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Cases missed out of hours

Delays in diagnosis or failure to diagnose at all are the main reasons for complaints and negligence claims against out-of-hours GPs.

Medical Defence Union figures showed that these featured in 15 of 18 negligence claims in 2006 and 61 of 182 complaints.

Non-diagnoses of appendicitis, pneumonia or meningitis were common. Communication problems between GPs and patients were featured heavily in complaints and negligence claims, the MDU report added.

Out-of-hours GPs had poor access to medical records and had to rely on patients' own knowledge of their medication history – which was not always accurate. And there was difficulty arranging follow-up care for a patient if a consultation was required the next day with the patient's own GP. In one case a 34-year-old man died from pneumonia after an out-of-hours GP's request for a home visit was not passed on.

Dr Stephen Green, MDU head of risk management, said: 'Some of the negligence claims arose after a previous complaint, but many arose without any earlier contact.'

He said of communication problems: 'When patients are seen out of hours, doctors are reliant on the patient for accurate recall of medication history.'

Out-of-hours consultations were often stressful for patients because of extra waiting, he added. 'They may feel more vulnerable because it is the middle of the night, and they will usually be seen by a doctor they have never met before.'

MDU GP members were subject to 155 complaints in 2005 and 23 negligence claims. It was too early, however, to detect trends in the nature of complaints and claims since April 2004, when GPs opted out of out-of-hours care, said Dr Green.

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