December 2021 Newsletter

Dear PRASIS Member

The PRASIS Board wish all members and their families a happy, safe and peaceful festive season and 2022.

We would also like to extend our thanks to you for your loyalty in remaining a PRASIS member through what has been a challenging period.

We are grateful to Simon Downing, Managing Director of MIC and its staff for all their support to PRASIS through the difficulties of the Covid-19 Pandemic and the challenges associated with our change of brokerage. We continue to strengthen our relationship with MIC, and broadening their work for the benefit of PRASIS members.

We are here to help members with any enquiries. The quickest way to get through to a Board member is to contact the PRASIS Board Secretary Helen Roberts, via email or mobile phone (see below), and she will ensure your query is forwarded to the correct member of the team.

With Best Wishes

The PRASIS Board

Chair:

T Yeoman

Clinical Board:

Steve Hamilton

Mark Henley (Advisor)

Graham Offer

Jim Kirkpatrick

J Srinivasan (Srinivas)

Ruth Waters

Legal Advisor:

Nicky Collins, Lawyer at Slater Heelis, Former PRASIS Chair

PRASIS Board Secretary:

Helen Roberts (helen.roberts@prasis.org)

Mobile: 07930509646

PRASIS BROKERS – MEDICAL INSURANCE CONSULTANTS (MIC)

PRASIS members have now transitioned from our previous brokers MPIG (now part of Arthur J. Gallagher & Co.) to our new brokers MIC.

Please note that the duty of our Broker - MIC - is to act on behalf of PRASIS and each individual PRASIS member, and that its duty is not to the underwriters.

Our broker MIC deals with virtually all of the medical indemnity insurers.

This transition requires the submission of the signed Broker of Record (‘BOR’) form to MIC, which is worded to allow MIC to act on your behalf in administering your current policy and renewal. Signing this form does not result in any changes to your cover or insurer, and does not place you under any additional renewal obligations. A copy of this form is attached.

Only MIC is authorised to contact members on behalf of PRASIS and this process should not involve other brokers. We understand that some members who have signed a BOR appointing MIC are continuing to be contacted by our previous brokers. If this has happened to you, please let us know and we will take this up with Gallagher & Co. on your behalf. (Email: board@prasis.org)

We are also aware that some members may have signed a ‘BOR’ form for more than one Broker. Please note that a Broker of Record is only required to change the broker acting on your behalf. If you are looking around for quotations then a simple Letter of Authority is sufficient for any information needed to be shared. It is worth noting, that although there may be a number of brokers offering indemnity for surgeons, there are in reality only a handful of insurers that provide surgeons’ indemnity. This means that quite often your proposal form may land on the same insurer’s desk several times, so we would advise discussing any issues you may have with MIC to establish a trusted working relationship. Their role is to advise and support members.

Only a small number of members have left PRASIS since the beginning of the Covid-19 Pandemic, a proportion of which have cited the payment of Additional Premiums, incurred as a result of their actual income being significant multiples of their initial projection. We would caution members who elect to do this as such actions can expose the surgeon to the risk of inadequate (or lack of) insurance cover with their current insurer, particularly if any claims or complaints have been notified. This is because your cover is based upon key elements, one of which is your projected income, so if you earn more, then you are due to pay more, as this would be a change in a material fact. If the appropriate premium is not paid for the cover, as insurers see it, then you could potentially be liable to pay a proportion of any claim based upon the underpayment.

As mentioned previously there are not a great number of medical indemnity insurers for surgeons, with numbers shrinking recently due to tough conditions and unsustainable pricing. Talk to MIC before you make any decision about moving so they can advise you on the benefits and disadvantages, as premium is not the only factor that needs to be considered.

Telephone: 01935 847382
Email: prasis@m-i-c.co.uk

LABIAPLASTY EXCLUSION

It is the duty of our Broker (MIC) to monitor the insurance market and note how insurers are responding to certain factors that can have a bearing on your medical indemnity coverage. Our main insurance provider is CFC who constantly review and update the way in which they underwrite policies to respond to evolving trends, both clinical and from a claims perspective. Recently some members may have noticed an exclusion appearing on their medical indemnity renewals, in relation to labiaplasty procedures and how they will be covered going forward.

It is widely acknowledged that performing a labiaplasty for purely cosmetic reasons is not deemed best practice and claims activity on the scheme now reflects increasing levels of litigation against surgeons who have carried out this procedure. Damages being sought by patients can be extremely high eg after expert review of a recent claim insurers have reserved (damages plus legal costs) at over £400,000. The labiaplasty exclusion is very specific and only excludes labiaplasty procedures carried out for purely cosmetic reasons i.e. where there is no functional indication. Reflecting good clinical practice guidelines, if there is a functional reason for carrying out a labiaplasty procedure then the procedure will be covered, even where there are also cosmetic considerations. As always, members should ensure that their notes clearly and accurately record the indications for the procedure.

Insurers are now requesting additional information relating to any purely cosmetic labiaplasty procedures members have carried out in the past so that these will still be covered, and it is important that members declare these and provide that information to ensure that cover in the event of that a claim may arise.

If any member would like to discuss this or has any other questions relating to labiaplasty procedures, please email: prasis@m-i-c.co.uk

UNDERWRITERS

CFC continues to be the main underwriter used by MIC for PRASIS members, and currently all PRASIS renewals have been with them, though in certain instances alternative cover and insurers may be appropriate for a member as recommended by MIC.

In contrast to several other providers we believe that CFC has excellent credentials in terms of expertise, experience, capacity, financial security and longevity to provide PRASIS members with safe and stable insurance.

Sharon Brennan, Medical Malpractice Practice Leader at CFC, gave an insightful talk (on the inaugural webinar with our sister organisation for Orthopaedic surgeons - OTSIS) on 18 November 2021 into how Underwriters perceive risk and how surgeons can limit their exposure to it within an increasingly litigious society.

Webinar open to PRASIS members. PRASIS will be hosting further webinars in 2022, open to non-members.

CONSENT

The whole issue of consent continues to evolve and challenge the field of Medical Indemnity.

The PRASIS chairman Tony Yeaman, a highly experienced senior medico legal lawyer spoke with great clarity on this subject at the OTSIS/PRASIS webinar and offered valuable insights and advice on ‘Consent in the Modern Era’ (see Members’ section of the PRASIS website).

PRASIS TRAINEE MEMBERSHIP

Trainee membership is available through MIC, our broker, who can advise you of the benefits available to trainee members. A key element of the policy is that it is insurance, not discretionary and allows you to assist, under supervision, in a far more flexible way than Medical Defence Organisation cover. You can also add in some private practice for procedures, such as Botox and fillers for an additional premium.

The PRASIS Trainee Policy is fast becoming the go to policy to ensure you are fully covered as you progress towards developing your own private practice. Annual premiums start from £498 and can be spread over 10 months for a small additional charge.

SOCIAL MEDIA

PRASIS Twitter and Instagram accounts

PRASIS now has a Twitter account: @PRASIS_UK

and an Instagram account: prasis_uk

Conversely please also note the talk ‘How to Cut it in the Media: pitfalls and actions to take in the face of negative press coverage, social media posts and/or online reviews’ given by Ms Tingy Simoes from Wavelength Marketing Communications, at the recent OTSIS/PRASIS webinar, in which she gave advice on how to deal with this increasing challenge for doctors in modern society. Webinar open to PRASIS members. PRASIS will be hosting further webinars in 2022, open to non-members.

CONFEDERATION OF BRITISH SURGERY

The Confederation for British Surgery is an official trade union which is able to provide members of the surgical community with support and resources that the specialty associations, colleges and indemnity schemes, such as PRASIS are unable to offer.

The Confederation has recently launched the Surgical Advisory Service. A document detailing the background to its development, the challenges which surgeons face and the support available is enclosed. It is hope that this will make interesting reading and assist you to avoid many challenges to your professional and personal wellbeing and encourage you to join.

The PRASIS Board is keen to support this development so has arranged funding to give you free membership for your first 2 years. You will need to sign up individually to gain this benefit because of the rules regarding trade union membership.

Please follow the link below and join: https://www.cbsgb.co.uk/membership_application.aspx

LATEST PRASIS SPONSORSHIP

1. RCS Cosmetic Surgery Certification Scheme

The aim of this Scheme is to set the standards of Aesthetic surgery and to provide accreditation for key competencies so as to demonstrate expertise to patients, and ultimately to help make the cosmetic surgery industry safer by improving professional behaviours in this sector.

The main contributors were selected Plastic Surgery colleagues from BAAPS and BAPRAS, supported by other Specialty associations.

It is supported by all four surgical Royal Colleges.

Please see the following link for further information:- https://www.certify-cosmeticsurgery.org.uk/home

While credentialing with the GMC is not yet mandatory, it is likely that this will follow soon.

The “Professional Behaviours in Aesthetic Surgery Course’ has been produced as part of the Certification process. It is currently offered as fully online course, see:-

https://www.youtube.com/watch?v=8wjwCi4vSmQ&feature=emb_logo

Completion of this course (along with provision of details of the applicant’s operative practice) is necessary to apply for this Certification.

PRASIS members are encouraged to undertake this process.

The current cost of the course is £475. However, PRASIS will reimburse members £300 of that fee on production of proof of its completion by the member.

Members should also note that in addition to the cost of this course there is an application fee for the Certification Scheme of £650.

For further information or to book this place on the course, please email:- apply@certify-cosmeticsurgery.org.uk

2. BAPRAS/ PLASTA/SAC National Teaching Programme

Webinar Series

PRASIS are pleased to have contributed to the funding of this series of webinars designed to encompass the new Plastic Surgery curriculum, specifically aimed at the level of the FRCS Plast examination.

http://www.bapras.org.uk/professionals/training-and-education/bapras-events/bapras-sac-plasta-national-teaching-programme

3. PLASTA ‘Innovations in Plastic Surgery’ Congress,

2 December 2021;

PRASIS are pleased to have provided some sponsorship for this exciting event, which was very successful.

FURTHER EDUCATIONAL AND PROFESSIONAL RESOURCES

We would like again to remind you of the following resources available to all members as part of their membership.

1. EIDO Healthcare

EIDO Healthcare provides members with a Procedure-specific patient information library to support informed consent:

You can download and print your personalised documents by entering your login details provided with your PRASIS membership, at:

https://inform.eidosystems.com

These patient information documents (in the ‘Plastics’ section of the ‘Procedure Information’ menu) are:

endorsed by the Royal College of Surgeons.
fully referenced and up-to-date.
Crystal-Marked by the Plain English Campaign.
certified by the DoH’s Information Standard.
widely used across the acute NHS and private sectors.

2. Elsevier ClinicalKey in Plastic Surgery

This allows PRASIS members to view the wide range of Elsevier plastic surgery journals (including eg Clinics in Plastic Surgery) and plastic surgery textbooks.

For a list of available journals and textbooks, see: https://store.clinicalkey.com/product/plastic-surgery/.

The subscription for this is normally $749 per annum, but it is accessible without charge via your login to the Members section of the PRASIS website. https://www.clinicalkey.com/#!/

Elsevier Flyer

COMMON CALL TO THE HELPLINE

Over the last few months, one particular issue that has come up on a number of occasions, is that of ‘use by dates’ on surgical equipment and products.

During the extended break in surgical procedures over the peak of Covid-19 lockdown many surgical products were left unused.

In recent weeks we have been notified of cases where surgical procedures have been undertaken using equipment or products which were past their ‘use by date’, including staples, surgical mesh and implants, which was noticed only after the procedure had been completed.

In these situations, it is important that the following steps are taken:

Contact the manufacturer for product specific advice on the potential consequences.
Consider whether revision surgery is indicated, or whether that would carry more risk.
Fully inform the patient of the situation as soon as possible, even if no further surgery or action is required.
Inform the hospital, and all other members of staff involved.
Ensure that the situation is documented in the medical records.
Contact your indemnifier to notify the circumstance.

Depending on the individual circumstances the responsibility for such checks may not lie with the surgeon, but we wish to highlight these recent reports and emphasise the importance of surgeons undertaking all appropriate steps in this regard

SUMMARY BENEFITS OF PRASIS

Stability and security should be the overriding considerations which drive a choice of indemnifier and we believe that our current Underwriters and Broker provide these.

This is particularly the case in such challenging times as the present, in which Covid-19 is generally reducing capacity in the Insurance market and affecting the ability of those left to take on risks, leading to large increases in premiums for some professional groups and great difficulties in securing any cover at all for others.

PRASIS creates and provides a community for plastic surgeons who have shared core values based on their training and working practices, and for this reason PRASIS members are viewed as a safer group, and therefore an attractive risk for insurance companies.

Whilst PRASIS has lost small number of members in the last year, it has also taken on new members during this period.

PRASIS is also unique in having a Clinical Board, all of whom are senior plastic surgeons, and who provide their insights and influence to the wider team.

Members of the Clinical Board are always pleased to provide clinical advice to PRASIS members, and when appropriate to act as advocates for them in their dealings with the Brokers and Underwriters of PRASIS. To do this requires the member’s written consent for disclosure to the Clinical Board Member(s) of the full background information relating to the issue in question - be it a clinical matter, or a matter relating to the member’s policy (eg their premium).

In addition to this and as outlined above PRASIS supports educational activities and opportunities for its members for their benefit in particular, and more widely to benefit the Plastic Surgery community as a whole.

PRASIS is an Introducer Appointed Representative of Medical Insurance Consultants Ltd which is Authorised and Regulated by the Financial Conduct Authority and is entered on the Financial Services Register under reference 309026.