Medico-legal tips for IMGs in the UK

Doctors in the UK can be held accountable for their actions (as well as what they don't do) by various bodies, including:

• their employer
• the General Medical Council (GMC)
• civil and criminal courts.

Understanding key medico-legal concepts is crucial to avoid stressful or career-damaging situations.

That's where the MDU can help. As the UK's leading medical defence organisation (MDO), we can support you as an international medical graduate (IMG) with allegations about your clinical practice, offering legal representation and indemnity. We provide guidance on navigating complex situations in the best interests of the patient and in line with the relevant laws and standards.

This guide highlights common medico-legal issues, so you can make sure your time in the UK is memorable for all the right reasons.

Navigating challenges for IMGs

Many of the medico-risks you'll face as an IMG are the same as your UK-qualified colleagues, but some others might arise from being unfamiliar with the system or cultural differences.

Based on our experience, here are some aspects of practice that could cause problems.

• A patient-centred approach to consent in the UK focuses on a dialogue with individual patients about any material risks of a procedure, and which risks matter.
• Patient confidentiality. While you might encounter questions from relatives and friends about patient care similar to what you're accustomed to, it's crucial to remember that sharing information without that patient's consent is generally inappropriate, even with close family members. This is especially true for patients who are able to make their own decisions.
• Responding to patient complaints. All healthcare providers in the UK are expected to have a complaints procedure that emphasises listening to and learning from complaints. The MDU can help you in effectively addressing complaints to prevent minor issues from escalating to other formal processes wherever possible.
• Social media. Beware of blurring professional boundaries, unintentionally disclosing patient information, and becoming involved in online disputes. The GMC provides specific guidance on social media use, stressing the importance of being mindful of what you say even in private groups.
• Record-keeping. Accurate and complete record-keeping is crucial; inadequate clinical notes can compromise patient care, create challenges for colleagues, and hinder your ability to justify clinical decisions. Good record-keeping is essential for explaining your decision-making when necessary.
• Chaperones. While you may be used to having one present during intimate examinations, it's important to know who can act as an appropriate chaperone in the UK. Chaperones should be trained professionals, not family members. Are you prepared to handle situations where a patient refuses a chaperone, or know your options as a doctor if you prefer consultations to be chaperoned but the patient disagrees?
• Communication failures. As with anywhere else, patients in the UK increasingly expect to be involved in decisions about their care. This includes receiving comprehensive information and explanations about diagnoses and treatment plans. Misunderstandings, omitting relevant information or perceived rudeness can often contribute to complaints, GMC investigations or claims.

Being aware of these differences can ease your transition to a new post in the UK. There are also practical steps you can take to prepare for practising here.

Sort out your indemnity

The GMC requires doctors to have adequate indemnity in place. Indemnity provides financial support if a patient makes a clinical negligence claim, ensuring compensation for any harm caused.

• If you work in NHS secondary care, the state typically provides indemnity for clinical negligence claims. This is often referred to as NHS indemnity, and also applies for primary care in England and Wales.
• GPs in Scotland or Northern Ireland must arrange their own indemnity for their day-to-day clinical work.

Doctors practising privately or outside the NHS will usually need to arrange their own indemnity. If you're not sure whether NHS indemnity applies, check with your employer before starting work.

While the state indemnifies you for clinical negligence claims from NHS work, it does not extend to other medico-legal issues that you might run in to as a doctor practising in the UK. For support in these areas, you'll need to join a defence organisation. This includes:

• GMC investigations
• coroners' inquiries
• complaints
• disciplinary procedures
• criminal investigations
• dealing with the media.

These processes can be stressful to deal with, and unless managed appropriately with the help of an MDO, can have professional consequences for a doctor.

Follow practice guidance and regulations

The GMC sets professional standards of care and conduct for UK doctors. Alongside its core publication 'Good medical practice', it offers detailed guidance on key areas such as consent, confidentiality and treating children, with more resources in its ethical hub.

While you don't need to learn the guidance by heart, it's important to know the principles and your duties as a doctor. Failure to meet the GMC's standards makes you more vulnerable to complaints and even a fitness to practise investigation, so get specific advice if you need it from the MDU's 24-hour helpline.

As well as the GMC, you can find guidance and advice on our website, NHS England, the relevant royal colleges, NICE and SIGN, or your NHS employer.

Focus on communication

Your communication skills are one of your best assets in day-to-day practice, from obtaining consent from a patient to clarifying a task with someone in the team.

Ask for feedback from your colleagues about your communication strengths and weaknesses. Consider signing up to a communication skills course to boost your proficiency and confidence in areas like tone of voice, body language, and active listening.

Your employer should be able to arrange this. You can also check out the MDU's 'Introduction to communication skills' course (discounted for MDU members).

Be proactive

It's much better to pre-empt medico-legal risks or be prepared to address them straight away. Here are five ways to ensure you won't get caught off balance.

1. Keep up to date with continuous professional development (CPD).
2. Make the most of your employee induction and familiarise yourself with local protocols and procedures.
3. Be open and honest when something goes wrong as required under the duty of candour, and participate in audits and investigations so you can reflect and improve.
4. Don't delay reporting patient safety concerns or incidents - the sooner you contact your MDO, line manager or employer, the better the chance of resolving it.
5. Ask for help when you need it. Stress, financial worries and health problems could affect your performance and leave you vulnerable to complaints. There's plenty of sources of support available for UK doctors.

As an MDU member, you call our advice line 24/7 about a medico-legal issue to get help, and visit our support hub for more information.

More helpful links

The GMC - the UK medical regulator

The Medical Defence Union (MDU) - the UK's leading medical defence organisation

The British Medical Association - trade union for the doctors

NHS England, NHS National Services Scotland, NHS Wales and Northern Health and Social Care Trust (Northern Ireland) - country-specific NHS websites

This page was correct at publication on 27/06/2024. 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.