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New head of advisory services and former GP, Dr Caroline Fryar, talks to Good Practice about the challenges of her new role.
Monday morning is a traditionally busy time for GP practices when anxious patients and their families are most likely to call for advice or to make emergency appointments.
It's a similar story on the MDU advice line as former GP, Dr Caroline Fryar reveals: "Members who are involved in a case are invariably under great strain and without the distraction of work they can easily spend the whole weekend worrying about their situation. Many are audibly relieved to be put through to an adviser who understands the process they are going through and can reassure them."
Sadly, the number of members in this predicament is on the increase. During 2013, the MDU took more than 33,400 calls from members on its advice line, an increase of 3% from the previous year and up 17% on five years ago. A quarter want general medico-legal advice about areas such as confidentiality and mental capacity but 40% of calls relate to a complaint or some form of investigation, including scrutiny from the GMC and employers' disciplinary processes.
Complaints to the GMC have been growing since 2007 while according to the Health and Social Care Information Centre (HSCIC), the NHS attracted the equivalent of 3,000 written complaints each week in 2012-13. In that context, it's little wonder that the MDU advisory team opened over 13,000 new case files in 2013 to assist members.
As the new head of advisory services, it is now Caroline's job to manage the response to the unprecedented level of demand for our services, ensuring medico-legal advisers are on hand to offer expert guidance and support to members from the outset. She explains:
While medico-legal advisers are no longer in clinical practice, the relationship we have with members is similar in many ways to the one we had with our patients. We need to support them and we become very close as months, and sometimes years, go by...
"The way an adverse incident or complaint is managed initially can make a difference to the way the situation develops so it's important our advisers are as accessible as possible and can get things on the right track from the start. It's why we offer a 24-hour advice line service and why we have appointed ten more doctors to our team, bringing the number of medico-legal advisers to 40."
Caroline succeeds Dr Michael Devlin, who has taken on a new MDU role as Head of Professional Standards and Liaison, representing the MDU in dealings with the Department of Health, the GMC and other national organisations.
Caroline agrees it is a challenging time to take on the role but doesn't feel the advisory team's growing caseload represents a decline in standards. "There are increasing public expectations of medical practice and a culture which seeks to apportion blame if something goes wrong. There is also greater awareness of problems which emerge in practices and hospitals and these tend to be handled in more formal ways."
A medico-legal adviser since 2006, Caroline qualified in 2000 and worked in general practice in Cheshire before joining the MDU. She is typical of most advisers in having a long-standing interest in the law and completed a postgraduate law degree in 2011. She is also a member of the Faculty of Forensic and Legal Medicine (FFLM) where she is an examiner and recently helped develop the new Diploma in Legal Medicine so that professionals with an interest in legal medicine can develop their knowledge.
Outside the office, she is an enthusiastic runner, pounding the streets around her home in Cheshire and competing in 10k races and half-marathons where her best time is under two hours although since having had children, she jokes that she is now delighted to make it around the course.
Back at the MDU, Caroline oversees a team from a wide range of medical specialties, from general practice to neurosurgery. "It's important that medico-legal advisers have experience of clinical practice at a senior level," she says. "We want members who call our advice line to speak to an adviser who has 'been there'. We've all had our own 'heartsink' moments in practice but the level of scrutiny is becoming more intense.
"While medico-legal advisers are no longer in clinical practice, the relationship we have with members is similar in many ways to the one we had with our patients. We need to support them and we become very close as months, and sometimes years, go by.
"It's shocking to think that a number of the members' files I took on in 2007 only closed in 2012 after several different investigations into the same incident."
Reflecting on the personal qualities needed, Caroline observes: "Advisers must be able to empathise but equally importantly they need excellent communication skills to speak with, and on behalf of, members. And they must quickly get to the heart of the matter and ensure the doctor receives a realistic assessment of the possible consequences and how best to respond. This sometimes involves seeking advice from the MDU's in-house legal team and flagging cases to colleagues in the claims team.
"They also need the strength and skill to have difficult conversations. We often see correspondence relating to a member's case before they do. As a result, we might have to break the bad news of a GMC investigation or that a journalist is looking into the case. Unfortunately, the media has a seemingly inexhaustible appetite for medical stories. Advisers can call on the MDU's press office for help in managing the media, which members tell us they find very reassuring."
While much of her time is spent helping doctors in difficulties, Caroline is also focused on representing the interests of members and helping doctors adapt to changes in the regulatory landscape, such as revalidation and CQC. She concludes: "As a GP, I was drawn to the MDU because I felt it always had the profession's interests at heart and represented them. Now it's rewarding to be able to contribute to that work."
This article originally appeared in the printed Good Practice June 2014 issue entitled "Setting the pace in advisory services"
This page was correct at publication on . Any guidance is intended as general guidance for members only. If you are a member and need specific advice relating to your own circumstances, please contact one of our advisers.
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