The NHS has been a conversation piece for many years now amid concerns that a lack of funding is starting to hit home. Despite the fact that government after government insist funding is “going up in real terms” there appear to be more challenges going forward. Indeed the Medical Defence Union (MDU) has confirmed that over the last three years, more than £30 million has been paid out in compensation to issues which have arisen through out-of-hours GPs visiting and advising patients. This is certainly a problem which needs addressing but what are the underlying facts?
Breakdown Of Compensation Claims
Before we look at the issues in more detail it is worth noting that claims relating to delayed diagnosis (or failure to diagnose) accounted for 71% of claims, an incorrect referral or failure to refer a patient accounted for 18% with 9% revolving around medical issues such as the wrong treatment.
The £30 million in payments over the last three years covers both compensation and legal costs on behalf of GPs. When you bear in mind that 71% of these claims revolved around diagnosis, this is an issue which could be argued that needs to be addressed sooner rather than later by the authorities. They need 24/7 access to client records via a reliable computer system!
Lack Of Patient Details
Over the last 20 years or so we have seen major improvements in electronic record-keeping across the whole NHS. Billions upon billions of pounds have been poured into new computer systems and on the whole, while there have been teething problems, they have helped to improve the overall service. It is therefore a little surprising to learn that out-of-hours GPs do not seem to have access to patient data as and when required. This would seem to be the crux of the compensation issue which is now in danger of swallowing up much-needed funding.
Dr Pierre Campbell, head of underwriting at the MDU, has also highlighted the significant difference between compensation awards for out-of-office issues when compared to traditional surgery claims. At first glance, it is difficult to see why there should be such a difference but when you dig a little deeper it soon becomes apparent.
Unfamiliarity With Patients
Those of us who have a regular doctor will visit as and when required and more often than not our doctor will know our background and issues which have troubled us in the past. We should never underestimate the value of an overall picture of a person’s medical health as opposed to a one-off visit to somebody potentially suffering from a life-threatening condition. If you put yourself in the position of a doctor, you have an unknown patient who is suffering from a painful and sometimes life-threatening condition. Do you act on your gut feeling? Do you take time to gather all of their records?
The truth is that GPs are put in an impossible situation, especially when servicing out-of-hours patients. Very often they walk into the unknown, patients are not always as fluid as they could be and sometimes it can be difficult to get important facts from them regarding their issues. So in some ways, GPs are left to join the dots and while more often than not their gut feeling is correct, there will be times when patients are misdiagnosed.
What Is The Alternative To Out Of Hours GP Services?
It is unfortunate in the extreme when we have to compare the cost of offering an out-of-hours service against the compensation claims this can create. A £30 million shortfall due to compensation and legal fees over a three-year period may not be huge in the overall scheme of things but it is significant. While there is no doubt the vast majority of these claims are valid and above board, with some topping £1 million in compensation, others have been borderline. We can only hope we do not come to a situation where many out-of-hours GP services are withdrawn simply because the system cannot afford the potential for personal injury claims going forward.
We have come to depend upon our NHS, a service which is unparalleled across the globe, but additional funding is already required and more risky services will be withdrawn. These changes will be done very quietly and away from the public eye but this in itself could prompt more legal issues than it resolves!
Government Indemnity Schemes
The UK government introduced a Winter Indemnity Scheme for doctors working out of hours in England which obviously takes away some of the pressure. We can only imagine the type of pressure GPs are under on a regular basis never mind having to worry about potential personal injury claims in the event of misdiagnosis or other issues. # There are hopes that the UK government will not only extend these types of indemnity schemes but also carry out a “root and branch” reform of the personal injury claim system for general practitioners.
Is It Possible To Reform The System?
As the cost of out-of-hours GP personal injury claims continues to rise the authorities will need to find a long-term solution. The Winter Indemnity Scheme is all good and well but this is just a short-term sticking plaster for a long-term gaping wound. The NHS has become an integral part of everyday politics in the UK and while it is treasured across the board the cost of offering services free at the point of use is growing let alone additional personal injury claims. The UK government has proven itself willing to change the personal injury claims regulations, with recent changes regarding Small Claims Courts, etc, so there is some hope that the GPs out of hours service issue will be addressed.
It will be impossible to remove all medical claims from the personal injury claims system because unfortunately many are the result of negligence or misdiagnosis. Trying to find a balance between borderline claims and those which are perfectly valid is a challenge which has stretched the minds of legal boffins in the overall personal injury claims sector. We can only hope we do not go down the route of asking patients to sign indemnities which effectively waive an array of protections. This might be an option in the longer term but for many GPs this goes against the grain of providing medical care to those often so desperately in need.
