For example, frontline clinicians do their best for patients while often having little influence over their working environment. But all too often the response to adverse incidents is to seek to blame individuals rather than learn lessons. The rise in gross negligence manslaughter investigations against doctors is one symptom of this, as is the unsupportive approach of some NHS organisations during investigations.

And then there is the long-term issue of soaring claims inflation. This is not the fault of doctors. The underlying cause is an obsolete civil litigation system, compounded by the Lord Chancellor's decision to reduce the discount rate to an historic low.

The spiralling level of settling claims has serious ramifications for the NHS - NHS Resolution's latest annual report estimates that its total liabilities have almost trebled to £77 billion in four years. It has also contributed to a crisis in general practice by pushing up the cost of GP indemnity to unaffordable levels. It's perhaps not surprising that a third of GP respondents to an MDU survey in 2017 were thinking of leaving the profession or retiring over the impact on practice finances.

But while this hostile medico-legal environment is daunting for a lone professional, doctors are not alone. As a mutual medical defence organisation, the MDU has the strength to stand up for our members when the going gets tough, whether that is providing robust representation to individuals or, more broadly, by seeking to make a positive difference to their working environment.

The MDU's medico-legal expertise makes us an authoritative voice when it comes to advocating legal and regulatory reforms in the interests of the whole profession. You can read about this aspect of our work in this issue, including our contribution to the Williams Review into gross negligence manslaughter in healthcare, where many of the reforms we had put forward were reflected in the final recommendations.

Looking beyond indemnity

Dr Christine Tomkins

Looking beyond indemnity