4 in 5 GPs fear reprisal over delayed referrals

Nearly 4 in 5 GPs in the UK (77%) are concerned about facing investigation if patients come to harm as a result of delayed referrals or non Covid-19 services being unavailable or limited, according to a survey by Medical Protection.

The survey of 688 UK GPs, follows a report from Macmillan which estimates that there are around 50,000 ‘missing’ cancer diagnoses across the UK.

Medical Protection said it expects a significant number of medicolegal disputes, complaints and investigations where delayed referrals have seriously impacted on patients’ prognoses and outcomes due to circumstances beyond their doctors’ control.

It says the impact of an investigation on the already emotionally and physically exhausted doctors involved, would be significant, and urged the Government to consider this as they keep the need for emergency laws to protect doctors from unfair investigation under review. 

Dr Rob Hendry, Medical Director at Medical Protection, said: “We have been talking to members throughout the pandemic and know concern around investigation following an adverse patient outcome which has resulted from a delayed referral has been high, but our recent survey indicates that almost 4 in 5 GPs are now worried about this.

“Before the pandemic, there were already long-standing concerns about the extent to which individual doctors are held to account for delayed diagnoses and other incidents that occur due to system pressures or failures. Covid-19 has had a serious impact on the availability of services, and this has severely exacerbated the problem.

“The prospect of a poor outcome under these circumstances would be devastating for any patient, but the psychological impact on the already emotionally and physically exhausted doctors involved would also be significant. On top of that, they face potential medicolegal disputes, complaints and investigations relating to situations they have had no control over.

“We have called for emergency laws to protect healthcare workers from unfair investigation since the start of the pandemic and recently urged the Government to introduce the legislation without delay to protect those at risk of inappropriate legal challenge following difficult decisions on how limited resources are allocated in hospitals. 

“Doctors also feel vulnerable when it comes to delayed referrals and the potentially devastating impact on their patients through no fault of their own. The Health Secretary agreed to keep the need for emergency laws under review, and we would again urge him to consider what protections need to be put in place.”

Some GP’s who took part in the Medical Protection survey, commented anonymously:

“We are handling more and more patients who have chronic deteriorating conditions who would normally have been seen and managed by secondary care by now. The clinical risk is greater, the referral pathways extremely delayed and we are going to see the morbidity (and mortality) effects of this pandemic for years to come.”

“I’m very concerned that referrals are bounced back sometimes with a list of investigations which might not happen in a timely fashion. Patients are also not attending for treatment or follow up - who’s accountable?”

“As the initiator of referrals to secondary care, we are being continuously asked by patients to chase their referrals. There is a feeling that we have not highlighted the urgency of their situation and that is the reason for the delay.”

“Life threatening diagnoses are sometimes made in the course of routine investigations - including so called ’early cancer diagnoses’.  As a GP, I’m unable to investigate my patients in the usual manner. Routine referrals for investigations are being rejected and sent back to GPs and it is then left up to us to explain to the patient why the investigation has not been done. Patients are being assessed remotely which will inevitably miss important pathology. There is a whole spectrum of undiagnosed pathology that will come to light once this pandemic is over and my worry is that GPs will then be at the coal face of this undiagnosed pathology and will undoubtedly be in the firing line for blame.”

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Additional information:

• The Macmillan report referred to: https://www.macmillan.org.uk/_images/forgotten-c-impact-of-covid-19-on-cancer-care_tcm9-359174.pdf
• 688 GPs in the UK contributed to the survey which was undertaken by Medical Protection between 8-12 January 2021.

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