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NICE replacing Bolam as negligence case defence

Guidelines from the National Institute for Clinical Excellence are beginning to replace the Bolam test as a medicolegal defence strategy, according to the institute's leader.

Professor Sir Michael Rawlins, chair of NICE, said solicitors were keen to see GPs adhere to NICE guidelines as they provided a robust defence in medical negligence claims.

Under the Bolam test, GPs will not be found negligent if they acted in accordance with a responsible body of medical opinion.

Sir Michael told delegates at the British Society of Gastroenterology's annual meeting in Glasgow last week: 'Appropriate adherence to NICE guidelines is likely to be a defence against negligence claims.'

He added linking implementation of NICE guidelines to PCT star ratings would force trusts to provide money for prescribing in line with the institute's guidance.

Sir Michael stressed that for individual GPs, NICE guidelines were advisory rather than mandatory. 'They cannot cover 100 per cent of eventualities.'

However, he added that where two sets of guidelines conflict, GPs should follow the NICE guidelines as they were adopted by the NHS and took into account other factors such as cost-effectiveness. He said: 'No one else does that, it's almost unique in the world.'

Dr Emma Sedgwick, clinical risk manager for the Medical Defence Union, said NICE guidelines did not cover all aspects of care but they were influential as a defence to a clinical negligence claim.

She added: 'In our experience I don't think GPs are using the guidelines per se and quoting them in their defence.

'Our advice is that guidelines are good practice and doctors should follow them where appropriate, but there will be occasions where they don't follow them for a good reason and they need to explain why they have deviated from the guidelines.

'Doctors get bored by the MDU saying to record things scrupulously, but it's important if a claim is made years later.'

The Department of Health is reviewing the way medical negligence claims are handled because of the soaring costs of litigation. Part of the consultation process includes evaluating the Bolam test to see if it is still the most appropriate test to use, said a spokesman.

By Rob Finch

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