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Choosing medical defence cover

Finding the right type of medical defence policy for you is essential, writes Fiona Barr.

Peace of mind costs GPs between £2,500 and £5,200 a year. That will buy you 12 months' cover full-time work from a medical defence organisation or professional indemnity insurer.

GPs say that the cost pales into insignificance when problems do occur.

Huntingdon GP Dr Ian Williams says: 'As soon as you need to contact them as a result of a complaint, it becomes worth every penny.'

The type and cost of cover offered by the five providers reviewed here varies. The Medical Protection Society (MPS) and the Medical and Dental Defence Union of Scotland (MDDUS) continue to stick to the discretionary, occurrence-based indemnity they have always offered.

Towergate MIA and Howden Medical Insurance Services provide insurance policies, while the Medical Defence Union's (MDU) cover is a mixture of indemnity and insurance.

Types of cover
With insurance protection, GPs can be certain they will be covered for all the eventualities listed in their policy.

With discretionary cover, the provider can choose, on a case-by-case basis, whether to help.

The MPS and MDDUS argue that discretionary cover enables them to be more flexible and offer assurances that they will not leave GPs out in the cold.

Discretionary cover also means GPs are covered for incidents that occurred while they were members, even if a claim is made against them after they have moved to another provider. With pure insurance cover, GPs need to pay extra for this continued cover if they switch provider.

The MDU claims its policy offers GPs the best of both worlds: the security of an insurance policy for negligence claims plus discretionary support for other matters such as GMC hearings.

'Insurance gives you the certainty of the contract wording and it's regulated by the Financial Services Authority,' says Dr Matthew Lee, MDU deputy director of professional services.

Every year the MDU takes over 20,000 advice line calls from members and opens 1,500 new medical negligence files.

While the medical defence bodies say the number of medical negligence claims against doctors are currently levelling off, they point out that those being made are more likely to be successful and to be settled for higher amounts.

There has also been a steep rise in GMC hearings.

About half the settled claims against GPs relate to delayed or failed diagnosis with another quarter due to medication errors. The largest-ever claim the MDU has paid was £3.9 million in a case concerning a baby that suffered brain damage.

The price of protection irks some GPs. Bristol GP Dr Phil Yates who has been with the MPS since 1979 says: 'I wonder if there should be a no claims discount for people who could be assessed as lower risk.'

The providers argue that a no claim bonus is unworkable because a claim can crop up years after the event prompting it.

MDDUS chief executive officer Professor Gordon Dickson says the most extreme example of this to come the MDDUS's way was a claim recently for an incident 36 years earlier.

The providers offer a range of services including a 24 hour helpline, support with GMC hearings and other disciplinary matters such as inquests.

Traditionally, cover has been on an individual doctor basis.

MPS director of communication and education Dr Stephanie Bown, says: 'We are here to assist with problems that arise out of a doctor's professional practice relating to professional competence and conduct as distinct from personal issues and employment contracts.'

But the newer organisations in the medical defence arena say that should change. Asgar Hassanali, director of Howden Medical Insurance Services believes that GPs working together in a practice should buy cover for the practice rather than each individual making their own indemnity arrangements.

He says that if indemnity cover is based on the whole practice, when somebody retires or leaves the cover stays with the practice.

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