go wrong for a self-employed POH
Four situations that lead to a notice of liability in this work.
Record the moment of consultation
Where a deterioration is missed, the first question is whether you consulted the GP and what was decided. A verbal report in the corridor is not evidence. Note the consultation in the GP information system, with the time, the content and the decision taken. Without that note you carry the risk of a decision you did not take alone.
Suicide risk and crisis escalation
In POH-GGZ the most serious claim comes from surviving relatives. The insurer assesses whether you carried out a risk assessment, whether you involved the GP and whether the safety arrangements were recorded. Work in line with the current guideline and record what you agreed with the patient and with those close to them. Even an assessment carried out well with a bad outcome can be defensible. An undocumented one cannot.
Several practices, several arrangements
If you work for different practices, who delegates which task and which protocol applies differs from site to site. Make sure you have one policy of your own that covers all your activities at all sites, and check the sum insured required for each engagement. If your range of duties changes, report it; Articles 7:928 and 7:930 of the Dutch Civil Code attach consequences to an incorrect declaration.
What is not reimbursed
The following, among others, are outside the cover: fines and disciplinary measures where you are registered under the Wet BIG, refunding your own fee, and liability you take on by contract through an indemnity. What is caused by intent or wilful recklessness is excluded by Article 7:952 of the Dutch Civil Code. Your own loss of income during proceedings also falls outside. For that, look at disability insurance.
What does your premium depend on?
- Annual turnover from assignments: the basis for setting the premium
- POH-somatiek or POH-GGZ: the claims patterns differ greatly between the two fields
- Reserved procedures: injections and punctures are assessed separately
- Number of practices you work for: more sites means more protocols and more contracts
- Requested sum insured: usually prescribed in the agreement with the practice
- Run-off period: important when ending an engagement or your business
Insurers weigh these details differently. That is where your saving is.
What falls under which policy
| Situation | AVB | BAV |
|---|---|---|
| Sharply raised blood pressure that you did not discuss with the GP, resulting in a stroke | No | Yes |
| An insulin dose you titrated according to protocol but increased too quickly, resulting in a severe hypo | No | Yes |
| A patient who trips over the scales in your consulting room | Yes | No |
| A blood pressure monitor belonging to the practice that is damaged while you transport it between sites | Provided that | No |
| The cost of defending yourself against surviving relatives alleging a missed risk assessment | No | Yes |
| The hours you spend calling patients back in after a diary error | No | No |
The AVB covers injury and damage to property in the consulting room, the BAV the consequences of your clinical decisions. Your own remedial work falls outside both.
Frequently asked questions
This is what people ask us most.
The GP has ultimate responsibility. Do I still need insurance myself?
Yes. The doctor's ultimate responsibility does not remove your own professional liability, and the practice policy only covers you if you are named on it as an insured person. What is more, many engagement agreements state that the practice can recover loss from you and that you must be insured yourself. Ask the practice for clarity in writing about your status.
May I give injections if the GP asks me to?
Only with an instruction from the doctor, sufficient directions and demonstrable competence. The Wet BIG governs that in Articles 35 and 36. Record when you did the training and how your competence was assessed. In an incident that is the first thing both the insurer and the inspectorate ask about.
A patient says his diabetes was adjusted too late. What do I do?
Report it to your insurer as soon as you know of the claim; Article 7:941 of the Dutch Civil Code requires you to. Admit no liability and make no promise of compensation. Make sure the records are complete: values measured, advice given, consultation with the GP and the follow-up arrangements made. That is what the matter is judged on.
I work in the practice's GP information system. Who is responsible in a data breach?
For the system, the practice is the controller. For your own equipment, email and notes, you are. So a breach through your laptop or phone is your problem. Investigation, notification and liability towards patients belong on a cyber insurance, not on this policy.
Read more
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