State-backed indemnity, which started on 1 April 2019, only provides indemnity for clinical negligence claims arising from primary care work under an NHS England or Wales contract.
As discussed in previous articles, one clinical incident can lead to a number of different adverse outcomes for the doctor involved. This is called multiple jeopardy, and GPs will still need the support afforded by MDU membership to request assistance with patient complaints, GMC referrals, ombudsman investigations, performers' list actions, media intrusion, criminal investigations - and as the case study below illustrates, coroners' inquests.
Don't leave your career exposed by relying on state-backed indemnity alone. For more information on how important it is to have the MDU available to help you even after state-backed indemnity is introduced, visit our website.
A GP member contacted the MDU about a patient who had liver disease. The patient was admitted to hospital for planned surgery, but unfortunately following this his liver disease rapidly deteriorated and he sadly died.
The practice had requested an updated scan of the patient's liver and had received the result, which demonstrated the presence of ascites (fluid in the abdomen) for the first time and may have indicated progression of his liver disease, a few days before the surgery.
The patient's widow was critical of the care provided by the practice and the hospital and complained to the hospital, which investigated her concerns and responded. The widow subsequently wrote a statement for the coroner which was very critical of the care provided by both the hospital and the practice. The statement made reference to the information provided by the hospital in its complaint response.
The member was asked by the coroner for a report detailing the practice's involvement in the deceased's care, and was then called to the inquest to give evidence in person. The deceased's widow was legally represented at the inquest. A few weeks later the patient's widow instituted a negligence claim against the practice. The member asked the MDU for advice and assistance.
The coroner did not criticise the practice's care of the patient in his final determinations, concluding that the patient had died from natural causes.
The member remarked, 'I really can't fault the support and advice offered to me by the MDU, which has been exemplary from beginning to end. I have always felt well supported and advised by the MDU every step of the way.'
Commentary from Dr Caroline Fryar, MDU head of advisory services
Being made aware of your involvement in a potential adverse incident is a heart-sink moment for any doctor. No one sets out intending to cause harm to a patient and any suggestion that you might have done is devastating.
More often than not, our members' first port of call on receiving such news is to call our 24-hour medico-legal advice line. Understandably, members are often very distressed, sometimes feeling unable to share their predicament with colleagues or seek support from their close friends or family.
Our advice line is staffed around the clock by specially trained fellow doctors who fully understand the challenges of clinical practice and sadly know that things can and do go wrong in medicine.
The initial role of the medico-legal doctor on our advice line is to provide support, to share the problem and to work through, with the member, what might follow and how best to proceed. There are many immediate considerations - for example, whether the duty of candour threshold is met or whether any formal notification is required - alongside advising on whether there are steps that can be taken to mitigate the impact of any incident, or whether personal learning or systems changes might be needed to prevent a similar incident in the future.
In many cases, the member will be invited to write in for further advice so they can be allocated their own named medico-legal adviser who will guide and support them every step of the way.
In almost 90% of the cases that we defended, the GMC made no adverse finding at all.
In dealing with complaints we help members with their draft responses, ensuring they contain appropriate levels of clinical information, clear explanations, apologies (where appropriate) and reassurances of steps taken to prevent recurrence.
Advice often includes the need to coordinate the response across providers. Our aim is to get the complaint resolved at an early stage and prevent escalation, and a responsive approach to complaints and adverse incidents means that very few cases later develop into claims. Furthermore, if the GMC later comes knocking, we are already well placed to respond on behalf of members, having already apologised, reflected and remediated as appropriate. In fact, in almost 90% of the cases that we defended in the last five years, the GMC made no adverse finding at all.
In the case study above the coroner was also involved. We assist hundreds of GPs each year faced with a coroner investigating the death of a patient and can offer support to members all the way through the process, from helping draft reports for the coroner to providing legal representation at a hearing.
Again, the pro-active approach outlined above means that criticism of our members is ultimately uncommon and very few of our cases see the coroner issuing prevention of future death reports. Even more uncommon, but a matter we are always alive to, is the possibility of a police investigation for gross negligence manslaughter. Our advice in this situation is to speak to your MDU adviser - and quickly. We are the only MDO with an in-house team of specialist solicitors specifically dedicated to defending allegations of medical crime.
As highlighted above, few of our advisory cases progress to a claim, but when they do, we allocate the case to our in-house specialist claims handling unit. Their expertise sees us successfully defend over 80% of cases without payment of compensation or claimant costs.
The member's thanks for our support in this case echoes so many expressions of gratitude we receive each year. We are here for you as our members to stand with you in your time of need - on your side, by your side.