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Two thirds of GPs practising more defensively amid fears of 'compensation culture'

Exclusive: Two thirds of GPs have become more defensive in the way they practise medicine over the past year, with the vast majority citing the fear of litigation as the driving force behind the change, a Pulse survey reveals.

Almost three quarters said they had altered their practice because they were afraid of legal action from patients, while a quarter blamed concerns over regulatory action.

Overall, Pulse’s survey of 229 GPs found 65% believe they are practising medicine more defensively compared to this time last year, with the GPC saying this could be due to the increasing amounts of complex clinical work shifted from hospitals into primary care.

The BMA has launched an investigation into the psychological effects of complaints on doctors, after evidence of rising complaints from patients and managers.

Last year, the Medical Defence Union found there had been an 18% increase in claims handled for GPs in 2011 and the defence body said it expected this to increase further. The same year, GMC complaints rose by 23%, with half of complaints made against GPs.

The MDU told Pulse that it had seen signs of rising concern among GPs regarding litigation, with the total number of calls to its advice line for medical or dental advice up by 7% to a total of 32,000 calls in 2012.

MDU medico-legal advisor Dr Emma Cuzner said GPs were worried they would fall victim to the ‘compensation culture’ that had developed in the NHS.

She said: ‘Many patients now have an expectation that most things are curable and they will get better. We are also often asked whether [patients] are in general more litigious, and I think there is an element of that as well.’

She added that the most likely reason for an alleged negligence claim against a GP was a delay in diagnosis, and GPs should ensure they have communicated clearly with patients and kept adequate records.


GPC negotiator Dr Chaand Nagpaul said GPs were taking on more complicated work and this was adding to fears they would have legal action taken against them.

He said: ‘The work shifted into general practice from secondary care has added enormous pressure and risk for GPs. It comes as they are also facing pressure to deal with patient issues in the community and not refer to hospital.’

‘The greater workload means that GPs are often stretched beyond their capacity, and due to the shift from secondary care, sometimes beyond their competency.’

Dr Robert Jordan, a GP in Chesham, Buckinghamshire, said he was practising more defensively because of fears over litigation. He said: ‘It is depressing but it is the only way to survive.’

Dr Enda Cunningham, a GP in Enniskillen, Northern Ireland, said: ‘Litigation is far more likely due almost to cultural expectations now rather than likely medical problems.’

And Dr Peter Windross, a GP in Wiltshire, said he worried about litigation from patients ‘due to negative spin in the press from the Government about GPs, plus the widening gulf of rising expectations and decreasing funding and resources to manage the same demands, with a private level of service expected for year-on-year cuts’.

Pulse asked: Have you become more defensive in the way you practise medicine in the past year?

Yes: 65%

No: 30%

Don’t know: 5%

Survey of 229 GPs



Readers' comments (7)

  • We are now between a rock and hard place with risk; Litigation v reduced referral and admission CCG expectations.

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  • The artcle had hit the nail on the head.
    I too am practcing defensive medicine and in fact all newly qualified doctors are inheremtly practicing defensive medicine. There are several reasons:
    1. NICE guidance
    2. Negativve goverment and media spin aginst GPs
    3. dichotomy between what the public is told is available form the NHS and what the professionals are told by Goverment ( cuts..cuts ..cuts..).
    4. the drive to create new pathways for the sake of a change
    5. the real conflict is yet to come betwen GPs and OCCG- where in some cases it is a top down approach.
    I must confess that the GMC is culpable in all this.

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  • My attitude as a patient is there is nothing to worry about if you follow the hippocratic oath . If the corporate contract & commissioning has taken over which is unreasonable you must expect people to want to survive.
    Don't worry though the GMC & legal system are call centres not addressing issues fairly.
    I expect Doctors to stand up , unite & be counted not allow the corporate to take over unreasonably. Do they have a conflict of interest?
    The system is in need of restructure as one is placed into adversarial position & blamed.

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  • risk averse and defensive = thorough and diligent

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  • I have been in General Practice since 1988. Lately, the PCTs have been taking up some really frivolous of complaints. I had a complaint against me because I refused to provide a sick note for two weeks to a patient who had a cold. Another patient complained because I asked him not to attend the Accidents and Emergency to have his blood pressure taken- The practice had offered him same day appointments for this service. Yet he chose to attend the casualty on a monthly basis to have his BP checked. This is the frustrating issue. It will be impossible to deliver if the PCTs expect take up such complaints.

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  • Most of us as GPs are thorough and diligent but throw in the fear factor that whatever we do for patients wil never be good enough= defensive. can you blame us? we are not far off the point that if we can't guarantee imortality for our patients then we risk being litigated! am I cynical or what?!!

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  • Patients expectations are raised by Govt. GPs are told to cut referrals.Patients attend A& E / UCC for a second opinion. GPs are then told to reduce A&E attendances.
    GPs referrals are monitored by Referral Management Centers often managed by junior staff.
    This blended with GMC lines on Good Medical Practice,
    Nice guidelines, CCG pressures and compulsory attendance at silly meetings - all lead to pressure and stress leading to complaints as patients
    This leads to defensive medicine & rightly so leading to expensive and sometimes unnecessary investigations.
    GPs and particularly GPC have lost their influence.

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