By Gareth Iacobucci
A leading defence body has warned that complaints against GPs related to out-of-hours consultations are growing in number, with a 50% increase seen in the past two years.
The Medical Defence Union said it had been notified of 517 complaints related to out-of-hours consultations by GP members in 2007 and 2008, compared to 337 in the previous two years, an increase of 53%.
The study follows renewed calls from the Conservatives for GPs to take back responsibility for out-of-hours care, and the on-going inquest into the death of a patient given a fatal overdose by out-of-hours German locum GP Dr Daniel Ubani.
The MDU’s study found that OOH complaints now represented around 10% of the annual total of GP complaints, compared to 8% in the previous two years.
In total, the MDU reported 73 claims related to OOH consultations over the two years of the study, compared to 41 in the previous two years.
It also said only two claims have been settled to date, and in the MDU’s experience, around two-thirds of claims are discontinued or unsuccessful.
Dr Stephen Green, head of risk management at the MDU, said: ‘OOH care continues to represent a significant and growing proportion of the complaints we see. This analysis also highlights the communication challenges associated with OOH consultations which may make a complaint more likely if something goes wrong, compared to consultations within surgery hours.
‘For example, OOH consultations are generally associated with high levels of stress and anxiety for patients and their families: there may have been a wait to be seen by a doctor they have never met before; and they may feel more vulnerable because it is the middle of the night.
He added: ‘We are advising OOH doctors to pay particular attention to the need for clear, unambiguous communication with patients and colleagues, including accurate and comprehensive note-taking and arranging follow-up if necessary.’
Shadow health Minister Mark Simmonds blamed the increase on the Government’s changes to the OOH system back in 2004.
He said: ‘I have no doubt that this increase in complaints is mainly down to Labour’s flawed changes to the GP out-of-hours system, which took responsibility for the service away from GPs and gave it to local bureaucrats.’
OOH Key findings in the MDU study
– 120 complaints and 52 claims included allegations of apparent failures or delays in diagnosis or referral. Most common conditions involved were myocardial infarction, septicaemia and meningitis. While it is inevitable that diagnoses will occasionally be missed, the MDU advises doctors to undertake and document the patient’s history and examination, including relevant negative and positive findings.
– 75 complaints and 17 claims were made following the death of a patient. It is impossible to rule out a sudden deterioration in a patient’s condition but it is important to review any diagnosis if there is any change and explain to patients and careers what to do if the condition does not improve.
– 71 complaints included allegations of rudeness or that the doctor had an uncaring or off-hand manner. One case featured an allegation that the doctor was chewing gum during the home visit.
– Problems with telephone triage featured in 19 complaints. In one case, a GP assessed a patient with abdominal pain and prescribed medication without visiting the patient, who later developed appendicitis.
– 13 complaints and claims in the study were referred to the General Medical Council (GMC). Four followed the death of a patient; two were sexual allegations and the majority of the rest related to poor performance.
Source: The Medical Defence Union