The welcome news that NHS doctors in England are to receive a pay rise cannot disguise the feeling that this is a difficult time for the profession.

Many doctors are struggling to deal with workload pressures caused by unprecedented demand from patients with complex health needs, a staffing shortfall and a crisis in social care provision. But the MDU has also witnessed how the worsening medico-legal climate has left many doctors feeling vulnerable and powerless.

For example, frontline clinicians do their best for patients while often having little influence over their working environment. But all too often the response to adverse incidents is to seek to blame individuals rather than learn lessons. The rise in gross negligence manslaughter investigations against doctors is one symptom of this, as is the unsupportive approach of some NHS organisations during investigations.

And then there is the long-term issue of soaring claims inflation. This is not the fault of doctors. The underlying cause is an obsolete civil litigation system, compounded by the Lord Chancellor's decision to reduce the discount rate to an historic low.

The spiralling level of settling claims has serious ramifications for the NHS - NHS Resolution's latest annual report estimates that its total liabilities have almost trebled to £77 billion in four years. It has also contributed to a crisis in general practice by pushing up the cost of GP indemnity to unaffordable levels. It's perhaps not surprising that a third of GP respondents to an MDU survey in 2017 were thinking of leaving the profession or retiring over the impact on practice finances.

But while this hostile medico-legal environment is daunting for a lone professional, doctors are not alone. As a mutual medical defence organisation, the MDU has the strength to stand up for our members when the going gets tough, whether that is providing robust representation to individuals or, more broadly, by seeking to make a positive difference to their working environment.

The MDU's medico-legal expertise makes us an authoritative voice when it comes to advocating legal and regulatory reforms in the interests of the whole profession. You can read about this aspect of our work in this issue, including our contribution to the Williams Review into gross negligence manslaughter in healthcare, where many of the reforms we had put forward were reflected in the final recommendations.

Indemnity costs are another important area where the MDU has striven to improve the situation for members. In addition to our Fair Compensation campaign, we introduced Transitional Benefits membership for GPs working in England and Wales until the government makes good on the commitment to provide state-backed indemnity for GPs.

Transitional Benefits have already had a beneficial impact on members. Around three quarters of GPs taking part in our most recent survey about indemnity costs said that reduced subscriptions increased the prospect they will continue working, while about half said it enabled them to recruit more staff and take on additional sessions. The MDU continues to negotiate with the English and Welsh governments about the details of the state-backed indemnity schemes which are due to come into effect from April 2019 and we will do our utmost to ensure the scheme is fair to our members.

At the same time, it's important to recognise that state indemnity is not a substitute for MDU membership. We go beyond indemnity to provide members with representation in the event of a GMC investigation, disciplinary hearing or inquest, assistance with patient complaints, professional development resources (such as our ethics and law course for GPSTs) and expert medico-legal guidance.

As anyone who has had cause to phone our advice line will know, being able to talk through concerns with a supportive expert can help forestall more serious problems. For example, our 2018 Cautionary Tales includes the case of a GP who called the MDU's 24-hour advice line after a mix-up in the records meant that a dying patient did not receive a home visit. With the help of a medico-legal adviser, the practice was able to address the concerns of the patient's family and resolve the complaint.

Ultimately, belonging to the MDU means that you can seek our support throughout your career. We are there to guide, support and defend you, and as a powerful voice to make a positive difference for the whole profession.