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Medical cover chief demands 2014 vote answers

THE leading provider of indemnity for medical and dental professionals in Scotland has lined up meetings with politicians on both sides of the independence debate as it seeks clarity on how the referendum could affect its members.

The Medical and Dental Defence Union of Scotland (MDDUS), a mutual with 35,000 members across the UK, has no plans to take a position on the debate because of its "apolitical" status.

However, with more than two-thirds of its income coming from members south of the Border, and with significant investments in Government bonds, chief executive Gordon Dickson is pressing politicians for answers on issues critical to the organisation.

He said: "I think the best way to characterise would be to say we are agnostic. We've read the white paper cover to cover. We have a number of meetings lined up with both sides of the campaign because we need to better understand any implications there might be for us and our members.

"I'm not wanting to appear to be sitting on the fence, but there is so much detail in the white paper that it would be foolish to say one way or another. I think we are genuinely agnostic. We have a number of questions we want to be clear about."

With MDDUS managing a fund of £487 million for its members from its Glasgow base, Mr Dickson said it was seeking more information on the proposal to establish a Scottish monetary institute in the event of a Yes vote.

The white paper on Scottish independence envisages that such a body would work closely with the Bank of England and perform key functions such as independently undertaking research and monitoring developments in the financial.

Suggesting the white paper was more of a manifesto than a detailed plan, Mr Dickson, a former dean and vice-principal of Glasgow Caledonian University, said: "We need to know what that means. What will that mean for regulation of organisations like ourselves?

"We need to be clear about monetary policy - where will interest rates be set? We need to be clear about our fund and continuing investment in UK Government gilts.

"We need to be clear, too, about regulation of the professions that are within our membership - doctors and dentists.

"There are very practical things. It is not airy fairy, it is not political. It's just: can you please answer our questions? That will help us decide our stance and, consequently, what our advice to our members on the matter should be."

The intervention by MDDUS, whose board includes former Lord Advocate of Scotland, Dame Elish Angiolini, in the constitutional debate comes at a time of strong growth for the organisation.

With its status secured as the dominant body for medical and dental defence in Scotland - 98% of GPs here are members - its recent focus has been to grow membership south of the Border.

Its market share in England has doubled in the past six years, with the proportion of GPs who are members down south having risen from 9% in 2006 to 20% today.

Although doctors and dentists risk running into the same kind of medical mishaps on both sides of the Border, Mr Dickson notes that claims are more likely to take place in England. They also tend to be higher.

Mr Dickson said there is no definitive reason why this is the case. He said: "People seem more litigious than they were, much more so in England.

"Now this will be a surprise to many people. But many, many studies and our actuarial data confirms that if you are a doctor, for example, in England, you are three times more likely to have a claim made against you than if you are a doctor in Scotland.

"That claim is likely to be very much more expensive than a claim in Scotland. Far greater brains than mine have tried to work out why that should be, but I think it is deeply rooted in a number of social and cultural factors."

Mr Dickson said the MDDUS approach to fund management comes under the traditional, Scottish mutual mould. He explained: "The fund is there for the members. If you think about a traditional risk pool, we have got 35,000 members. Very few will need to draw on that pool, but when they need to draw on it, they need to draw on it, and it could be very, very expensive indeed. Our task is to manage that fund so that when the member needs access to the money, then it is there. That's an extremely complex job."

A particular challenge involved in members' funds, he said, is balancing the level of risk to reflect that claims can take place many years after an alleged neglect or malpractice occurs.

Explaining that MDDUS offers "occurence-based" cover - in other words, defence at the time an incident occurs - he cited the example of a doctor who was a member of MDDUS for several years before emigrating to Australia in 1972 . In 2002, he faced a claim of negligence when he was involved in the birth of a child born with serious brain damage in 1996. MDDUS, which won the case, defended him because he was a member at the time the birth took place.

Mr Dickson noted: "We have got to ensure that the fund we are managing today will have adequate resources in it for all those years to come."

The fees it charges, meanwhile, reflect the level of risks its members face in their role, Mr Dickson said: "If the risk is higher in England, members pay more than in Scotland. Obstetricians and gynaecologists can result in far more expensive claims than anaesthetists and dermatologists, so they pay more. We relate it to the risk the member brings to the pool."

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