The Lowdown on Medical Indemnity for F1 Doctors
This article has been written in collaboration with MDDUS, one of the leading medical defence organisations. They've offered a £25 Amazon voucher to F1 doctors and medical students who join them using a special code from Messly, which you can read more about here.
As an F1 doctor, you might be worried about the clinical settings that you'll find yourself working in, and levels of responsibility that you'll be taking on, as you start your medical career. For many, that results in anxiety around the risk of medico-legal issues, patient complaints, and even medical school or GMC fitness to practise referrals.
In this article, you'll hear from Doctor Richard Brittain, a medical and underwriting adviser at MDDUS, one of the leading medical defence organisations (MDOs).
He graduated from Nottingham University in 2004 and undertook his Foundation Training in Nottingham and Bristol. He then obtained clinical fellow posts in London, whilst completing his legal training. He started working in medical law in 2008 and gained MRCP in 2011, joining the MDDUS in 2013. He continues to work on a part-time basis as a coroner, having been appointed to this role in 2012.
Here, Doctor Brittain provides detailed insights about the medico-legal issues you need to be aware of as a medical student and F1 doctor, what support you'll get from within your medical school or the NHS, and how an MDO can help.
What kinds of legal issues might I need protection from or support with?
There are two broad categories of medico-legal issues that can arise from your work as a doctor:
Clinical negligence claims
In this case, the medical school or hospital where you're placed is sued by a patient or their family for alleged negligence because of potential errors that were made during the patient’s care. This is a legal matter that is either settled out of court, or in rare cases resolved in court.
As a student or doctor you'r very unlikely to be personally named in the legal proceedings, although this can happen in some cases.
These are sometimes referred to as ‘non-claims.’ They include a range of issues which don't involve compensation claims but can be serious situations. Common examples for F1s include:
🔴 Patient complaints
🔴 Inquests (and fatal accident inquiries if you're working in Scotland)
🔴 GMC fitness to practise referrals
🔴 Disciplinary investigations
🔴 Good Samaritan acts
🔴 Criminal investigations arising out of clinical practice
🔴 General ethical questions.
These are potentially very serious situations that could have an impact on your fitness to practise, and will cause you some stress if they arise.
What protection does the NHS give me against clinical negligence claims?
The NHS provides an indemnity to protect its employees against clinical negligence claims. As your F1 role is within an NHS setting, you are covered by this.
For medical students, your medical school has similar cover when you're on placement in a hospital.
What happens if there's a clinical negligence case against the medical school or hospital relating to a patient I cared for?
You're likely to be asked to provide a statement, effectively as a witness, to help the parties involved understand the series of events that took place.
This may be your only involvement with the case. This is especially true for students and doctors, as you won't be the most senior clinician on the team at the time of the events.
If you're a member of an MDO (which we'll explain below), they can support you with advice through this process and help you draft your statement.
What if I do non-NHS work?
It's unusual for F1 doctors or medical students to work clinically outside the NHS, but this could include signing cremation forms or something similar.
For non-NHS roles, you must get your own cover against clinical negligence claims. Many MDOs don't provide indemnity for private practice, except for specific income such as cremation forms and medical reports undertaken as part of NHS placements.
If you're considering picking up some clinical work outside the NHS, we’d recommend speaking to a medical indemnity provider first to check your position. There's more information on this below.
Will my medical school or NHS support me with medico-legal issues?
It's likely that you'll only have limited support on medico-legal issues.
Unfortunately, this means that if a GMC referral occurs, for example, you may find your Trust’s legal department is not forthcoming with support or advice, even though the events took place whilst you were working for them.
Therefore, it's important to carefully consider whether you want to get additional protection to ensure you're fully covered if any of these issues arise in your role. This is where medical indemnity can be useful.
What is medical indemnity?
The most common model is to join a medical defence organisation.
MDOs tend to be mutual membership organisations that provide indemnity and support for their members. MDOs aren’t insurance companies, but rather provide protection on a discretionary basis. They were established, and are run, to look after their members, using t
heir discretion to support their members. Having said that, some MDOs have started to offer insurance for particular products.
If you're a student or doctor, and you want this indemnity and support, you'll have to join an MDO and pay an annual subscription fee to be a member.
What support will I receive when I join an MDO?
You'll gain a full service of advice and support when you become a member of an MDO.
They have expert advisers who you can contact via a telephone advice line, where they'll give you support and guidance to help you through your circumstances.
You can also speak directly to fellow medics who have specialist medico-legal training and experience. They offer expert advice, including for emergency situations that can arise unexpectedly.
If a situation requires legal representation, your MDO will also have a team of in-house and external legal advisers who can provide additional support.
Is it compulsory to get medical indemnity or an insurance policy in place?
As you're likely to be working exclusively within an NHS setting, where the NHS clinical indemnity applies, it's optional whether to get additional protection. You can rely on this basic protection for clinical negligence claims alone. However, this does mean you'll be without support if any of the medico-legal issues mentioned above arise.
MDO membership is likely to be a good option for you if you value the comfort of knowing you have full support available in case any other issues arise from your work.
What should I do if I have concerns about patient safety, or I feel it's unsafe for me to work? How can I protect myself against any potential liability?
A common concern for F1s is that you’ll be forced to work without senior support, get asked to hold another bleep, or find yourself doing the ward round alone.
The GMC has clear guidance regarding the obligation on all doctors to raise concerns regarding patient safety. NHS organisations are also likely to have in-house policies regarding these kind of concerns.
It's generally appropriate to raise concerns to your educational or clinical supervisor. Follow this up in writing to ensure there's documentation of the issues, how you raised them, and what response you received. Your Trust’s Guardian of Safe Working is another person you can raise concerns with.
You can also seek advice from your MDO at an early point regarding such concerns. They'll be able to assist you in escalating matters internally and with any other guidance you might need.
If, as a medical student, I'm signed off for a procedure, do it unsupervised, and an issue arises, would I be liable for this or would it be my supervisor?
As a medical student, it would be necessary to ensure that unsupervised practice has been included as part of the sign-off process. If this has been agreed upon and something goes wrong, the detail of who is liable will come down to the specifics of the case. The details of cases such as this are complex.
If the sign-off was inappropriate and shouldn't have been approved, this would be a matter for the individual who undertook this.
If the incident arose from the procedure being carried out inappropriately, despite the sign-off being appropriate, liability would probably fall to the medical school, acting on behalf of the student.
Can I join an MDO whilst in medical school?
Most MDOs allow students to join and encourage this when clinical placements start.
What is the rough cost of an MDO membership?
To give you an indication of what you might pay, F1 members of MDDUS typically pay an annual fee of £10 and benefit from indemnity for claims of up to £10,000 of private income received for completing cremation forms and medical reports, undertaken as part of an NHS placement.
Medical student membership with MDDUS is free of charge. Please note that you should aim to have arrangements in place before your clinical work starts.
How do I choose an MDO?
If you decide to opt for the support of an MDO membership, the next consideration is which one to pick.
The best thing to do is shop around, and make enquiries with multiple organisations. Find the MDO that feels like the best fit for you and the best price.
Regardless of which one you decide to go with, it’s best to start doing your research as early as possible. This will ensure you have all the information you need and everything in place before you start your role.
Messly and MDDUS
Here at Messly, we want to help our members easily find good quality indemnity cover from a reputable provider.
We did some ‘secret shopping’ and spoke to a large group of doctors, and we were most impressed with MDDUS. They're one of the larger MDOs, with over 54,000 members, and offer wide-ranging medical expertise, competitive pricing, and have a ‘doctors for doctors’ personal care ethos that can support you in times of need. They also have other health and wellbeing benefits for their members.
The MDDUS is offering offering you a £25 Amazon voucher if you join them using a special code from Messly. For nearly all F1s, as the membership will cost you just £10, you’ll end up £15 better off after joining with this voucher!
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