Dr Christine Tomkins

Dr Christine Tomkins seems decidedly non-corporate. Dressed in a yellow jacket and swishing dress, she rises from her chair with a smile and a soft hello. There is something disarmingly sweet, girlish even, about the first female chief executive of the UK’s largest medical defence organisation.

But appearances can be deceptive. Ever since she took the helm of the Medical Defence Union (MDU) nearly a year ago, Tomkins has shown a steely determination in promoting the organisation’s interests. And she is fiercely protective of its public profile, stressing that it is the UK’s “first and best” medical defence organisation (MDO).

In the beginning

The MDU was founded in 1885 as a mutual, members-led medical defence organisation that protects doctors when they are faced with a legal challenge. Dentists were allowed to join in 1948. With membership climbing to more than 180,000, the MDU now represents 50% of the UK’s doctors and 30% of dentists. Last year, the organisation’s revenue was £180m – and it earned it. On average, the MDU rebuts 70% of the claims brought against its members every year.

But as her career demonstrates, Tomkins is not content to rest on her laurels. After forging a successful career as an ophthalmologist while also raising three young boys, she was ready for a new challenge. In 1985, she spotted the role of medico legal adviser at the MDU while flicking through job vacancies in the British Medical Journal. Although her knowledge of the medical defence sector was minimal, it piqued her curiosity. She applied for the job, and was successful. “I thought, ‘This looks really interesting. I’ll give it a go for six months’, and then I just got sucked in,” she laughs.

Tomkins rose through the organisation, becoming head of claims in 1993, and then director of professional services in 1995, before landing the top job last September. “My proudest achievement is being appointed chief executive, to be the first woman in the role and the only woman leading a medical defence organisation,” she says. But now she is focused on another goal: dragging the sector into the 21st century.

The art of self defence

In contrast to other healthcare practitioners, such as chiropractors, osteopaths and optometrists, doctors and dentists in the UK are not legally required to have a professional indemnity insurance policy. In most other EU countries, insurance for doctors or dentists is compulsory or the norm. As Tomkins points out, the MDU is the only MDO to offer a professional insurance policy. Underwritten by SCOR UK Ltd and by the International Insurance Company of Hannover Ltd, the policy guarantees indemnification against medical negligence claims.

Other MDOs only offer a discretionary policy, following a tradition in place since they evolved in the 19th century. The decision to cover medical negligence claims is wholly discretionary; there is no contractual right to indemnity.

Shockingly, this means a substantial number of the UK’s doctors are not covered by insurance if they are sued for malpractice. And patients who have suffered from negligence may fail to be compensated. “If it wasn’t so serious, it would be laughable,” Tomkins sighs.

Moreover, as an insurance intermediary, the MDU’s decisions are scrutinised by the FSA. There is no external body to monitor providers of discretionary policies.

Over the past decade, Tomkins has played a key role in the union’s campaign to make this a legal requirement in the UK. Under mounting pressure, the Department of Health granted the General Medical Council (GMC) and General Dental Council (GDC) powers to make insurance compulsory for doctors and dentists in 2006 and 2005 respectively. But so far they have failed to do so. “If I was in their shoes, I would feel this was an issue they need to look at very carefully, because they are charged with protecting patients,” she warns.

Nonetheless, Tomkins admits the MDU’s stance offers more than the chance to take the moral high ground. “It gives us a great advantage in the market,” she says, before quickly adding; “We did it because it was quite clearly the right thing to do.”

The legal position

Tomkins is not just fighting the GMC and the GDC. She is also taking on the legal system. After Lord Justice Jackson’s review of civil litigation costs was announced, she ensured that the MDU was at the front when views were being taken into account. “The costs on the claimant’s side have been inordinately large,” she says.

Indeed, she cites one particular claim where the claimant’s costs amounted to £39,330; more than double the MDU’S costs, of £18,495. As a result, it has recommended capping success fees in conditional fee agreements, setting fixed hourly rates for solicitors, and abolishing ATE premiums.

Tomkins treads with caution when asked if there has been a surge in “have a go” claimants. She is careful to ensure that the MDU is seen as being on the side of the patients as well as members. “I do think the costs are excessively expensive,” she says warily. “But my view is that if the patient has been negligently treated, they should be properly compensated. I don’t subscribe to the view that there’s a runaway compensation regime in the UK.”

But she must have seen some outrageous claims if the union is managing to prevent seven in ten from getting through the door each year? Not so, says Tomkins. She explains that it is often down to misunderstanding on the patient’s part and lack of communication on the doctor’s. “Just because outcomes are not what you wished them to be, it doesn’t mean the doctor is negligent,”

she says. “It can be difficult for the patient to understand that, which is why explanations and communication are so important.”

The MDU’s 24-hour advisory helpline provides support to members, and receives up to 25,000 calls a year from practitioners trying to grapple with an evolving minefield of potentially litigious situations. Tomkins says such queries could range from members worried about a vaccine inadvertently given to a child against a parent’s wishes, to a doctor’s fears about police demands that he hand over confidential files. “It can be about anything under the sun. You couldn’t make up some of the questions if you tried,” she says.

So how does she get away from these pressures? When she escapes her office, Tomkins is a keen cyclist and, in a quirky twist, says she loves riding a pony and trap in the countryside at weekends. But she agrees her main struggle is finding time to meet all of her commitments. “My biggest personal challenge has been in ensuring that I distribute my time properly that I give my job, my children, and my interests the best shot I can.” Unsurprisingly, she adds: “I don’t like to do things by halves.” IT