Many GPs are surprised to learn that a single clinical incident can lead to multiple investigations. While state-backed indemnity may in future support GPs with compensation claims, there are many other ways GPs can be held to account and need our help. These include patient complaints, GMC referrals, Ombudsman investigations, performers’ list actions, coroner’s inquests and even criminal investigations.
In the last 12 months, the MDU has opened over 6,000 medico-legal case files on behalf of GPs and members of their practice teams facing such matters, which we anticipate will not be covered by the state-backed scheme.
The MDU’s mind the gap campaign highlights the likely gaps between the state-backed scheme and the broad range of services the MDU offers.
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This article is funded by the MDU for GP Connect
An example scenario
The following is a fictitious case based on real MDU files on how a patient examination can lead to multiple investigations.
A woman saw her local GP with symptoms that required a routine eye examination. As part of his assessment the male doctor dimmed the lights in the room and examined the patient’s eyes with an ophthalmoscope.
Following the appointment, the patient made a complaint to the police stating that the doctor had sexually assaulted her by pressing his chest against her breasts and that he had done so in a darkened room. The doctor was advised that the police intended to interview him under caution at the local police station as part of a criminal investigation into an alleged assault.
The doctor contacted the MDU, explaining that although a nurse would often be present in the room during examinations, he could not remember whether this was the case on that occasion. There was no record of whether a chaperone was present or offered. The GP was supported by an MDU-instructed solicitor during a police interview later that week at the police station.
The MDU adviser explained to the doctor that the police might notify other organisations about the investigation, such as the GMC. The adviser recommended that the doctor begin reflecting on the incident and to record evidence of professional development and learning relevant to this incident in his portfolio.
A few weeks later the GMC informed the doctor that it was investigating the incident and possible concerns about his fitness to practise. The medico-legal adviser explained that the GMC would obtain the patient’s medical records and an expert opinion on the consultation. The GP was advised not to make comments to the GMC while the criminal investigation remained open.
The GP was contractually obliged to inform NHS England of the GMC’s investigation, which in turn began a local performers’ list investigation. NHS England asked the doctor to give a voluntary undertaking to use a chaperone for all examinations of female patients whilst their investigation was ongoing.
It was several months before the police confirmed that no further action would be taken. During this time the doctor also attended an interview with the case investigator for NHS England, supported by an MDU medico-legal adviser. The case investigator concluded that the doctor had conducted an appropriate routine ophthalmological examination and NHS England closed its case.
The MDU then explained to the GMC that the incident had been investigated by the police and NHS England, both of which had decided there was no case to answer. The adviser explained that the doctor had since reflected on the consultation as well as the GMC guidance on intimate examinations and the use of chaperones. The adviser also submitted evidence that the doctor had completed communication and record keeping courses.
The GMC obtained an opinion from a GP expert who said that the doctor’s examination of the patient was reasonable. The GMC was further reassured that the doctor had learnt from the incident. Therefore it closed the matter without any adverse outcome on the doctor’s registration.
The multiple investigations by the police, NHS England and the GMC caused a great deal of stress and uncertainty for the GP involved over a period of several months.
This case highlights some of the investigations doctors can face after an apparently routine consultation and illustrates why, even after the introduction of state-backed indemnity, GPs will still need the expert support and guidance that MDU membership provides.
- Dr Leask is a medico-legal adviser at the MDU