The Medical Defence Union (MDU) described the £30m figure as ‘much higher than we would expect’, given that fewer consultations take place out-of-hours compared to in-hours.
But it added that claims against GPs working in unscheduled settings are often higher value and ‘more difficult to defend’ than claims arising from routine care, meaning settlement is more likely.
The huge cost of payouts has contributed to the steep fee hikes GPs have faced in recent years to maintain legal cover during out-of-hours work, it said. GPonline reported last year that 90% of GPs had seen fees rise in the past year.
The MDU revealed that the most common reason behind successful claims was the delay or failure to diagnose a condition, responsible for three quarters of cases (71%).
Many of these involved patients with serious conditions including heart attacks, meningitis, septicaemia, appendicitis, cauda equina and testicular torsion. A quarter of the settled claims involved the death of a patient.
Other popular triggers for complaints included allegations about failure to make a referral or making an incorrect referral (18%) and medication issues such as prescribing the wrong drug or dose (9%).
It comes as the out-of-hours workforce has particularly struggled to remain fully-staffed – largely driven by escalating indemnity costs pricing GPs out of doing the work.
Dr Pierre Campbell, MDU head of underwriting, said: ‘Out-of-hours GP services play a vital role in ensuring people who become ill at weekends or overnight can get access to emergency help.
‘Often doctors will be trying to make the correct diagnosis based on limited information and little or no access to the patient’s medical records.
‘Added to that, GPs may also be triaging and diagnosing patients over the phone or internet, or supervising other health professionals that are doing so.
‘We are seeing unprecedented increases in the cost of claims from general practice overall. However, nowhere is this more apparent than in the provision of emergency unscheduled care.
‘While the government has set up a winter indemnity scheme to support GPs in England working additional out-of-hours sessions, in the longer term we need root and branch reform of personal injury law to address the rising cost of compensation claims.’
GP out-of-hours advice
The MDU advised that GPs can take a number of measures to minimise their risk during out-of-hours consultations, including:
- Put yourself in the best position by reviewing all the patient information available in making a diagnosis. Be prepared to alter this if things change.
- Make sure the patient understands what to expect and watch out for and when to seek further review, and document your management plan and this ‘safety netting’ advice.
- Try to manage patients’ differing expectations and remain polite and professional.
- Record negative findings from the consultation or examination, as well as positive ones.
- Ensure patients are appropriately followed up by secondary care or the patient’s GP practice.
- With telephone/online consultations, be aware of their limitations and be prepared to ask the patient to come in for a consultation if an examination is necessary.