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An age-old problem

01 September 2011

The following case occurred in the UK in 1983, when it was common practice for patients to contact their GP for antenatal advice rather than their maternity unit. The practice was able to settle the claim 28 years later as a result of occurrence-based indemnity, which can meet claims arising from treatment carried out by a member, regardless of when the claim is brought, without the need for any further payment to be made.

Standards of care are assessed by the standards at the time of the incident, rather than at the time a claim is brought.

The doctor’s surgery was extremely busy and all of the urgent appointments for the morning session were booked. A telephone call came through from Mrs P, a 29-year-old who was 30 weeks pregnant. Mrs P was pregnant for the first time, and had been seeing her doctor for routine antenatal care. So far, she had had an uneventful pregnancy.

Mrs P had become worried by what felt like strong contractions and she had called her husband at work in a fluster. She had tried the surgery a couple of times and eventually got through to a receptionist. Ms A, the receptionist, had been working at the surgery for one year, but had been working in other surgeries for more than 15 years. She felt she was an experienced receptionist. Mrs P described the contractions to Ms A and how she and her husband had become increasingly worried and would like to speak to a doctor.

Ms A, a mother of three, listened to the story and immediately reassured Mrs P, explaining that these were likely to be “training contractions” she herself had experienced in all of her pregnancies. Ms A also reassured Mrs P that it was too soon for these to be birth pains.

A few hours later, another call came through to the phones, this time from Mrs P’s husband. He had come home from work and found that rather than getting better, his wife seemed to be in worsening pain. He asked for a GP to visit them at home. The receptionist Ms A explained that unfortunately, all the urgent slots for patients had been taken and the doctors were all busy at that time, but the doctor would visit after surgery.

Two hours later, Mrs P had a breach delivery at home. Her husband had called an ambulance that arrived a couple of minutes later. However, the baby suffered hypoxic brain damage, and as a consequence required long-term care. A claim against the surgery was settled for a very high sum.

Learning points

  • GPs and practice managers need to ensure that all staff are aware of their roles and responsibilities within the practice and their limitations.
  • Reception staff who are responsible for dealing with patients on the phone or in person should not give medical advice to patients.
  • In this case, when the patient first called they should have been given an urgent appointment with a doctor or been put through to speak on the phone. When doctors are busy or there are no appointments, reception staff should inform the doctor of the patient’s request and the doctor can then arrange appropriate action.
  • When doctors’ surgeries are busy it can be difficult for reception staff to approach doctors. Measures must be taken to make sure that at all times reception has at least one doctor to deal with queries from reception staff who are booking appointments.
  • Doctors need to be accessible and approachable to their fellow staff in order to avoid errors such as the above.
  • Reception staff should have regular and appropriate training to fulfil their role. Practice protocols should be kept up-to-date and all staff should be familiar with what’s expected of them.