COVID-19: Delayed referrals and medicolegal disputes

Dr James Thorpe, Senior Medical Educator at Medical Protection, looks at why the UK Government should prioritise the clearing of referrals backlogs due to COVID-19

A recent survey of Medical Protection members revealed that more than two in five doctors (43%) are concerned that they will face a regulatory or criminal investigation if patients come to harm as a result of delayed referrals, or non-COVID-19 services being unavailable or limited.

Medical Protection has urged the UK Government to commit adequate resource and support to clearing the backlog of referrals and delayed follow-ups in secondary care. A further snapshot survey of Medical Protection members – conducted following a recent webinar – found that 60% of secondary care doctors had seen a decrease in referrals, while 50% of GPs said they had seen referrals being declined or deferred.

Buried within the many delayed referrals will be patients with serious conditions, not yet identified. For some, if diagnoses are missed or significantly delayed this could seriously impact those patients’ prognoses and outcomes.

This may give rise to medicolegal disputes, complaints and investigations – and this is why we continue to press the UK Government for emergency laws to protect doctors from investigations arising from impossible situations like this.

Despite these efforts, we are aware that our members may require assistance with referral issues arising from the disruption caused by the pandemic. Medical Protection is here to provide expert assistance and support if and when things go wrong, and the following case study – which is hypothetical and not based on a current case – outlines how we can help with the various difficulties one case can create.

Case study: A referral goes wrong

Mr D is a 43-year-old man who consults with his GP, Dr A, over non-specific abdominal symptoms. Clinical examination and basic blood tests are unremarkable, but the symptoms persist. Mr D has private healthcare insurance through his employer and asks to be referred to a private gastroenterologist. Dr A refers to the private clinic but is advised that no routine referrals are being seen due to the COVID-19 crisis and suggests that the patient is re-referred once the situation returns to normal. The letter is filed in the GP record. Nine months later the patient attends with weight loss and anaemia and is found to have a stage 3b carcinoma of the caecum. He sadly later dies from his cancer. Mr D’s wife submits a complaint to both the practice and the GMC and Dr A seeks assistance from Medical Protection.

Medical Protection support

A complaint or referral to the GMC can have a devastating impact on an individual clinician. While state indemnity would provide assistance with any ensuing claim, our team of medicolegal experts would be on hand to support Dr A with other aspects of this difficult situation such as complaints, GMC referrals and inquests.

The complaint

Medical Protection can provide expert assistance for members when they are required to respond to a complaint. In this case, we would provide Dr A with advice on the tone and structure of his response letter, to share some of the burden of this difficult task.

The GMC referral

Our team of medicolegal consultants, case managers and in-house regulatory solicitors have unparalleled experience of supporting Medical Protection members to negotiate the GMC investigation process and achieve the best possible outcome. In this case Dr A can expect his named adviser to obtain expert legal advice at the appropriate time and, should it be necessary, a suitably qualified barrister to provide representation at any fitness to practise hearing. A GMC study in 2019 showed that doctors without legal support face tougher sanctions following Medical Practitioners Tribunal Service hearings, and serves as a powerful reminder of how important it is for a doctor to ensure their interests are safeguarded when it comes to a regulatory investigation.

Personal support

Our team of experts are also available to provide emotional support to Dr A during this stressful time. Medical Protection provides access to a free, confidential counselling service to members. During the current pandemic, access has been extended to any individual experiencing work-related stress, or stress that they feel could impact their practice.

Visit our wellbeing hub – exclusively for Medical Protection members – to find out more.