High value general practice claims

Dr Iain Barclay, Medical Protection Head of Underwriting Policy, examines what conditions are responsible for some of the highest claims against members in general practice.

It is a fact of life that GPs in the UK run the risk of a claim in negligence being made for compensation on average twice in a professional career. Unfortunately claims can cost considerable sums of money as it is not unusual for a claim to be in six figures. However we are also seeing a number of claims each year which have cost considerably more, exceeding £1m and even up to £5m.

The evolution of general practice now means that any one patient may see a number of different health professionals within a practice in respect of one clinical issue. It is inevitable that other healthcare professionals will increasingly likely to be drawn into a claim. It is true to say that any one claim could involve a number of different healthcare professionals, for example a patient may be triaged by a nurse practitioner, referred to a GP and thereafter treated by a healthcare assistant. The variations and degree of involvement are of course quite considerable.

Due to the potential involvement of a number of different healthcare professionals it might be interesting for the practice team to be aware of some of the incidents which give rise to very high value claims.

It should be borne in mind that not all instances of these scenarios will potentially give rise to high claims as levels of compensation vary tremendously depending on a number of factors including the amount of care any one individual might require, dependency claims and loss of earning potential as examples.

In the last year Medical Protection has had a number of significantly high value claims opened, with the most common cause being failure to diagnose meningitis. These cases are not confined to meningococcal meningitis and there has been the emergence of a few cases of pneumococcal meningitis and its sequelae. It is notable that the age range of patients who might be affected ranges from infancy to at least two cases with patients in their 40s.

The complications from meningitis can of course be fairly catastrophic, with significant mental and physical disability, amputations and hearing loss to name but a few. There have also been a few cases of encephalitis, which albeit is a different disease but nevertheless is of similar presentation at times.

Continuing the neurological theme, there have been a significant number of cases of delay in diagnosing cauda equina syndrome and the subsequent delay in carrying out decompression procedures in hospital with potential lower limb loss of power and sensation plus urinary and bowel continence issues.

Whilst the above are more acute examples of scenarios which can give rise to large claims, there are also examples of more chronic conditions, for example, delay in diagnosis in treatment of posttraumatic stress disorder and other neuropsychological disorders over a long time frame. The most common long-term monitoring problem often arises with diabetes, particularly in the recognition of complications and noting peripheral vascular disease and gangrene leading on to lower leg amputations with the potential high attendant care costs and loss of earnings. There have also been cases of delay in diagnosis of type 1 diabetes.

Other issues may arise out of failure to monitor long term prescribing or review patients on long term prescriptions, in particular steroids and the complications and side effects which can occur with such therapy, particularly osteoporotic collapse of vertebrae. On the same theme, there can be shortfalls in the long term monitoring of blood pressure including renal function, which can result in claims for end stage renal failure particularly when abnormal blood results are not acted upon.

There are a few other claims in the top costs category, including failure to diagnose slipped upper femoral epiphysis and delay in diagnosis and referral for a number of cancers, in particular bowel, bladder and metastatic disease.

Over the last year there have also been a few obstetric cases which are generally historical and reflect a time when GPs were involved more directly with birth management. However one case may still well be pertinent with a failure to diagnose pre-eclampsia with an outcome of a child suffering from cerebral palsy.

The claims mentioned above are relatively rare but nevertheless can have a significantly adverse effect in respect of potential costs and there is obviously a knock on effect thereafter on subscriptions for GPs. It is therefore important that members of the practice team are at least aware of their potential presentations and that they are within the practice protocols, appropriate delegation and referral patterns to deal with any such potential conditions which could, if missed lead not only to a potentially avoidable outcome for the patient but also a significantly high value claim.