As a mutual medical defence organisation, the MDU has been owned by and run solely in the interests of its members for more than 135 years. Members will likely know about the MDU's advice helpline and of the doctors who make up the advisers at the other end of the phone - but they are less likely to be familiar with the cases committee.

This group of eminent clinicians, drawn from nearly every specialty, plays an essential part in the running of the MDU, particularly in upholding its mutual status by representing the interests of their fellow MDU members.

Among the committee's members are the chair Dr Simon Watkin, a consultant respiratory physician, and Dr Harjinder Sandhu, a GP. Both have been MDU members throughout their careers and also serve on the MDU's Council, which acts as a forum for the discussion of medico-legal and dento-legal matters on behalf of the board of management.

The cases committee has a specific remit to represent the wider MDU membership and advise on complex questions related to high-value clinical negligence cases.

All members of the cases committee have been formally interviewed and their CVs reviewed by the MDU's council and board of management, and there is a rigorous process to ensure the committee has the necessary and relevant clinical experience and medico-legal expertise.

"We try to ensure there are representatives in each of the main specialities to comment on cases in their field," says Simon, "including GPs, orthopaedics, cardiology, neurosurgery and general medicine." As one of four GPs on the committee, Harjinder is regularly called upon by Simon to comment on cases involving general practitioners; they make up a greater proportion of the committee's caseload due to the nature of practice and the number of GP members.

Committee members gather every two months to discuss cases that have been raised with it by MDU claims handlers. Papers are sent out electronically before the meeting so the members have a chance to familiarise themselves with the salient points. "It is imperative that cases are considered with no prior knowledge of the case or clinicians concerned", says Simon, explaining that all cases are considered purely on the facts of the care in question.

The committee goes to some lengths to ensure none of the members have had any prior involvement in the cases considered, either from a clinical or medico-legal perspective, and would be excluded from the discussion if so. Furthermore, once a member has taken part in a discussion on a case, they may not accept instructions from any party to act as an expert on that case.

During meetings, cases are presented by the claims handler, who presents a brief summary and the specific questions they wish the committee to consider, such as what specialties of expert might be best placed to provide advice on the claim, and whether there are any less-obvious avenues that might be explored in its defence. A member in the same area of practice as the doctor involved in the claim is nominated to lead the discussion, before the floor is opened up to the committee as a whole to make observations.

The committee's discussions provide the claims handler and head of claims with a wide-ranging review of the case. While the committee doesn't take decisions on the cases, its observations can prove invaluable in the subsequent investigation of a claim.

The committee's discussions can also be a useful learning process, according to Simon and Harjinder. "I'm not the only doctor who would say that this is some of the best CPD they will ever get," says Simon.

While details of the cases are kept strictly confidential, Harjinder agrees that "It's an education. Every time I go to committee, I always pick up bits and pieces of general advice to pass on to my registrar trainees, and sometimes even with my practice partners so we don't fall down these pitfalls ourselves, and can improve the quality of care we are providing in the practice."

General issues arising from committee meetings can also be noted and fed back to the council and to the wider MDU membership in the form of risk management advice so everyone can benefit. But the greatest strength of the committee is its significant role in representing MDU members themselves within the organisation, thereby putting its 'doctors for doctors' ethos into practice.

As Harjinder reflects, "It is not in the collective interests of members to defend the indefensible. But at the same time, members going through the stress of litigation should know that they will receive the best possible support and expertise from the MDU.”

Simon concurs: "The fact that the cases committee, council and board of management are populated by members genuinely makes the MDU a 'doctors for doctors' organisation."

Interview by Susan Field.