Dr Christine Tomkins
GPs should understand what state-backed indemnity will provide and what its limitations are. GPs face multiple jeopardy, for which they will continue to need MDU membership.
The introduction of state indemnity will not come a moment too soon for GPs, who have been hit hardest by the soaring cost of clinical negligence. The Department of Health and Social Care is committed to implementing a new state-backed indemnity scheme for GPs in England from April 2019 and the Welsh government is planning to follow suit.
At time of writing, details of the government's proposed scheme for general practices have yet to be announced but the level of provision is unlikely to differ significantly from the long-established scheme for hospital doctors (the Clinical Negligence Scheme for Trusts, or CNST). In other words, it will cover clinical negligence liabilities arising from GPs' commissioned practice but will not extend to non-NHS work, such as private travel clinics.
Nor will GPs be able to look to the scheme for help with other medico-legal matters, as the BMA recently reminded members: 'The MDOs will continue to play an important role in providing legal advice, representation for GMC hearings and also for the rare occasion where a criminal case occurs. Similar to hospital colleagues, it will be essential to maintain such medical indemnity.'
However, a recent survey of 700 GPs carried out by the MDU suggests that many GPs do not know what the limitations of state indemnity are likely to be. Some 40% of respondents believed the scheme would offer them support with performers' list actions, and 20% thought help with GMC investigations and inquests would be included too; this is unlikely to be provided under the state-backed scheme.
The risk of gaps in professional indemnity cover is a real concern; every doctor deserves and needs access to expert advice and legal representation when their practice is under scrutiny. And this support is even more important when you consider the wide range of different investigations that can take place arising from a single incident, a phenomenon we call multiple jeopardy.
To take an example based on MDU cases, a GP who was alleged to have pressed inappropriately against their patient during an eye examination was subjected to a police interview, GMC fitness to practise proceedings and a performers' list investigation before their name was eventually cleared.
In 2017, the MDU helped over 6,000 members with cases that we believe are unlikely to fall within the proposed scope of the state-backed scheme. Our advisers and lawyers see at first hand the heavy personal toll on MDU members for whom so much is at stake - career, reputation, livelihood and sometimes even freedom. It is inconceivable that a doctor would consciously decide to face the experience alone.
Expert legal advice can make all the difference to the outcome. For example, in 2016, the GMC recorded an adverse outcome in over 20% of fitness to practise cases closed in the year - the likelihood of an adverse outcome was more than halved for MDU members to just under 10%. Adverse outcomes were also less severe, with only 3% of MDU members suspended or erased from the register compared to 9% in the GMC figures. And when it comes to criminal proceedings, the MDU is the only medical defence organisation in the UK to have an in-house criminal law team, who are equipped to provide members with an expert defence from the moment an allegation is made.
Retaining your MDU membership will ensure you continue to have access to a wide range of benefits above and beyond clinical negligence cover.
The significant cost of legal representation makes it prohibitively expensive for unrepresented doctors to instruct a solicitor, let alone one with the requisite medico-legal expertise. In the MDU's experience, the legal costs of an MPTS fitness to practise hearing often exceed £50,000 and can be more than £150,000.
In criminal cases the financial situation is even worse. Household income generally makes doctors ineligible for legal aid in magistrates' courts and obliges them to make ongoing contributions to defence costs if their case reaches the crown court. And it is now impossible for defendants who have been forced to fund their own defence to fully recover reasonable costs on acquittal, leaving some facing financial ruin.
I do not want any GP member to be caught in this invidious position because they have mistakenly assumed that state-backed indemnity is all encompassing. Retaining your MDU membership will ensure you continue to have access to a wide range of benefits above and beyond clinical negligence cover, including specialist legal representation at no additional cost, 24-hour medico-legal guidance and access to press and media advice.
The MDU's doctors and lawyers are also on hand to provide pastoral support when doctors are struggling through an investigation. As one member put it, 'I would like to take this opportunity to thank you from the bottom of my heart for all that you have done for me. It has been a rough ride and you have been behind me all the way and for this I give you my sincerest gratitude for all your hard work'.
Of the 40,000 requests for advice and assistance that the MDU and DDU received last year, only a minority were from members seeking help with a claim. Most, like the doctor above, were seeking medico-legal expertise, support and reassurance at a difficult point in their professional lives.
GPs should not see state-backed indemnity as a replacement for MDU membership. The MDU will be there for our members in their time of need.
To see the likely differences between state-backed indemnity and MDU membership, visit our website.