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Independents' Day

Out-of-hours GPs subject to largest compensation claims

Out-of-hours GPs have been subject to the largest increases in compensation claims in recent years, with one of the UK’s largest indemnity providers paying out £30million in the last three years.

The Medical Defence Union reviewed three years of claims against GP members in out-of-hours or unscheduled care to assess why ‘indemnity risk’ and related costs were growing at an ‘unprecedented’ rate.

The review found that 71% of claims related to a delayed or missed diagnosis, followed by a missed referral (18%), medication mix ups (9%) and then inadequate treatment.

In a quarter of missed diagnosis claims a patient had died. The most common conditions involved include; cauda equine syndrome, limb ischaemia, gastrointestinal complaints, myocardial infarction, and meningitis or septicaemia.

Dr Pierre Campbell, MDU head of underwriting, said claims against out-of-hours services were more often due to working with ‘unfamiliar’ patients, with undiagnosed and ‘potentially deteriorating conditions’.

This results in claims that are on average higher and more difficult to defend - several of the cases in the review incurred costs in excess of £1million.

He added: ‘Often doctors will be trying to make the correct diagnosis based on limited information and little or no access to the patient’s medical records. Added to that, GPs may also be triaging and diagnosing patients over the phone or internet, or supervising other health professionals that are doing so.’

‘We are seeing unprecedented increases in the cost of claims from general practice overall. However, nowhere is this more apparent than in the provision of emergency unscheduled care.’

MDU advice on minimising risk in out of hours consultation, includes:

  • Make sure the patient understands what to expect and watch out for and when to seek further review, and document your management plan and this ‘safety netting’ advice.
  • Try to manage patients’ differing expectations and remain polite and professional.
  • Record negative findings from the consultation or examination, as well as positive ones.
  • Ensure patients are appropriately followed up by secondary care or the patient’s GP practice.
  • With telephone/online consultations, be aware of their limitations and be prepared to ask the patient to come in for a consultation if an examination is necessary.

Readers' comments (3)

  • Don't do out of hours again and never will again.I suggest everyone do the same.Poisonous UK.

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  • 'Make sure the patient understands what to expect and watch out for and when to seek further review, and document your management plan and this ‘safety netting’ advice.'
    - in other words - cover all bases however unlikely and ensure the consultation notes are as voluminous as 'War and Peace' - very practical.

    We have this on the one hand and on the other there's the incessant push for 'hospital avoidance' - paramedics ringing 111 because they are under extreme pressure not to take patients to hospital. I've had personal experience of triaging these calls and realising that the patient meets the criteria for red flag sepsis!

    The job is fast becoming undoable.

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  • I agree with 11.32pm...

    I do OOH work... Much of this is lack of time... why do they push patients thru at the same or similar time as regular GP slots??? Why is there often no hlth assitants to help by checking obs, getting urine dipsticks done, etc...

    No way is 10-12mins consults safe... It CANNOT be done safely at that speed. We need time to take a thorough Hx, do an appropriate good examn... and time to THINK!!!! Plus....discuss the patients 'ideas, concerns, expectations... Plus recording all the above!!!

    Just because it is OOH GP does not mean it can be hurried... the pts are real and have real problems...

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