Cover letter

September 2009

There needs to be a careful balance between protecting individual interests and the collective good

ne of the core values that is fundamental to MPS is being fair in all our activities but most particularly in the way we interact with our members. At times this can result in difficult decisions being taken, as what may seem to be fair to an individual member may not be fair to the membership when taken as a whole. There needs to be a careful balance between protecting individual interests and the collective good and I thought that I would set down some examples of the issues faced.

Setting subscriptions in a fair and equitable manner can be particularly challenging at times. A little more than 20 years ago all doctors in the UK, apart from those recently qualified or with very limited income, paid the same subscription rate. This meant that a full-time obstetrician paid the same as a dermatologist or a part-time GP. Since then we have moved rapidly to try to charge subscriptions that accurately reflect the risk that each practitioner faces. For GPs, subscriptions now vary depending on the number of sessions worked each week, whilst for those engaged in private work, subscriptions vary by specialty and income. In England and Wales we now have around 250 subscription categories with a similar number for Scotland.

Even with this number of rates, we still only have nine risk bands that cover all specialties and we regularly have pleadings from individuals or groups of doctors for new subscription categories to be created for them in the hope that they will pay less. In practice, every time we reduce subscriptions for a new category, it means that others will have to pay more and achieving a fair balance is not easy.

As a mutual that was created with the ethos of “doctors for doctors” and the sharing of claims experience, it is interesting to debate how far we should go in differentiating risk

We currently do not charge different rates depending on which part of England and Wales doctors work in, although there is some evidence that could justify such an approach. More importantly, we do not take into account how good each doctor is. In theory, we could assess individual qualifications, training courses attended and even testimonials from patients.

As a mutual that was created with the ethos of “doctors for doctors” and the sharing of claims experience, it is interesting to debate how far we should go in differentiating risk, as ultimately we could end up by assessing everyone on an individual basis. This would undoubtedly result in some doctors being unable to afford the calculated subscription, which has happened elsewhere in the world, particularly for obstetricians and neurosurgeons.

Although we start by charging everyone in a particular specialty that works similar hours or has similar earnings the same subscription, the next issue we have to address is to what extent we should intervene when someone has materially worse claims or disciplinary experience than their colleagues. Is it because someone has simply been unlucky or is there a problem that needs to be addressed? Trying to be fair to the individual doctor and the membership as a whole needs careful handling. We aim to be supportive and caring whilst not ducking serious issues where a few members clearly need some form of remedial help, frequently in the area of their communication skills and behaviour, rather than their knowledge or clinical expertise.

Everyone, whatever their business or profession, makes mistakes at work from time to time and it is important that we learn from our mistakes. Our medicolegal staff review every case that comes to our attention and we aim to write to members with guidance whenever we feel that there are lessons to be learned from what has happened. If there are a number of repeat cases with a similar theme, we may well recommend specific types of training, which we believe will be of assistance to our members in avoiding problems in future.

Apart from the above, there are a very small number of members that we invite each year to enter our Membership Governance Programme. These are individuals whose experience, for whatever reason, is materially worse than their colleagues and we aim to work with them to try to reduce the likelihood of future claims or complaints arising. Depending on our assessment of the individual needs, in order to remain in MPS membership we may require compulsory attendance on an intensive course or we may place some restrictions on their benefits of membership. The aim of this is not only to help the individual members but also to protect the assets of the rest of the membership as MPS is a custodian of your money.

You will see that we take the concept of fairness very seriously but I would welcome your views on any of the points I have raised above, as we can only improve on what we do if we listen and react to what our members tell us.

Yours faithfully,

A D Mason
Chief Executive