GP careers: The GP who helps defend doctors

Dr John Dale-Skinner combines a salaried GP post with medico-legal work as a senior medical claims handler at the Medical Defence Union (MDU). He explains how his experience of the pandemic has informed both roles.

Dr John Dale-Skinner, London GP and senior medical claims handler at the MDU
Dr John Dale-Skinner, London GP and senior medical claims handler at the MDU

Since the pandemic took hold in the UK last Spring, Dr John Dale-Skinner has been able to trace its impact from two different angles.

As a part-time salaried GP at a busy London practice with its diverse population of 16,000 patients, Dr Dale-Skinner and his colleagues had to adapt fast to the challenges of remote video consultations, PPE and additional workload but as the months passed, he has seen the enormous toll that the pandemic has had on everyone and the impact on general practice.

Dr Dale-Skinner says: 'It was upsetting that some patients who I have known for many years died of COVID-19 and it has been hard to witness the anguish of families who have been caring for the seriously unwell. I often talk to patients who worry about being alone when they become unwell, without the prospect of visits from friends and loved ones.

'The pandemic has again showed that GPs are great innovators but the pressures on primary care have been immense. For example, I had not previously used video consulting or photo messaging to consult with patients so I have learnt a lot about how to remotely review a patient safely while staying alert to the limitations.

'The suspension of routine and elective hospital care over the past months has been particularly challenging, as a lot of time has been spent dealing with patients who have had their appointments cancelled or referrals deferred.'

Dealing with complaints and claims

Dr Dale-Skinner’s parallel job as a senior medical claims handler (SMCH) at the MDU has given him a useful insight into likelihood of pandemic-related complaints and claims. The MDU has already supported members with 3,800 complaints and adverse incidents since the first lockdown in March 2020, including alleged delays in accessing routine screening and tests, and communication difficulties associated with remote consultations.

Dr Dale-Skinner’s medico-legal work involves investigating claims and assessing the evidence on the member’s behalf, liaising with claimant’s solicitors and supporting members throughout the claims process. He knows how stressful this experience can be for doctors in ordinary circumstances but in the context of the pandemic, he believes that GPs could be hit particularly hard by allegations of negligence.

'Doctors go into medicine to look after people to the best of their ability so many take it very personally when they receive a complaint or claim which alleges that the care they have provided may have fallen short,' he says.

A survey by the MDU and GPonline in February this year found 43% of GPs had faced abuse from patients and that 60% of respondents feared facing a claim due to the pandemic.

'I worry that receiving a complaint or claim could be particularly stressful for GPs in the current circumstances, even with the support of their MDO. That is why the MDU has called for healthcare staff to be protected from litigation against the NHS caused by the pandemic,' Dr Dale-Skinner explains.

Value of a portfolio career

Dr Dale-Skinner believes his twin roles complement each other and highlights the value of a portfolio career. 'It’s nice to have the variation in your working week,' he says, 'and I find the knowledge, skills and understanding I acquire in one place are often transferrable.

'Reviewing guidelines and expert reports in the course of my MDU work helps me keep up-to-date in my clinical practice and alert to medico-legal risks. Likewise, being in clinical practice provides relevant experience of current GP systems and protocols which helps me when reviewing the clinical sequence of events giving rise to a claim.

'It also means I can help non-medical colleagues navigate some of the more complex clinical details to gain a deeper understanding of the issues involved. My clinical experience helps to inform the presentations and training sessions I am involved in within the MDU.'    

After graduating from Nottingham Medical School in 2008 and qualifying as a GP in 2013 Dr Dale-Skinner worked full time in general practice before joining the MDU seven years ago. 'I went through a comprehensive in-house training scheme and had a mentor to help me manage my own files from the first day. However, I think much of what I now know comes from practical experience.' 

Orgnaisation is key

He remains working at the same inner-city practice he joined after qualifying and says that organisation and teamwork are key to the success of his portfolio career.

'It’s essential to keep on top of my GP paperwork as I might not be next in the practice again for a few days. As far as possible, I try to make telephone calls to other healthcare professionals at the end of my morning clinic. I am also very fortunate to work with great colleagues in both of my places of work, who I can depend on if something comes in that requires urgent action and I am not there,' Dr Dale-Skinner says.

'There are lots of roles in the medico-legal world. For example, the MDU employs qualified doctors to help members with claims, complaints, inquests and GMC matters. There are also clinical advisor roles for organisations within and outside the NHS. Experienced GPs who are interested in becoming an expert witness can find further information from the Expert Witness Institute.'     

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