By Robin Stride
The president of the Independent Doctors Federation (IDF) has expressed alarm at a Medical Defence Union (MDU) decision to stop covering spinal surgeons in private practice.
Dr Brian O’Connor said: ‘We are very concerned by this latest development which does not bode well for the practice of medicine in “high-risk” areas.’
And he warned: ‘It seems that the MDU are departing from the concept of indemnifying the full spectrum of highly qualified specialists performing to international standards and are now beginning to cherry-pick according to risk of individual specialities. Organisations such as the MDU ought to embrace the concept of pooled risk.’
The MDU move came three months after the then Lord Chancellor Liz Truss changed the controversial ‘discount rate’ formula used by courts to adjust large compensation payments to take account of future investment returns.
Independent Practitioner Today warned then that the future of potentially thousands of consultants and GPs in private practice was threatened by big rises in indemnity costs.
Many in the sector predicted the MDU’s action and there are fears other specialties, such as obstetricians, could follow.
Other indemnity and insurance providers said they were still providing cover for spinal surgeons. But, according to one report, some surgeons have already decided to stop operating privately.
The MDU admitted some members were upset by its decision, but said it gave ‘plenty of notice’ and felt it had no choice.
A spokesman for Medical Protection said: ‘Surgeons, including those who undertake spinal surgery, are welcome to apply for membership with Medical Protection. All applications are considered on a case by case basis.’
The Medical and Dental Defence Union of Scotland said: ‘MDDUS offers membership, including access to indemnity for private practice, for consultant spinal surgeons who hold a substantive NHS contract.
‘As a mutual, not-for-profit membership organisation, we consider the risks that we are prepared to accept on behalf of our members.
‘The recent changes to the discount rate will have an impact on the cost of claims, and we expect these to be particularly significant for specialties such as spinal surgery, where there is a greater chance of a patient suffering significant neurological injury.
‘We keep all of our membership grades and subscription rates under close review, but we have no plans to stop offering membership for spinal surgeons.’
Medical Indemnity said it could ‘potentially provide cover for any UK spinal surgeon’.
Christian Beadell, of medical negligence law firm Fletchers Solicitors, claimed the MDU’s decision could have ‘catastrophic consequences’ for the health sector.
If specialists could find no other provider to insure them, they would be forced to self-insure or even completely stop doing certain procedures.
He said: ‘In the case of private spinal injury surgery, this could have a disastrous effect on the NHS, as the burden of providing these procedures will be passed back onto the public healthcare services and hospitals, placing more pressure on a service that is at its limits.’
What the MDU says
How have the benefits of MDU membership changed in respect of private spinal surgery?
In light of the discount rate change, the MDU has reviewed the indemnity risk in relation to certain types of work undertaken by members and, regretfully, we have concluded that the impact on the cost of settling spinal surgery claims makes it impossible for us to continue to provide indemnity to members undertaking private practice in this specialty.
Why have you taken this decision?
Despite strong lobbying by the MDU and other organisations, the Lord Chancellor recently announced a change to the discount rate (the mechanism courts use to calculate the size of lump sum compensation payable to claimants) which dropped dramatically from 2.5% to -0.75%.
The change has had retrospective effect and its impact is profound, as it will increase the size of compensation awards substantially and more than double the cost of many high-value clinical negligence claims, such as those which can arise from spinal surgery.
Are members being indemnified to the end of their subscription year?
Yes, where current members are already indemnified to undertake this work, we will continue to provide indemnity for the work, at the price quoted, until the end of their current membership year; at which point, if they plan to continue to undertake this work in the private sector, they will need to source alternative indemnity.
We will be contacting each member who has told us that their private practice includes an element of spinal surgery individually, well in advance of their membership renewal.
Will you indemnify them for historic problems? What about current cases?
Members will continue to be able to ask for our support with claims from their independent practice that arise from incidents until their next membership renewal year. We will also continue to assist with ongoing cases.