The UK's oldest medical defence body took a significant step when it appointed former locum GP Dr Caroline Fryar to lead its medical advisory services.
Dr Fryar became the first woman in the 129-year history of the Medical Defence Union (MDU) to take up the post, leading a team of 40 doctors providing medico-legal support to MDU members.
Easing her way into the role has not been an option as the MDU sees unprecedented and growing demand for its services. 'We are there for members in their time of need,' says Dr Fryar, at the MDU's London HQ. 'But we are also a port of call before there is a problem, and an authority for anything medico-legal.'
Part of her role, she explains, is monitoring upcoming legislative and regulatory changes, to advise members how they might be affected.
'My role is to be alive to what's going on externally, to see how we can best help,' she says.
When plans for primary care CQC inspections were announced, the MDU was 'quick to realise that would have a significant impact on members'. It launched an online tool to provide GPs with registration and inspection advice, which was used by about 1,500 practices.
On the near horizon, Dr Fryar is looking at proposals to introduce a duty of candour, requiring clinicians to be open and honest with patients when things go wrong, and the introduction of a criminal offence of wilful neglect.
'We don't believe there is a need for any further layer of scrutiny on our members,' says Dr Fryar. In a recent survey of MDU members, 95% of those who had been involved in an incident said they gave an explanation and an apology to the patient or a relative.
The statutory duty of candour was proposed in the Francis report to promote openness in the NHS. 'It may have the converse effect,' argues Dr Fryar, 'and may take away from the culture of openness that is starting to shine through.'
The MDU believes this could exacerbate problems, adding an administrative burden. Similarly, wilful neglect proposals, Dr Fryar says, will add nothing to the 'considerable scrutiny' GPs already face.
'GPs are facing increasing scrutiny in all areas,' she says. 'There is increasing regulation by the CQC, in NHS England and CCG requirements, and the general medico-legal environment. We are seeing GMC investigations increasing, GP complaints rising, claims against GPs rising.'
The GMC is the final arbiter, Dr Fryar says, and extra regulation adds unnecessary complication. In fact, she argues, the growing scrutiny faced by GPs makes the profession less attractive to young doctors. 'It has the potential to deter people from going into general practice,' she says.
Awareness of the right to complain and easier access to online complaints processes are driving rising complaints, the MDU believes. But the increase in complaints against GPs should not be seen as a symptom of declining standards.
Standards of care
'I don't think it reflects any change in standards of care. GPs are doing a wonderful job and working hard on behalf of patients,' she says.
Complaints are often caused by a 'mismatch in understanding' between GP and patient, so the role of the MDU adviser is to encourage doctors to meet complainants, to resolve misunderstandings.
But things do go wrong, says Dr Fryar. One cause can be workload pressure. 'The increasing workload puts GPs under incredible strain,'
she says. 'A busy GP who's taking calls, triaging, things can be missed.
'They can intend to do their referral there and then, but be called to see another patient, go back in and the telephone rings. It's easy in that kind of situation to see things go amiss.' She recommends robust management systems to mitigate risk.
GPs are particularly vulnerable to complaints, says Dr Fryar, because of the nature of general practice compared with other branches of medicine. GPs see the patient first, without the help of diagnostics and test results to make their diagnosis, which, says Dr Fryar, opens them up to greater questioning and uncertainty should something go wrong.
The rise of part-time working and portfolio GP careers also brings risk. 'Patients may not see the same GP as regularly as they did previously,' she says.
Dr Fryar's priority, she says, is to find innovative ways to help members with advice.
The current environment suggests her team will remain busy. Although recent work by the DH and NHS England to streamline performers processes could reduce duplication, Dr Fryar fears nothing can be done to reduce the level of complaints and threats.