News MDDUS Dr Ian Simpson: An appreciation EDITOR Dr Barry Parker


FIGURES released by NHS England in February of this year confirm a very challenging time for staff in A&E departments this winter, with only 77.1 per cent of emergency hospital patients being seen within four hours during January. There may be many factors involved, not least the seasonal surge in acute illness and a virulent flu outbreak. The strain on the NHS has been widespread and the hard work of frontline medical and nursing staff in primary and secondary care should be applauded. We did not intend for “burnout” to be a special theme of this issue of Insight but several of the articles address the current “crisis” and the effect it is having on healthcare staff. In our Q&A on page 10, Dr Tajek Hassan – President of the Royal College of Emergency Medicine – argues that deteriorating performance has created effectively “winter all year round”. He addresses the challenges in ensuring that the NHS is better prepared in future years. On page 8,


“The strain on the NHS has been widespread and the hard work of frontline medical and nursing staff...should be applauded”


Joanne Curran asks whether greater patient “self care” might be one solution to rising demand


and dwindling resources within the NHS, and on page 9 Alan Frame examines the pressures faced by GPs to prescribe antibiotics when their patients have requested them. Deborah Bowman (page 21) looks at the impact of work pressure from an ethical standpoint and her own personal experience of how ethical practice is never more remarkable than when it occurs under pressure. Our Dilemma on page 20 is about a GP on the verge of burnout but not wanting to let the side down. Among the other content, Allan Gaw (page 12)


provides some fascinating historical background to “Gillick competence” and medical consent in children, and Jessica Rothnie (page 14) offers advice on getting the most out of the new GDC ECPD requirements.


Dr Barry Parker 4 / MDDUS INSIGHT / Q1 2018


WE ARE sad to report that former chief executive Dr Ian Simpson (pictured) passed away in December of 2017. Dr Simpson took up the post of secretary of MDDUS in 1987 in succession to Dr James Patterson. The title of chief executive was later added to the post. He retired in 2004 and during 17 years at the helm he guided MDDUS through major changes in the scope and volume of the business and implemented the staffing and infrastructure additions which this required. Dr Simpson was an Aberdeen graduate and came with nine years’ experience


and a wealth of knowledge as a medical adviser with the Medical Defence Union. When he arrived the membership was 15,910 and the annual indemnity and costs were modest by today’s standard at £1,778,752. The scene was, however, changing rapidly with rising levels of claims per member and costs per claim. The full member subscription was still a universal cost for all members irrespective of speciality and unrest was growing because of the inevitable steady rise to meet claims. This culminated in the introduction in 1990 of crown indemnity for hospital and community doctors and dentists. Transfer of assets from the Union to government required hard bargaining which was skilfully led by Dr Simpson. Differential subscriptions for different specialities were also introduced at this time, based on actuarial assessment of risk. Despite the loss of hospital cases,


the Union’s business burgeoned and the decision was taken to purchase Mackintosh House which opened as company headquarters in February 1994. Staff numbers were increased to cope with the increasing caseload and the establishment of an education department allowed us to reach out to members with a view to reducing the risk of costly incidents and, as a consequence, increasing patient safety. Improvements in the governance of finance, computerisation, human resources and communication with members all followed during the 1990s under Dr Simpson’s careful guidance. On a personal note I had, as treasurer and later chairman, a close working


relationship with Ian and found him unfailingly friendly and helpful. His last two years with the Union were overshadowed by the tragic loss of his daughter and by his own health problems but there is no doubt whatever of the debt we owe him for taking the Union forward in 17 years of major change.


Dr Alistair D Beattie


GDC proposals to reform dental regulation


THE GDC has published an analysis summarising responses to its discussion document: Shifting the balance: a better, fairer system of dental reform.


Commenting on the document,


MDDUS chief executive Chris Kenny said: “We support the GDC’s ambitious proposals to build a new culture and encourage debate on reform. There is a great demand within the profession for accountability in terms of the GDC’s overall spending, particularly


with regards to the fitness to practise function.” MDDUS head of dental division


Aubrey Craig added: “The fitness to practise process should focus on the most serious allegations, where there is a risk of harm to the patient. This will help reduce the number of unjustified final hearings. “We are particularly keen for steps to be taken to improve and streamline the early stages of the investigative process, prior to case examiner involvement. This would help ensure more efficient and fairer case handling for registrants. “We are encouraged by the GDC’s


aim of reforming dental regulation without the need for legislative


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