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Independents' Day

Proper state-funded indemnity would reduce NHS demand

Dr David Turner

Dr david turner duo 3x2

A decade ago, I used to refer about half of the patients who presented to me with breast lumps immediately to breast clinic, now I refer a hundred per cent.

Patients complaining of chest pain, unless barn door cardiac pain, would have had blood tests and an ECG before being referred to cardiology. Now anybody who even mentions pain above the diaphragm on exertion is referred to the rapid access chest pain clinic without delay.

During my GP registrar year I once asked a GP in my training practice how to organise a blood test for a child. ‘Oh we don’t do blood tests for children in primary care,’ came the response. A couple of decades later and I’m arranging blood tests for kids most days.

So what has changed? A recent study of how complaints impact on NHS doctors highlighted that patients are being put at risk by being prescribed unnecessary drugs and having needless investigations, due to GPs’ concerns about a complaint.

This would allow us to practice sensible, realistic medicine not the defensive variety

In the past there seemed to be an unwritten agreement between doctor and patient that by and large doctors do their best for patients and when things go wrong it is due to genuine human error not a deliberate desire to cause harm by the doctor.

This unwritten agreement seems to have been gradually eroded, as those in power, seemingly fully signed up to the ‘divide and rule’ principle, continue to sow suspicion and discontent with abound.

A combination of successive governments' rubbishing of the medical profession and the proliferation of avaricious personal injury solicitors has led us to where we are now.

It’s not so much the fear of being sued; as we know, most complaints are either vexatious or driven by greed and go nowhere. It’s the time and stress spent dealing with them we wish to avoid.

I’m pretty confident I’d halve my prescribing, investigations and referrals if the Damocles sword of a potential complaint for the slightest of errors was removed from above my head. I’m sure many other doctors feel the same.

Full crown indemnity for GPs and fixed compensation packages for genuinely wronged patients would, overnight, take away the persistent low level knot of anxiety in the pit of our stomachs the current medicolegal minefield brings and allow us to practice sensible, realistic medicine not the defensive variety.

Result: less demand on secondary care and a better NHS.

There you are Jeremy, another good idea for free for you. Don’t say I didn’t try.

Dr David Turner is a GP in west London

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Readers' comments (11)

  • Cobblers

    Not sure about that DT.

    It is a genie that once out of the bottle will be exceedingly difficult to put back.

    Secondly stop and think how much extra time and how many more appointments in primary care are taken up with you doing bloods, ECG, etc for non specific chest pains. Quick refer to rapid access chest pain clinic and you've reduced your workload.

    Result: less demand on primary care and a better NHS.

    Jeremy (he who wants to be prime minister FFS) are you listening?

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  • Harm directly caused by not doing something- easily assignable to individual clinician

    Harm caused by excessive treatment or investigation- much more "nebulous", hard to trace

    hence we overtreat and overinvestigate

    who loses out? patients.

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  • Completely agree - my referrals have doubled in the last 10 years.

    Not worth taking the risk

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  • The politicos,lawyers and excecutive have set the agaenda let them reap the whirlwind.Who will suffer the workforce of the NHS and the citizens of the UK.Who will pay in the endm we all will.

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  • I agree in principal. However there are two aspects to the litigation. The money involved and the stress involved. When I have seen colleagues (not me yet, but only a matter of time) going through a litigious process, they all know that they have insurance, so their home etc is safe.

    But the process is still ridiculously stressful. It feels very personal when blame is being assigned to you - even if the case is settled just because that is the easy route.. No amount of insurance will change that.

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  • Knowledge is Porridge

    Compensation culture needs closing down. The government got a taste when having to defend litigation for soldiers in Iraq. I know politicians get blamed for everything, but surely fixing this issue would be a vote winning open goal, like banning tobacco advertising was 20 years ago. Who loses?

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  • Disagree entirely. Litigation is only one aspect of GP complaints. GMC/NHSE/CQC/CCG are all complaints patients can make, and are all investigated seperately, at enormous cost in both time and emotional energy for the GP concerned, however unfounded. The ship has sailed unfortunately.

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  • Forgot ombudsman, so 5 avenues of complaint.

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  • excellent article. I used to have lowest referral rate in area but now just send everything. Less stress but much less reward. I think the political cycle of frequent government change makes any significant improvement impossible.

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  • Dr turner says what we all do but don't say. my referral rate has been high for years . all referral do have reason for referral.there is nothing to be gained by taking unnecessary risk except pet on back by ccg. when thing go wrong there is no one to help you.

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