Leading an organisation that has been around for over 135-years brings its own particular demands. While Paul Riordan-Eva is justifiably proud of the MDU's longevity and values, he is conscious of the need to be open to new ideas and stay relevant to the professional lives of members.

Since being appointed chair of the board of management in 2017, Paul has calmly steered the MDU through an intense period of transition as several senior staff retired after many decades' service, including chief executive Dr Christine Tomkins, finance director Maurice Gallivan and marketing and sales director Nick Dungay.

Of course, these changes could be carefully planned, but it was impossible to imagine how the world would be transformed before the end of his term by a global pandemic, or how this event would magnify existing stresses on healthcare professionals. However, as he looks ahead to his own well-deserved retirement, Paul believes the MDU is currently in great shape to support members and meet their needs.

It is testament to his positive outlook that Paul recognises the challenges of organisational change but also sees the benefits. "The MDU has some very long-serving staff and this accumulated experience and knowledge is certainly advantageous, but it can be disruptive when there has to be a handover," he says. "On the other hand, it is wonderful to see new people come in and look at the organisation with a different pair of eyes. It's very helpful to get a fresh view on things."

Paul also believes the MDU's management structure provides continuity where it counts, ensuring decisions are always made in the interests of members, rather than being purely commercial considerations. "Members are represented on our board of management and council, so their voices are heard in discussions," he says. "And I think it is advantageous that our CEO continues to be a doctor. When Christine Tomkins retired, we cast the net wide for her replacement, but Dr Matthew Lee was the right choice and his appointment reaffirms the powerful message that the MDU abides by its 'doctors for doctors' ethos."

Ensuring that doctors and dentists have someone on their side has never felt more important than right now, with so many exhausted by the demands of working through a pandemic and witnessing its impact on services.

Paul is pleased with the unwavering support that the MDU offered members throughout, particularly the advisory team, which was always on hand to provide guidance and reassurance. "Of course, the pandemic placed a lot of stress on the system and there were all sorts of changes from one minute to the next, especially for those in dental practice. I was astounded by the way our advisory teams were able to keep ahead of everything that was happening so they could help members whenever they were in contact."

This commitment to providing a high-quality service in all circumstances is valued by members, Paul observes. "Being able to give members the attention they need, promptly and effectively, is very important. We know from member satisfaction surveys that encounters with the MDU are generally well received, and we get wonderful comments as to how well members feel they have been looked after by our advisory services."

Another strength demonstrated during the pandemic was the MDU's adaptability, Paul suggests, as staff switched quickly to home working to maintain member services. "We had a head start because the medico-legal advisers and some other employees were already home-based, but there were enormous logistical challenges and our IT and facilities teams did an amazing job. It seems to me that we now have a good balance whereby people may have the opportunity to enjoy the freedom of working from home but still come into the office when they need to meet in person."

As chair, Paul admits to mixed feelings about the adoption of video-conferencing to conduct MDU board meetings. "It made it possible to do things, but it has difficulties because relationships rely so much on one-to-one interactions. I am always struck by how difficult it is to have a normal conversation or catch up with people during a virtual meeting, which is very important. I'm certainly relieved we are now able to hold board and committee meetings in person, but video conferences are useful and continue to be convenient for some, particularly ad-hoc, meetings."

Ensuring the MDU board operates effectively so it is able to carry out its core functions is the primary duty of the chair, says Paul. These include corporate governance, financial oversight and helping direct the MDU's strategy in the interests of members - in particular, how it can deliver benefits that help alleviate the burdens of modern practice.

"At the moment, the most pressing item in our in-tray is considering new avenues of service provision to members," confirms Paul. "For example, there is no doubt that the administrative burden has increased in recent years, particularly for GPs who are working evenings and weekends trying to catch up. In response, the MDU is looking at ways to support members through benefits such as the tax and business advice service."

Equally, he stresses that new services have to be consistent with the MDU's core purpose as a not-for-profit mutual organisation. "We must think about what would actually be useful to members. The MDU exists to support our members in their professional activities at a reasonable cost. It's not about diversifying into unrelated products or services, which I think would actually be detrimental to our relationship with them."

Ultimately, members have always looked to the MDU to defend their professional reputations and Paul believes that access to expert medico-legal advice and representation has never been more important. "State indemnity has been extended to GPs, but it's important to be aware that this doesn't protect you in the event of a GMC or criminal investigation.

"Without wishing to belittle the turmoil and anguish of a clinical negligence claim, the consequences of such a claim can pale into insignificance in terms of a members' professional career, compared with a referral to the GMC or GDC, which could hang around for a long time and where an adverse finding could put them in enormous jeopardy professionally. This is where the MDU comes into its own: over the last five years, we have assisted with well over 99% of requests for our help, and 83% of GMC cases involving MDU members at the case examiner stage were resolved without referral to an MPTS hearing in 2020."

In addition, the MDU continues to be an authoritative voice for the profession on medico-legal matters of concern. These include the government's proposals to reform the regulation of healthcare professionals, the GMC's new version of 'Good medical practice' with obligations for doctors to take action in cases of bullying, harassment, or unfair discrimination, and of course civil litigation reform, which has become a hot topic again after the publication of an inquiry by the House of Commons Health and Social Care Select Committee, to which the MDU contributed evidence.

"The GMC's consultation document highlights a growing tendency for doctors to be held professionally accountable for the behaviour of others," says Paul. "I fear this will impose more pressure on doctors to take responsibility for employment matters at a risk of being referred to the GMC."

As for long-overdue action on clinical negligence compensation, Paul is hopeful that renewed attention on the issue is a sign the dial might have shifted. "I think Jeremy Hunt understands that the clinical negligence burden on the NHS is just getting completely out of hand and something needs to be done. It has been a very slow process but we are at least moving in the right direction."

Despite the uncertainties in medical practice, Paul is confident that the MDU will be part of the medico-legal landscape for many years to come, supporting medical and dental professionals throughout their careers. "I am optimistic that the organisation is in a good position," he says. "The performance of our investment portfolio had a positive impact on our financial situation and we’ve been able to manage, and we have been able to manage internal and external change. We continue to focus on doing the things our members want and keep doing them well."

As to his own future, Paul hopes to spend more time on the golf course. He has a handicap of 12 but ruefully observes that the lower the handicap, the tougher it can be to win matches. He also serves as a voluntary member of an NHS Research Ethics Committee, focusing on social care research applications. "The great joy for me is meeting people from other walks of life and hearing their views. It's fascinating to see the social care arena developing a research capability but of course it raises ethical issues in terms of data handling and the capacity of participants."

He may have stepped down from the MDU, but Paul has every intention of playing an active role in ethical and legal debates in the years ahead.

Interview by Susan Field.