News MDDUS MDDUS pressing for clarity on claims costs EDITOR Dr Barry Parker


THOSE who are displaced from their homes through war or conflict and seek refuge in the UK have particular health needs that may be difficult to meet under standard models of NHS care. Refugees may arrive in the UK in poor physical health, suffering infections such as TB or hepatitis, and with severe mental health issues such as PTSD and depression as a result of the traumas they have endured. Problems accessing care may be compounded


by lack of understanding of systems, language barriers and homelessness. It is therefore heartening to hear of the outstanding work undertaken by the Health Inclusion Clinic in London. On page 10, Jim Killgore interviews two members of the team, which has been recognised with a BMJ award for its innovative work. Also in this issue, Majid Hassan highlights an ongoing medico- legal case which addresses the duty to warn a third party about genetic risk, and conflict with a patient’s right to confidentiality. We await the final outcome of this important


“Refugees may arrive in the UK in poor physical health, suffering infections such as TB or hepatitis, and with severe mental health issues”


case with interest (page 12). James Tang focuses on the common occupational hazard of back and neck pain in dentists, offering practical advice on page 14. Alan Frame examines the tricky issue of doctors receiving gifts from patients. Is it ever acceptable (page 9)? On page 8, Joanne Curran discusses the


controversial proposal to make NHS service mandatory for doctors trained in the UK. Would it be fair or workable? And in the wake of the tragic and high profile court case involving baby Charlie Gard, Deborah Bowman reflects on the virtue of “compassionate silence” on page 21. Finally, Alan Frame tackles a dilemma related to the safeguarding of child protection records on page 20.


Dr Barry Parker 4 / MDDUS INSIGHT / Q3 2017


MEMBERS will have seen reports about the impact of the change to the personal injury discount rate on indemnity subscriptions. Let me bring you up-to-date with developments. The UK Government lowered the personal injury discount rate from 2.5 per cent to minus 0.75 per cent in February. The Scottish Government followed suit in the following month. The effect is to increase the amount of damages paid to claimants in cases involving loss of future employment and long-term care costs, in some cases significantly. The Government recognised the problems caused to the NHS by earmarking an additional £5.9 billion in the March budget to meet the consequences and indicated that “appropriate funding” would be available to manage these consequences for GP indemnity. The Ministry of Justice also launched a consultation about finding a better system to set the rate in future. Since then, MDDUS has been in the forefront of the debate to put some


rationality into the system. We have made clear to both UK and Scottish ministers that we may well judicially review the decision unless the current consultation on a new system reaches a speedy and satisfactory outcome. We have underlined the need for a comprehensive set of legal reforms to limit the impact of claims inflation, whilst ensuring that legitimate claimants are properly and speedily recompensed. In the short-term, we have put proposals to Government for ensuring that subscriptions do not need to rise further because of the discount rate change, whilst ensuring that locum and salaried GPs’ positions are also protected. We have also made clear how disappointed we are with the lack of ambition in Lord Justice Jackson’s proposal on capping legal costs and the slow progress of the Government in tackling the issue. We continue to talk to both Governments about these issues and the need to


take a comprehensive approach which bolsters the model of profession-owned mutual discretionary indemnity. Neither anything in the market from commercial insurers nor crown indemnity matches this model, which ensures that doctors and dentists receive comprehensive, responsive 24/7 support covering the full range of medico-legal, regulatory, disciplinary, inquest and FAI-related matters, as well as a full claims service. We will keep you up to date with developments. Chris Kenny is CEO of MDDUS


Working out of hours


MDDUS defines ‘core’ hours as being from 8am to 8pm, on normal weekdays (excluding bank holidays). Where any part of a session falls outside these hours, it will be categorised as ‘extended hours’ or ‘out-of-hours’ work, as set out below. Extended hours work is that conducted outside core hours but where a GP has full access to the


patient’s NHS GP clinical records and delivers predominantly non- urgent care to patients. It is allowable within our standard sessional rate. Pre-booked patient appointments on weekends and evenings are likely to fall into this category. Out-of-hours care is defined by


MDDUS as that provided between 8pm and 8am on normal weekdays, or any time at weekends or bank holidays, and which does not fall


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