Being a doctor is a very rewarding profession and one that provides good job satisfaction and the opportunity for lifelong learning. However, it is important that support and advice is available when you need it most.
The MDU offers membership for doctors throughout their careers and can be an invaluable source of assistance when things might not have gone according to plan, or when you simply need advice.
What is the MDU?
The MDU is a mutual, not-for-profit medical defence organisation, owned by its members since it was established in 1885. It's staffed by doctors, who can relate to the challenges faced by its members and is the leading medical defence organisation in the UK. More doctors in the UK choose us for their indemnity than any other medical defence organisation.
The MDU offers benefits of membership at the discretion of the Board of Management on an 'occurrence basis'. This simply means you can ask for our assistance as long as you were a member at the time of the incident that gave rise to the matter in hand.
Therefore even if you're no longer an MDU member, have stopped practising, are retired or are on a break (such as parental leave), you can still seek the MDU's help with matters arising from a time when you were in membership. Your estate can even ask for the MDU's help after your death. This is important because many claims, complaints, GMC investigations or coroner's inquests occur years after the date that care was provided.
What is indemnity?
The word indemnity comes from the Latin 'indemnis', meaning uninjured, suffering no damage or loss. The Oxford English Dictionary defines it as 'compensation for loss incurred; a sum paid for this; security against loss; legal exemption from penalties etc. incurred'.
Professional medical indemnity specifically refers to the financial support received by a medical professional who is sued in order to defend a clinical negligence claim and, if needed, to compensate a patient. The costs associated with defending a claim can amount to hundreds of thousands of pounds, and the damages paid in compensation can run into the millions.
The GMC says that doctors must have adequate insurance or indemnity in place so that patients are not disadvantaged if they make a claim. Doctors working for an NHS body (or the HSC in Northern Ireland) should have access to NHS indemnity via a clinical negligence scheme, although they may want to consider whether they need additional indemnity for clinical work not included in NHS indemnity.
Many claims, complaints, GMC investigations or coroner's inquests occur years after the date that care was provided.
Doctors working in general practice or the independent sector need to make their own arrangements for indemnity, and the MDU can offer indemnity for work which is not NHS indemnified.
MDU membership also provides access to support with many other medico-legal issues arising from clinical practice that are not covered by NHS indemnity. These can include attendance at an inquest, a complaint to the GMC, a professional, disciplinary or criminal investigation as well as help with media enquiries.
So what does MDU membership offer?
MDU membership provides access to professional indemnity for claims arising from normal clinical practice which are not indemnified by the NHS, but it doesn't stop there. Whether your work is NHS indemnified or not, being an MDU member provides many benefits.
Although doctors working for an NHS body should have access to NHS indemnity for clinical negligence claims, you may also want to have someone on your side giving advice and support when it comes to writing your statement or responding to questions put to the trust by a claimant's legal team. This is where the MDU can help.
Coroner's inquests and Fatal Accident Inquiries
However, doctors can face more than just a claim when a clinical incident occurs. Take for example the unexpected death of a patient. Depending on the area of medicine you choose to specialise in, writing reports for and attending a coroner's inquest (or Fatal Accident Inquiry in Scotland) may be part of your role.
Technically, a doctor in any specialty could face an inquest or FAI at some point in their career. Trusts are generally supportive of their staff when the coroner (or procurator fiscal in Scotland) investigates the death of a patient, but there are occasions where a conflict arises between a doctor and the trust, and it is not appropriate for both parties to be represented by the same legal team.
In such situations MDU members can seek our assistance with report writing and giving evidence in the coroner's court. Even where no conflict arises and the trust continues to support the doctor, it is still worth seeking advice from the MDU to ensure that your report for the coroner/ procurator fiscal is appropriate, and for general support as you go through the inquest/ FAI process.
NHS indemnity won't extend to matters where only the doctor's own liability is at stake, like a criminal investigation against a doctor. This might happen if a patient has died under unusual circumstances, or where a patient makes allegations of an inappropriate examination.
While the trust may be supportive of the doctor's predicament, the trust's legal department will not provide a solicitor for an interview under caution or for a criminal trial. MDU members can seek our support, advice and assistance when criminal allegations arise out of their clinical practice, but doctors without membership of a defence organisation would need to instruct a solicitor privately; as you can imagine, this can run into thousands of pounds.
When concerns are raised about a doctor's performance, the trust may initiate disciplinary proceedings. As the 'prosecutor' they are obviously not in a position to offer any meaningful support to the doctor in terms of a 'defence' team.
Disciplinary proceedings can be very stressful and the consequences of going to a disciplinary panel hearing can be very significant to a doctor's career. To ensure the best outcome, it's essential to get the right advice and assistance throughout the process.
Again, MDU members can seek assistance with disciplinary matters arising from the clinical care of patients. The MDU has a specialist team of medico-legal advisers who deal with disciplinary investigations for doctors working as GPs, in private practice or within NHS trusts.
Seeking appropriate advice and support from the outset is essential to ensure the best outcome.
As the doctor's regulator, the General Medical Council is responsible for ensuring a doctor is fit to practise when concerns arise. These may be raised by an employer, a patient or another third party, such as the police or the coroner.
A doctor's registration with the GMC is that doctor's responsibility. Trusts must ensure that doctors are appropriately registered before being employed, but if a doctor's registration is at risk for any reason, NHS indemnity will not cover the significant legal fees that may ensue.
Fitness to practise investigations are stressful and time consuming, and seeking appropriate advice and support from the outset is essential to ensure the best outcome. The MDU offers exactly this to its members to ensure that they are in the best possible position to respond to the allegations.
Even with a simple complaint, which the trust will deal with and respond to, it is always advisable for doctors to seek their own advice when asked for comments on their involvement in a patient's care. The MDU can assist members in responding to complaints and other adverse incidents, making sure they're in the best position to provide an appropriate apology (if necessary) and explanation.
Responding appropriately to a complaint may avoid further investigation into the doctor's practice and help to resolve the complaint at the local level.
Although it doesn't happen very often, doctors face the possibility of multiple jeopardy when a clinical incident occurs, and all of these investigations can arise from a single incident. Even if your work is NHS indemnified for clinical negligence claims, there can be several other aspects where you require guidance, support and defence.
When the worst happens, our members tell us that they are thankful they had the MDU on their side and are grateful for the support and assistance they were offered at a time of considerable stress and anxiety.
Find out more about MDU membership on our website.
Dr Kathryn Leask BSc (Hons) MBChB (Hons) LLB MA MRCPCH FFFLM DMedEth
MDU medico-legal adviser
Kathryn has been a medico-legal adviser with the MDU since 2007 and is a team leader, trainer and mentor in the medical advisory department. Before joining the MDU, she worked in paediatrics gaining her MRCPCH in 2002 and did her specialty training in clinical genetics. She has an MA in Health Care Ethics and Law, a Bachelor of Law and a Professional Doctorate in Medical Ethics. She is also a fellow of the Faculty of Forensic and Legal Medicine and has previously been an examiner and Deputy Chief Examiner for the faculty exam. Kathryn is currently a member of the faculty's Training and Education Subcommittee.
See more by Dr Kathryn Leask BSc (Hons) MBChB (Hons) LLB MA MRCPCH FFFLM DMedEth
Dr Judith Clark
Clinical risk manager
MA(Oxon) BM BCh(Oxon) MRCP
Judith qualified from Oxford University Medical School in 1999, and obtained her MRCP in 2002. She then completed specialist training in rheumatology and obtained her CCT in 2012 before moving to her current role at the MDU.
See more by Dr Judith Clark