News MDDUS EDITOR Dr Barry Parker


GMC investigations are extremely stressful for doctors, particularly where these are prolonged and result in MPTS fitness to practise hearings. However, we know from assisting doctors that the majority of cases are concluded in the early stages without any action on the doctor’s registration.


The GMC has recently highlighted changes


“The GMC has recently highlighted changes in approach in a number of areas, including fewer investigations being opened for single clinical incidents”


in approach in a number of areas, including increased support for doctors going through investigations and fewer investigations being opened for single clinical incidents. Many challenges remain, however, and in this issue (page 10) Dame Clare Marx, the recently appointed first woman chair of the GMC, responds to some of the most pressing concerns. MDDUS advisers are here to assist members at the outset of professional difficulties, but not seeking assistance at an early stage can have far-reaching consequences, as our feature article on page 12 highlights. On page 14,


dental adviser Mike Williams looks at the particular risks associated with shared decision- making and consent in cases where the prognosis is not assuredly positive. He advises: “An explanation given in advance of a procedure tends to be viewed by patients as the mark of a clinician who


knows which direction trouble is likely to come from. The very same explanation given after the event is generally regarded as an excuse.” Joanne Curran peers into a digital future as


envisaged by the NHS on page 8, and on page 9 Liz Price looks at some scenarios that can strain the boundaries of professional care. Our regular Dilemma (p. 20) concerns a covert recording of a GP consultation posted on Facebook – and on page 21 Deborah Bowman reveals how a passion for rugby can inform ethical decision making. Dr Barry Parker


4 / MDDUS INSIGHT / Q2 2019


Changes to GP membership in England and Wales


FROM 1st April 2019, all GPs working in England and Wales will have access to indemnity for their GMS, PMS or APMS contractual duties provided by the Clinical Negligence Scheme for General Practice (CNSGP) for English GPs or the General Medical Practice Indemnity (GMPI) for Welsh GPs. All MDDUS GP members working in England and Wales were sent a letter in mid-March regarding the changes to our GP grade of membership and detailing our new General Practice Protection (GPP) product. This new grade of membership will supplement the aforementioned state indemnity and will ensure continued access to the expert advice, support and representation currently enjoyed as MDDUS members. All members affected by the


state indemnity schemes have been transitioned onto the GPP product, and those due a pro-rata refund will now have received this. Most members will have seen from the pro- rata calculation that the cost of the MDDUS GPP product is significantly less than their previous grade of membership and members will continue to enjoy these lower rates when their annual renewal falls due. Maintaining your MDDUS membership at renewal is vital to protect your professional interests in areas not covered by CNSGP and GMPI, as these schemes will not provide indemnity for any work that you undertake outside your NHS contract.


The BMA has highlighted the essential future role of medical defence organisations (MDOs). It advises: “The scope of the state- backed scheme is to cover the cost of clinical negligence for NHS services. 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.” Our GPP product will provide


you with access to expert advice and representation for the following: • Complaints • Ethical/professional advice


• GMC investigations • Performer list/disciplinary investigation • Coroner’s inquests/fatal acccident inquiries


• Criminal matters (related to medical practice). Both CNSGP and GMPI have significant indemnity exclusions. The GPP product automatically includes indemnity for up to £10,000 annual earnings per GP, for non-NHS work on practice-registered patients, as set out below (the £10,000 limit applies whether or not the income is received personally or by the practice): • Report writing (for NHS patients but non GMS/PMS work), e.g. for court purposes


• Occupational health reports • Private certificates, e.g. fitness to attend court/sit exams etc • Statutory notification forms, e.g. notifiable infectious diseases • DVLA and sports medicals • Adoption/fostering medicals • Passport countersignatures • Private prescriptions • Life insurance reports and medicals • Travel insurance – reports and claim form completion • Event medicine – crowd doctor work at music, sports events, gala days, etc • All cremation form completion • All deprivation of liberty safeguards (DOLS) reports. If earnings from this work exceed


£10,000, we can of course offer a revised quotation based on personal circumstances. For GP partners, the GPP product


also provides indemnity for your share of liability arising from nurses, healthcare assistants and similar staff employed by you to perform the non- NHS work described above. Please ensure that you include your share of fees generated by such staff when you calculate your expected annual earnings. Again, we will be happy to provide a revised quotation for any GP whose earnings from this work will exceed £10,000 per annum. We can also extend your membership to include access to indemnity for a range of medical work outside of your practice setting, including private GP work, occupational health, sports medicine, cosmetic medicine and work as a forensic medical examiner. You should also note that standard inclusions within the pre-CNSGP/ GMPI grade may now have been removed. It is important to verify that you have ongoing indemnity for additional work you perform, such


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