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Not following guidelines doesn't necessarily make you negligent

Dr Graham Davenport, chair of the Primary Care Rheumatology Society, makes an interesting point in the news story 'GPs risk litigation for ignoring Government advice on NSAIDs' (June 2) when he advises that GPs who go against NICE guidelines could end up in court.

While widely accepted guidelines that are supported by a responsible body of medical opinion can help towards a successful defence if a doctor is sued by a patient, it does not necessarily follow that doctors who do not follow guidelines are negligent.

The key thing is that doctors who choose not to follow NICE guidelines must be able to justify their decision and this decision must be supported by responsible expert evidence in court. It goes without saying that a clear note of the reason for this decision should be made in the medical records.

Dr Davenport goes on to describe the difficulty some GPs may face in balancing the practice drug budget while following guidelines, but recounts how he successfully resolved this issue with his PCT by referring to NICE guidelines.

The GMC gives helpful advice for GPs facing this dilemma. It says: 'If you have good reason to think your ability to treat patients safely is seriously compromised by inadequate premises, equipment or other resources, you should put the matter right, if that is possible. In all other cases you should draw the matter to the attention of your trust, or other employing or contracting body.'

GPs who feel lack of resources impinges upon their ability to prescribe certain medications to the serious detriment of their patients may wish to raise the issue with their PCT, and can always seek the advice of their medical defence organisation before doing so.

Dr Paul Colbrook

Medicolegal adviser

MDU, London SE1

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