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Fairness to all: A look at Membership Governance

Many members of MPS will have very few medicolegal cases in the course of their career. But what happens to those who need assistance rather more frequently? Sarah Whitehouse finds out more.

If you are a member who has had few, if any, cases in the past, you might look at your subscriptions increasing and find yourself asking: “Am I subsidising colleagues who need MPS’s services disproportionately?”

Such a reaction is understandable. Why do some doctors experience more claims than others? There can be many reasons why doctors have a higher-than-average number of cases. Some doctors face additional problems largely because of where they practise, the patients they treat, or the specialty in which they work.

Some doctors face additional problems largely because of where they practise, the patients they treat, or the specialty in which they work

Some doctors go through periods in their career where additional pressures are created by health problems, social or domestic upheavals, financial difficulties or other factors. Others, however, do need help to improve poor practice.

As a mutual organisation, our first instinct is to help and support members through such difficult times. We all appreciate how stressful it is to have even a single complaint and for those who are experiencing a lot of problems, we find that the impact on them is greater than just in their professional lives.

Our first instinct is to help and support members through such difficult times

However, it makes little sense to wait until something bad happens and needs to be paid for – and more sense to invest in the prevention of problems in the first place. As a responsible organisation, with a duty not only to an individual member but also the membership as a whole, we must be responsible in using the subscriptions paid by members.

For this reason, MPS has developed educational programmes based on more than 100 years’ experience in this field, aimed both at helping all members and at providing that extra help that a small proportion of members will need.

Helping those in need

As part of our service, our medicolegal staff review every case and we aim to provide guidance to members if lessons can be learned from what has happened. If there are a number of repeat cases with a similar theme, we may recommend specific types of learning or training courses, which we believe will be of assistance to members in avoiding problems in the future.

In addition, there are a very small number of members who we invite to enter our Membership Governance Programme. These are members who have a significant adverse risk profile particularly in relation to claims. We aim to work with them to try to reduce the likelihood of future claims or complaints arising.

If there are a number of repeat cases with a similar theme, we may recommend specific types of learning or training courses

Depending on an assessment of their individual needs, we may require compulsory attendance on an intensive course, or we may place some restrictions on their benefits of membership in order that they can remain in MPS membership. Those in Membership Governance also pay an enhanced subscription, reviewed annually as part of continuing risk assessment.

We believe that as these members are more likely to be at greater risk of future claims, they should contribute more to the mutual fund. Through working with individuals on the Membership Governance Programme, we can try to mitigate risk for the whole of our membership. Those who refuse to accept the help offered will not be able to remain members of MPS.

We expect that individual members experiencing difficulties should be prepared to take reasonable steps to work with MPS to help themselves

We expect that individual members experiencing difficulties should be prepared to take reasonable steps to work with MPS to help themselves. As in all walks of life, there will be a very small number of members who cannot, or will not, change their risk profile and in such circumstances may be unable to continue in MPS membership.

The overall aim of Membership Governance is to help the individual member suffering more problems than their colleagues, and to protect the assets of the mutual fund for which MPS is a custodian, so that members are not subsidising colleagues who need MPS’s services disproportionately.

Education and Risk Management Workshops

Whilst MPS Educational Services offers help for those who have had a high level of claims and complaints, we also offer communication and interpersonal skills workshops for all members – helping you avoid problems before they arise.

Designed and facilitated by medical professionals, the Mastering workshop series is highly-interactive, with group discussions and activities, and is offered free of charge as a benefit of membership.

It has proven to be popular with members. Topics include: Mastering your Risk, Mastering Adverse Outcomes, Mastering Professional Interactions, Mastering Difficult Interactions with Patients and, new for 2012, Mastering Shared Decision Making.

For more information about dates, locations, and to book your place, visit the workshops section of the MPS website.

Education as a helping hand

The CCP was very helpful; it points out the difference between real and perceived communication skillsAn example of the type of course which a member may be asked to attend as part of the Membership Governance Programme is the three-day Clinical Communication Programme (CCP) workshop created by MPS Educational Services. The workshop focuses on improving communication skills and is followed-up with a six-month period of educational support.

Members who have attended the CCP have been encouragingly positive about the value of its content. Dr A said: “It made a real impression on me and made me aware of my shortcomings,” and surgeon Dr M said: “The CCP was very helpful; it points out the difference between real and perceived communication skills.”

The CCP was very helpful; it points out the difference between real and perceived communication skills

Other members revealed that the changes they have been able to implement in their communication with patients since attending the programme included moves to: “listen more”, “discuss various treatment options”, and “repeat, summarise, and question the patient to help with decision-making”.

Often, there may be a degree of anxiety, even resistance, amongst some members about being entered into the Membership Governance Programme. However, the intention of the programme is to work with members to mitigate potential future risk. Every member who is experiencing problems is encouraged to call and speak to our team about their cases and about any special circumstances which may have given rise to them.

When providing feedback, one member was very honest about their initial – negative – response to the programme, which makes their eventual appreciation all the more positive: “I am sure I had the typical response and resistance to the programme. It is without doubt one of the most invaluable courses I have done that has probably had more impact on my practice than any other. In hindsight (the best sight), I am grateful for being awarded the opportunity to do the CCP.”

The impact of the CCP is improved communications, a better identification of high-risk areas in clinical practice and, most importantly, an improved doctor–patient relationship

The impact of the CCP is improved communications, a better identification of high-risk areas in clinical practice and, most importantly, an improved doctor–patient relationship. GPs or others with an increased risk profile may be recommended to undergo a Member Risk Assessment, provided by MPS Educational Services. Here, the purpose is to assist in identifying existing and potential risks in their medical practice and throughout the surgery as a whole, and to make recommendations for change in line with national guidance and good practice.

Following a recent Member Risk Assessment, where the test results system was found to be unsafe, recommendations were made, and the member wrote to inform MPS that their practice now had a computerised “tracking system” to ensure that patients do not get lost in the system and there is adequate follow-up.

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