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When state indemnity isn't enough

Dr Kathryn Leask, MDU medico-legal adviser, looks at some recent claims in which the MDU supported NHS GP members that, had they arisen today, would have fallen outside the scope of the new GP state indemnity arrangements.

MDU medico-legal adviser Dr Kathryn Leask
MDU medico-legal adviser Dr Kathryn Leask

While the new state-backed indemnity scheme, which started on 1 April 2019, provides indemnity for clinical negligence claims arising from primary care work under an NHS contract in England and Wales, it does not extend to other areas of routine general practice. 

The GMC requires all practising doctors to have in place 'adequate and appropriate insurance or indemnity arrangements in place covering the full scope of your medical practice in the UK' and MDU membership makes sure its members meet this requirement by ensuring that any gaps in the indemnity provided by the state scheme are covered.

The MDU also assists many thousands of its NHS GP members each year who find themselves facing a range of other medico-legal difficulties including GMC investigations, Performers List actions and even criminal allegations arising out of clinical care.

This article, however, focuses on some compensation claims arising from elements of routine GP work not covered by the new scheme, showing why it’s vital for GPs to continue their membership of a medical defence organisation.

New GROUPCARE benefits

Following the introduction of state indemnity for GP practices in England and Wales, the MDU has announced new benefits for its GROUPCARE practices. These include free practice-based seminars, a 24-hour health and safety advice line and access to expert medico-legal advice for the whole team. There is a 10% discount on subscriptions when all GPs in the practice are MDU members. Find out more at https://www.themdu.com/groupcare

This article is funded by the MDU for GP Connect

Travel vaccines

A patient attended a travel clinic for a number of vaccinations before going on an overseas business trip. The practice nurse who usually ran the clinic was sick and as the patient was due to travel shortly, a GP offered to see her. The patient had a list of the vaccines she needed having looked at NHS advice online.

The GP administered the vaccines, including a yellow fever inoculation. The patient became very unwell and was admitted to hospital. The GP hadn’t realised the patient was immunocompromised and should not have received a live vaccine. The nurse had planned to talk to the patient about an inactive oral vaccine or an exemption certificate but the GP had not seen this in the notes.

As well as having to cancel her business trip, the patient suffered long-term health consequences and made a claim for clinical negligence against the GP which ultimately had to be settled by the MDU on the GP’s behalf. 

Paid-for travel vaccines are not covered by the state-backed indemnity scheme after 1st August 2019. This is also true of work-related vaccinations to practice staff. However, vaccinating staff is included within the benefits of MDU membership, available to our GP members at no additional charge, including where such services are provided by nurses or phlebotomists based at the practice. You can find more information here.

Incorrect completion of DVLA medical report

A practice had been providing medical information in response to DVLA requests about a patient who was a HGV driver for many years. The GP who usually completed the forms had retired and the patient made an appointment with another GP when his application needed to be renewed.

Unfortunately, the GP recorded some information on the form incorrectly. As a result, the DVLA withdrew the patient’s HGV licence which had a significant impact on his livelihood.

When the patient complained, the GP realised the mistake and contacted the DVLA to provide the correct information. She apologised to the patient for the error and explained how she had taken steps to rectify it.

The driver’s license was eventually reissued, but the patient made a claim due to the stress caused and to cover his loss of earnings, which amounted to several thousand pounds. Given the error, the MDU had no option but to settle the case on the GP’s behalf.

Signing medical reports is a routine part of a GP’s work, however, such work is not covered by state-backed indemnity and GPs need their own indemnity should a claim arise.

Breach of confidentiality to insurance company

A patient and her husband were forced to cancel a holiday due to the patient becoming unwell shortly before departure. The patient asked the treating GP to complete a holiday insurance form as they were making a claim and provided her consent. The form asked about the patient’s recent health, any long term conditions and any other relevant information.

The GP reviewed the records and included a printout of them with the form. This patient had a termination of pregnancy a number of years previously and had told the doctor she had been having an extra-marital affair. This was included in the records sent to the insurer. Although the patient had requested to see the completed form before it was sent, the GP forgot to do this.

The insurance company forwarded a summary of the information to the couple and the patient’s husband saw it. The patient was very angry about the breach of confidentiality and it caused considerable strain on the couple’s relationship.

As well as making a formal complaint to the practice, the patient complained to the Information Commissioner about a breach of confidentiality under data protection regulations and seeking compensation for the anxiety and distress caused and reimbursement of their legal costs.

The GP apologised for the error and explained that following a significant event audit, the practice had reviewed its systems so record disclosure to third parties were reviewed by a senior GP to ensure irrelevant information was redacted. The MDU resolved the patient’s claims with a modest settlement.

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