On the line

SEEK out Dr Barry Parker at his desk in the Glasgow office of MDDUS and you will rarely find him off the telephone in his job providing medico-legal guidance to members or discussing ongoing cases. But just three years ago his main contact with the Union was on the other end of the phone as an occasional user of the advice service. He was then working as a GP partner in a busy practice in Stockbridge in Edinburgh

“I was very happy there,” he says. “It was a really good team and I enjoyed the job. But I’d done clinical work exclusively for almost 20 years and felt the need to try something new.”

So in 2009 he applied for an opening at MDDUS as a medical adviser. He had already gained significant experience working in an advice and support role as a GP appraiser and had also attained an MSc in Primary Care. Out of a strong field of candidates he was appointed to the job and joined an experienced team of professional advisers.

“I had a less usual route into the field than a lot of medical advisers who get their MPhil or Masters first,” says Barry. “But I’m now in my third year of a Masters in Medical Law at the University of Glasgow.”

Just like Barry all the professional advisers at MDDUS are qualified doctors and dentists who come to the role with significant clinical experience supplemented with specialist medico-legal training. MDDUS prides itself on a personalised doctor-to-doctor/dentist-todentist service of support and advice. The Union may exist primarily to provide access to legal support and indemnity for members who find themselves the subject of complaints or claims of clinical negligence but the 24/7 service provided by Barry and the other advisers is an essential element in the proactive risk management philosophy of the organisation. The prime ethos is to avoid costly and distressing negligence claims or fitness to practise proceedings by providing timely advice to members so that what may be minor issues do not escalate into major difficulties.

Phone advice

So what is a typical week like for an MDDUS medical adviser? “The week is quite variable depending on case work and teaching commitments,’’ says Barry, “but we each have a number of regular half-day sessions providing phone advice to members.”

In the six months up to June 2011 MDDUS medical advisers in two offices in London and Glasgow handled over 3,400 calls on a wide range of topics. A trainee doctor might be worried about whether she is obligated to inform the GMC of a traffic offence. A practice manager might be seeking advice on the wording of a response letter to a patient complaint. A consultant surgeon could be phoning to say that he has been called as a witness in a coroner’s inquest and is worried that his actions may come in for criticism. Or it may be a simple matter of confirming vicarious indemnity coverage for general practice staff offering flu vaccinations.

“The single commonest issue we get called about is doctor-patient confidentiality,” says Barry. “Examples include – can you show the records of a child to an estranged father? How do you assess parental responsibility? What about someone who is not medically fit but wants to continue to drive? When do you contact the DVLA? What can and can’t you tell police about a patient’s health details? It covers a wide range of possible scenarios.”

Most advice calls to MDDUS are put through directly to an adviser from a secretary. The advisory team strives to avoid call-backs though at busy times, such as Monday mornings, this may not always be possible. There are no case handlers or triaging of calls. A doctor phoning MDDUS for advice will always speak with a doctor and the same goes for dentists.

“Doctors like to talk to doctors,” says Barry. “They like the reassurance of speaking to someone who is medical and understands the clinical scenario they’ve found themselves in.”

In addition to his weekly phone sessions Barry also does an out-of-hours rotation for a week every couple of months. This involves carrying a mobile phone and taking any emergency calls.

“Calls are usually for acute situations such as a casualty doctor phoning because there is a patient attending who has doubtful capacity to consent to treatment, or a doctor who is about to be interviewed by police regarding a clinical incident."

Sometimes advisers get calls they cannot answer immediately. In such cases they will call back having consulted other resources including written policies and procedures, GMC and other regulatory guidance. Each week the advisory team also meets in formal sessions to go over more difficult cases and pool knowledge.

“We have some very experienced senior colleagues who offer a wealth of information. Our in-house legal teams are also always available to consult.”

Member support

When not handling advice calls Barry spends much of the rest of his time in case management. Cases generally involve claims of negligence or investigations by the GMC in regard to a professional’s fitness to practise.

“At MDDUS we make sure it is a medical adviser dealing with medical colleagues right through all of these things,” says Barry. “We are the first point of contact and take members through the process, telling them what is going to happen at each stage.”

An adviser will correspond with the member over the course of a case, facilitating requests for information and arranging any necessary meetings with solicitors or counsel in advance of hearings or panels, either in person or via video link. Advisers will also attend GMC hearings to support members and offer representation in hospital or primary care disciplinary proceedings. MDDUS considers such contact vital. Part of the role of an adviser is to provide members with an understanding of the processes and procedures they may face when dealing with the GMC or in court. This includes explaining what will be involved in a hearing and the type of questions that might be asked.

“It’s important just to reassure members that at the end of the day, all that they are expected to do is give an honest account of what has happened. That’s all that’s being asked,” says Barry.

Another aspect of the job is outreach and education. Each week MDDUS receives numerous requests for advisers to give talks or run workshops in practices or hospital departments or at medical meetings.

“We give presentations to everyone from medical students up to consultant grades on a whole range of topics including confidentiality, consent, clinical negligence claims, fatal accident inquiries, coroner’s inquests, recent changes in death certification. Pretty much anything people ask us to cover as long as it has a medico-legal slant to it.”

Advisers also participate and comment on consultations for initiatives or guidance produced by the NHS or GDC and GMC, including the current and ongoing review of Good Medical Practice.

It makes for a busy and at times challenging role, but Barry hesitates only a moment when asked if he misses clinical medicine.

“Occasionally,” he replies. “I think you inevitably miss something you’ve done for most of your life. But you can’t go on being a clinician forever. All I’ve done is stepped out of it 10 or 15 years earlier. And now I’m doing something new which I find really stimulating and rewarding.”

Jim Killgore is editor of MDDUS Summons