The number of clinical negligence claims made against GPs in England was ‘very low’ in the first year of the state-backed indemnity scheme, NHS Resolution has said.
There were 401 cases reported to the Clinical Negligence Scheme for General Practice (CNSGP) in 2019/20, the first official report on the scheme revealed. Out of these, just 81 were followed up with a formal letter of claim, or formal proceedings.
This represented just 3% of the 11,682 new claims and reported incidents recorded by the body, which also handles secondary care claims, in that year.
The report said that ‘although 90% of patient contact in the NHS is via primary care, the number of claims are proportionally very low’.
However, it added that ‘no firm conclusions can be drawn from the first year’s data’ as the number of claims is expected to increase as claims are often reported years after the relevant incident has taken place.
And it pointed out that ‘some claims may not ultimately result in a finding that negligently caused harm has occurred’.
The report also revealed that:
- Cancer, sepsis and cardiac issues were the ‘most frequent case notifications’;
- ‘Nearly half’ (44%) of cases listed the cause as ‘delay/failure to diagnose’;
- Almost a fifth (19%) of complaints listed medication errors as the reason; and
- 10% of complaints focused on a ‘delay/failure to refer’.
NHS Resolution said the findings of the first analysis would set a ‘baseline’ from which to make future improvements, and concluded that ‘quicker and more accurate diagnosis and improved prescribing processes could result in better patient outcomes’.
It also noted that there is a ‘need for improved communication across primary and secondary care’.
The report set out eight ‘practical safety recommendations’ with the aim to ‘improve patient safety and prevent harm, thereby reducing the number and cost of harm events in general practice’.
NHS Resolution’s eight ‘key recommendations’ included:
- A digital GP ‘track and trigger’ risk assessment tool to identify deteriorating patients earlier alongside the promotion of existing safety netting tools
- ‘Further development’ of advice and guidance (A&G) services to improve ‘communication and collaboration’ between general practice and secondary care
- Protected learning time for GP practice teams
- Regulators to ‘consider using’ the Royal Pharmaceutical Society (RPS) competency framework to review prescribers and prescribing
- Research into ‘why clinicians override adverse drug reaction system prompts and how this may be minimised’
- ICSs appointing medication safety officers
- An increased use of telemedicine in prison services
NHS Resolution chief executive Helen Vernon said: ‘The vast majority of patient consultations happen within primary care and overall the care is excellent.
‘The amount of claims that have come through in the first year is a very small proportion of the total number of claims we received in the period the report covers.’
She added: ‘However, behind each number there is a patient who has experienced harm. It is paramount that healthcare providers understand what has gone wrong and are open and transparent with patients at the time the incident occurs.
‘This report aims to understand why harm occurs in general practice and share that knowledge with primary care colleagues, so healthcare can be improved, reducing opportunities for incidents to arise.’
The RCGP welcomed the report as ‘a valuable learning opportunity’.
In a foreword to the report, RCGP chair Professor Marshall said: ‘The themes identified, including missed or delayed diagnoses and medication errors, are not challenges unique to general practice, but ones which resonate across the healthcare system.
‘They will prove useful to general practice and the wider health service in planning guidance and care.’
The state-backed indemnity scheme was introduced from 1 April 2019 for GPs in England, amid crippling costs to GPs for negligence cover.
It covers claims for NHS work and means GPs no longer have to pay fees to a medical defence organisation for this area of activity.
GPs in Wales are also covered by a state-backed scheme, while Northern Irish GPs remain in negotiations to introduce one.
Last month, NHS Resolution’s annual report for 2021/22 showed a 13% increase in the number of clinical negligence claims and reported incidents received due to the ‘bulk take-on’ of GP indemnity claims for pre-1 April 2019 incidents from medical defence organisations.
But GP medical defence experts said the increase in GP clinical negligence claims was ‘not an indication of declining medical standards’.
Meanwhile, regional GP leaders at the LMCs conference voted in May that the BMA’s UK GP Committee should research a no-fault medical compensation scheme, following a ground-breaking legal case where a GP was successfully sued for failing to advise pre-conception folic acid.
Last year, NHS Resolution estimated that Covid-related clinical negligence claims alone will amount to £885m, £44m which could relate to general practice.
The whole narrative of UK medicine is one sick self-combusting joke. Pat yourself on the back institutes, for the dumbest agenda.
And yet my practice paid £55000 in medical indemnity for our partners last year ( we are in Northern Ireland)
There’s no state indemnity for NI gps