The following is a 5-minute Q&A interview conducted with Sharon Brennan, the Practice Leader for Medical Malpractice at CFC Underwriting.

You have had a successful career in the industry since the 1990s and were one of the first underwriters in the UK to get to market with an insurance policy for UK doctors in the private sector. In that time, what recurrent themes have you seen play out with the traditional MDO providers and the commercial insurance industry?

Working with and innovating insurance products for doctors for over 20 years now, there are many common themes that repeatedly crop up. Since the mid 2000s, when I was approached by surgical groups who were keen to attain better premiums in recognition for safe practice, great strides have been taken to educate the profession on the differences between the MDOs and the insurance market. We often get questions around claims made policies versus claims occurrence policies, as well as questions around contractual indemnity versus discretionary cover. Another topic that always seems to arise is around the future of indemnity, where a Government consultation exists, and the viability of the MDO discretionary model compared to insurance. As these are significant areas that impact the way doctors protect themselves in a litigious environment, the support of an independent insurance broker is key. They will be able to explain these very different structures and how they impact you as an individual.

What percentage of your business is currently from surgeons in private practice?

We have a very large portfolio of surgeons insured across many specialities which has grown over many years. My team have over 100 years of combined experience specialising in indemnity solutions and have built solid foundations in the surgical community where, I believe, we have a proven track record.

What are the consistent medicolegal problems that you see from Orthopaedic surgeons in the private sector that need the support of the profession to correct?

The common issues we see are not just particular to orthopaedic surgeons, but to the whole surgical and broader healthcare community. From my perspective, I have witnessed many cases succeeding against the profession which are not a result of poor surgery, but more about administration and process. Often complaints and claims arise as patients allege they did not understand the complications and had they of known they would not have proceeded. What is clear is that the time invested in getting to know patient upfront, carefully explaining the procedure and allowing a decent cooling off period to really consider their options all contribute towards safe practice. Ultimately, though, it is the consent process that captures all of this. If corners are cut there will be a gaping hole in any defence. Medicine is taught at university and takes many years of training in preparation, but perhaps modules for the softer skills like taking contemporaneous notes, reviewing the legal framework that exists (as this can change and impact on practice) should also be taught so that doctors are fully prepared for every aspect of practice. These skills will be utilised across both the NHS and private practice.

As a wider community issue, I think profession has to think about the use of experts during disputes, and standards that should exist for this group. It’s important to remember that legal cases are judged not by the indemnity provider or the legal profession, but rather surgical colleagues and peers who undertake this role. This is an area where very diverse standards exist, impacting both claimants and defendants (surgeons) alike.

How can CFC help OTSIS members in the current crisis who have no private practice income?

We have put in place measurers to keep premiums low during this period, which is as a result of adapting our underwriting methodology in its entirety, and we have extended our payment terms up to 120 days to ease cashflow. In addition, throughout the pandemic we have provided information and guidance to help clients understand how new ways of working impact indemnity. For example, moving to Zoom-based consultations and if this is covered (the short answer is yes). All of the support CFC provides remains under constant review to ensure that key developments are understood to ensure support in private practice – our aim is to provide clarity and certainty in a time where uncertainty exists.

Where would you like to see the collaboration between CFC and OTSIS developing over the next year?

There is always so much to learn and the better our understanding of the issues that impact the profession the better we can respond. Working in collaboration gives us the opportunity to hear first-hand the concerns and issues facing members at any given time. This means we can remain flexible and react accordingly to ensure the cover CFC provides evolves with the profession.