Settling GP clinical negligence claims cost £134m, NAO finds

The cost of settling clinical negligence claims has more than tripled in the last 20 years, with general practice having the largest number of claims by speciality, a new report from the National Audit Office (NAO) has revealed.

The NAO said that there is a risk that the Government ‘may be paying twice’ in some cases – first by settling a claim, and then again by paying for further treatment as patients could go on to use publicly funded health or social care services, despite the settlement being paid ‘with the assumption that they will use the private sector’.

It recommended that the Government should assess whether the current requirement to calculate damages based on privately funded care packages ‘remains aligned with its vision of a modern NHS’.

The annual cost of settling the claims has risen from £1.1bn in 2006/07 to £3.6bn in 2024/25 due to increased claim numbers and the rising costs of settlements, according to the report.

It found that in 2024/25 settled claims for general practice cost £134m.

Two new centralised schemes were introduced for general practice in 2019, and these are the ‘main reason for recent increases’ in the number of claims NHS Resolution has received and settled.

The report found that since the schemes were introduced, the number of settlements had increased to 13,329 by 2024/25. However, most settlements, including settlements under the GP schemes, are low value (£25,000 or less).

The report said: ‘General practice has the largest number of claims by specialty. Since their launch, the number of GP claims settled by NHSR increased from 273 in 2019/20 to 2,914 in 2024/25.

‘It will take some time for GP claims to stabilise following the schemes’ creation, and NHSR expects numbers to continue increasing.

‘An initial review of the GP scheme found that, similar to the Clinical Negligence Scheme for Trusts, most new claims were triggered by delays or failures relating to diagnosis or referrals.’

The NAO acknowledged that NHS Resolution has taken ‘significant steps to control costs’ but advised that even more can be done to manage cost pressures, including building on the use of analytics, and the Department of Health and Social Care reviewing the approach to claims in cases where the legal costs exceed the amount of compensation.

Head of the NAO Gareth Davies said: ‘Despite progress in containing the number of clinical negligence claims in some specialties, the increasing cost of the small number of very high value claims is driving higher costs for taxpayers.

‘Reducing harm to patients is clearly the best way of containing this cost. Alongside this, DHSC should consider whether the existing approach to legal costs remains proportionate for all claims, including whether alternative methods to compensate for negligent treatment could provide better outcomes for patients, with less cost overall.’

The report added that NHS Resolution should ‘build on its current work to use artificial intelligence to analyse damages awarded across its portfolio’ and ‘identify any inconsistencies’ in claims for similar needs.

NHS Resolution is currently piloting ‘an artificial intelligence tool’ to support consistent initial estimates of claim values.

Following the report, medicolegal experts called on the Government to act urgently to reform the clinical negligence system.

MDDUS chief executive Chris Kenny said that politicians of all parties ‘have been remiss’ in not addressing the issue of excessive clinical negligence costs.

He added: ‘NHS patients and staff – to say nothing of the general taxpayer – are suffering because of this dereliction of duty.

‘The Government needs to implement the now nine-year old plans for a fixed recoverable cost limit for cases worth less than £25,000 immediately and set out a glidepath for it to move us to cases worth £150,000 over the next two years.’

Thomas Reynolds, director of policy and communications at the Medical Defence Union, said that the findings are ‘stark’ but ‘sadly they come as no surprise’.

He said: ‘From a ratio approaching 4:1 in relation to legal costs versus compensation in claims of £25,000 or less, to the NHS almost certainly “double-paying” on a vast scale because of an outdated law that requires courts to disregard the existence of a national health service when determining compensation.

‘Or the fact that by the end of this parliament, the Government estimates that £4.1bn will be needed for annual payments of compensation and legal costs. This simply cannot go on.’

In a statement, NHS Resolution said: ‘The report concludes that NHS Resolution has “worked hard to reduce the financial and emotional cost of clinical negligence by resolving claims faster and without litigation wherever possible”.

‘The proportion of claims resolved without litigation has increased from 67% in 2006/07 to 83% in 2024/25. In addition, most clinical negligence cases (99.8%) did not proceed to trial in 2024/25, reducing both costs and emotional distress for patients and healthcare staff.’

A Department of Health and Social Care spokesperson said: ‘There has been an unacceptable rise in the cost of clinical negligence claims – billions that should have been spent on front line services.

‘From overhauling our broken safety landscape, to grasping the serious problems in maternity care – this government is grabbing hold of this problem and taking the decisive action patients and taxpayers deserve.

‘Our 10-year health plan makes clear that patient safety is the bedrock of a healthy NHS and we are working to ensure we reduce the incidents that lead to claims.

‘However, a large portion of these costs occur through the legal system and we have appointed legal expert David Lock KC to advise us on how to address rising legal costs and how we can improve the claims process for patients.’

Last month, NHS Resolution clarified that GPs and practice staff accused of clinical negligence linked to triaging online requests following the October contract changes will be indemnified.