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News MDDUS EDITOR Dr Barry Parker


“It’s always inspiring to hear from doctors who manage to juggle two successful careers, and author and GP, Dr Gavin Francis, discusses his “work-work” balance in these two roles”


DETAILS of the new state-backed indemnity scheme for GPs in England have now been released as the Government launches a new five-year contract for general practice. A similar Future Liability Scheme (FLS) has also been announced for GPs in Wales. Both schemes will commence on 1 April 2019 and in this issue of Insight we provide further details and also announce a new indemnity product for our GP members in England and Wales – General Practice Protection (GPP) – that provides protection for the many important exclusions not included in the CNSGP/FLS. On page 9 of this issue, Chris Kenny provides an MDDUS perspective on the new schemes, and on pages 10 and 11 we go into the detail of why it is so important for GPs to retain membership with MDDUS. It’s always


inspiring to hear from doctors who manage to juggle two successful careers, and on page 12 Dr Gavin Francis, GP and author of Adventures in Human Being and Shapeshifters, discusses his “work- work” balance in these two roles. On page 14, Sarah Harford highlights the importance of maintaining professional boundaries in all dealings with patients, and in these times of polarised opinions Deborah Bowman provides her own insight into


the ethics of neutrality (p. 21). Our regular selection of case studies on pages


16 to 19 includes a dispute over preventative care of enamel loss in a child, a clinical negligence claim alleging failure to diagnose Charcot foot in a diabetic, and a dental patient worried about mercury poisoning from his amalgam fillings. Our dilemma column (p. 20) deals with a GP in a rural area tempted to pursue a non-professional relationship with a current patient at the practice.


Dr Barry Parker 4 / MDDUS INSIGHT / Q1 2019


Resist requests to overprescribe during Brexit


GPs should avoid issuing longer repeat prescriptions in the run up to Brexit and should liaise closely with pharmacists if there are concerns over shortages of specific drugs. If all GPs prescribed greater quantities then this would increase the risk of a shortage of medication. Whilst concerns may exist regarding specific patients, it is important to consider the wider issue of supply and whether, for some patients, a short- term clinically appropriate alternative drug may be indicated. We would advise GPs not to alter


their prescribing habits and not to be pressurised by patients into prescribing greater quantities of repeat medicines. However, GPs must also comply with their obligation to raise concerns in line with the GMC’s guidance Raising and acting on concerns where they are worried that inadequate resources may put a patient at risk. Each


prescriber takes responsibility for the prescriptions they issue, so doctors must be prepared to explain and justify their decisions and actions when prescribing, administering and managing medicines. The GMC guidance Prescribing and managing medicines and devices states: “Whether you prescribe with repeats or on a one-off basis, you must make sure that suitable arrangements are in place for monitoring, follow-up and review, taking account of the patients’ needs and any risks arising from the medicines”. If GPs continue to have particular concerns regarding specific patients/ drugs, including short-term substitute drugs, then they should discuss these issues with the pharmacy lead of their local CCG/health board.


Dr John Holden is a medical adviser and joint head of medical division at MDDUS


CNSGP falls short of integrated service


MDDUS Chief Executive Chris Kenny has responded to “enabling regulations” to implement the Government’s plans for a new Clinical Negligence Scheme for General Practice in England (CNSGP). He commented: “We welcome the long overdue appearance of these regulations to enable the operation of the new Scheme. We are also working with NHS Resolution to help in the preparation of more user-friendly documentation for doctors. “What the regulations show is


how far the nationalised claims-only product falls short of the integrated service currently offered by MDOs.” He points out that, in particular,


Regulation 6 is permissive, not mandatory: “the Secretary of State does not have to pay and could walk away from these commitments at any time”. The Scheme therefore would not pass the regulatory tests which Government wants to impose on healthcare professionals in their consultation on regulation of indemnity. Regulations 8 and 10 set


out a range of exclusions and compliance rules on GPs which simply do not exist in MDDUS’ current Articles of Association. They add risk to GPs rather than provide certainty. He added: “In short, the


Government must keep rules and exclusions to a minimum and set out a clear process and timescale for evaluating the new Scheme given its unproven nature.”


Access the regulations at tinyurl.com/yyvbgwou


Dentists leading through uncertainty


Well-led teams are best equipped to meet increasing demands and to manage risk. With this in mind, and GDC standards requiring dentists “to demonstrate effective management and leadership skills if they manage a team”, we have adapted our popular and long-running leadership programme specifically for dentists with management responsibilities. This five-day programme running one day per month between August


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