Fear of complaints push 79% of GPs to practise ‘defensive medicine’

Four in five GPs say that the growing threat of complaints has led them to practise ‘defensive medicine’, potentially worsening patient care and access to general practice, a Pulse survey has found.  

GPs have said that they are more inclined to prescribe certain medications, refer, or spend a longer time writing notes because they are worried about patient complaints, a referral to the doctors’ regulator or potentially a letter from a solicitor concerning the care they provided.

Many GPs raised the point that there is an impact on patients in terms of being over-diagnosed, over-medicalised and made needlessly anxious – which also have implications for the NHS on both costs and waiting times.

The survey of around 836 GPs reveals that 78% agree with the statement ‘the threat of complaints has led me to practise more defensive medicine than I feel is best for the patient’, with 35% strongly agreeing and 43% somewhat agreeing.

This finding is part of a major report being launched at Pulse Live Birmingham today (Wednesday 10 June) on reforming the complaints and regulation process, supported by Medical Protection.

NHS England figures reveal that the number of complaints in general practice is increasing, while GMC figures show an increase in the number of complaints about GPs that they receive – although far more are being closed at initial triage stage.

Meanwhile, figures from NHS Resolution – which manages the GP indemnity scheme that covers the costs of legal cases – reveal it is dealing with around 3,000 cases a year concerning GPs.

As a result of this increase in complaints across the board, GPs say that are practising in a way they do not feel best, which is also having implications for workload and patient access.

As one GP put it: ‘I have found myself practising more defensive medicine at times, perhaps investigating or referring where previously I might have watched and waited. Despite time constraints, I find myself writing essays in patient notes to make sure I’ve covered my own back, safety-netted clearly. This, combined with patient attitudes, has made working in the NHS almost untenable in the current climate.’

Another one said that general practice is a ‘very high risk environment’ and, as such ‘the only way to navigate this is to act and practice defensively and have a low threshold of risk. Otherwise, almost certainly something will come back to bite you’. However, they added: ‘It will almost certainly happen even when you are practicing defensive medicine but you hope the risk is reduced.’

One respondent told Pulse they ‘certainly practice more defensively than I believe is ideal’, which has been a result of direct experience. ‘For example, where patients who have had a stroke have subsequently complained that opportunities to manage their cardiovascular risk factors were missed at routine reviews or even administration events in their medical record. This creates a pressure to pursue aggressive primary prevention even in patient groups in whom the evidence for these types of intervention is minimal, such as in elderly patients.’

There are also huge impacts on doctors themselves. Research published in the British Medical Journal in 2019 involving over 3,100 obstetricians and gynaecologists in the UK found a strong link between defensive medicine and burnout.

Dr Sarah Townley, deputy medical director at Medical Protection, said: ‘We know our members feel a growing sense of pressure. They’re worried about all sorts of medicolegal issues – complaints, claims, even police investigations – it’s definitely at the back of their minds.’

As a result, Medical Protection, through its research arm the MPS Foundation, is looking into the concept of defensive medicine and its impact on doctors in a study alongside Trinity College Dublin and University College Cork.

Dr Townley added: ‘There are multiple factors that can lead to defensive medicine. A lot of it is about fear of consequences. Now, that might be linked to complaints, it might be fear of the regulator, it might be fear of the patient being unhappy. The wider culture where doctors feel they’re being publicly criticised, may also be a factor.’