What medico-legal challenges will GPs face in 2019?

The MDU's head of advisory services, Dr Caroline Fryar, predicts which medico-legal stories will be making headlines next year.

Dr Caroline Fryar, MDU head of advisory services (Photo: MDU)

The MDU exists to provide expert advice and support for doctors, whether it’s a medico-legal adviser answering dilemmas on the phone, or supporting a member through a GMC investigation or defending them in court.

We also need to be aware of the bigger picture and to understand how policy and regulatory changes may impact on our members. Wherever possible, we seize opportunities to champion improvements on behalf of our members and the wider profession.


As a not-for-profit mutual organisation, the MDU is owned by its members, rather than shareholders. We exist to provide benefits our members rely upon and support you throughout your professional life.

For more information, visit www.themdu.com, follow us on Twitter @the_mdu or call 0800 716 646.

This article is funded by the MDU for GP Connect

With this in mind, here are some of the legal and ethical issues likely to impact on GPs over the next 12 months and beyond:

The introduction of state indemnity

The introduction of state-backed indemnity for primary care staff in England and Wales, which is due to start in April 2019, has been much anticipated. We still await full details of how the scheme will work however it is intended to cover clinical negligence claims from primary care services provided under contract.

It will not extend to non-NHS work such as private travel clinics. Nor will GPs be able to look to the scheme for help with serious medico-legal matters which threaten their livelihoods and careers. These include GMC procedures, coroners’ inquiries and criminal investigations.

GPs have already been advised by the BMA and the DHSC to continue with professional indemnity requirements. You can find out more about the potential gaps in indemnity and the importance of retaining MDO membership at www.themdu.com/mindthegap

Limited progress on claims costs

The MDU recently revealed that GPs can expect to receive a claim four times in a 40 year career and that compensation in excess of £10m for an individual claim is no longer unthinkable. The government is considering how best to address the issue of claims costs which have so badly affected the cost of GP indemnity. We expect to see the findings and, we hope, possible solutions from a joint departmental working group imminently.

The DHSC recently announced a consultation on the regulation of the indemnity provided to healthcare professionals for clinical negligence claims. The consultation ignores the fact that the root cause of the growing burden of clinical negligence costs in the UK (now estimated at £77bn for NHS Resolution) has nothing to do with regulation of medical indemnity providers. The cause, which the government has for years failed to address, is an outdated legal system, which it must now reform.

Find out more about the reforms the MDU is suggesting here.

Changing the discount rate

Meanwhile the drastic 2017 reduction in the personal injury discount rate, the formula for calculating personal injury compensation payments, has driven up the cost of claims dramatically. In the March 2017 budget the chancellor set aside an additional £5.9bn for the NHS to cover the cost of this change for a three year period.

The Civil Liabilities Bill is awaiting royal assent. It includes reforms to the process of setting the rate which will go some way to redressing the financial damage to the NHS caused by the discount rate reduction.

Reducing the stress of GMC investigations

A letter from the GMC is a worrying prospect for any doctor, with many fearing that a fitness to practise investigation could spell the end of their careers. The GMC has implemented reforms that have sped up the process and made it more proportionate. In doing so, it has sought expert insight from organisations like the MDU which has helped the GMC to devise ways to lessen the impact of its investigations on doctors.

One example is its provisional enquiries procedure which identifies cases and deals with them informally in a few weeks. The GMC says this has resulted in nearly 1,000 complaints being closed without the need for a full investigation since the procedure began.

During 2019 we will continue to work with the GMC to help it improve its procedures and will challenge the regulator where individual members are treated unfairly. For example we recently successfully helped one GP member to challenge the GMC’s decision to appeal a tribunal hearing at the Court of Appeal.

Dealing with the Ombudsman

When a clinical complaint about a GP is investigated by the Ombudsman, the doctor needs to have confidence that the standard against which they will be judged is understandable and reasonable.

Earlier this year, the MDU was successful in a challenge of the fairness and scope of the previous Ombudsman's procedure for investigating clinical complaints at the Court of Appeal, in a joint action with another MDO.

The Court of Appeal found that the standard applied by the Ombudsman was incoherent and failed to provide a yardstick of reasonable or responsible practice. Despite the criticism from the Court of Appeal, our concerns about the Ombudsman’s clinical standard persist and we have called for the current Ombudsman to be clearer about the clinical standard applied to general practice so that our members know in advance how they will be judged.

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