84% of GPs say fear of being sued has resulted in them ordering more tests or referrals
A full-time GP can now expect to receive two clinical negligence claims over their career
Legal reform key part of solution, to tackle cultural acceptability to sue for minor injuries
21 December 2017: A significant number of GPs say the fear of being sued is a major factor in their decisions to order more tests, make more referrals or prescribe medication – according to survey results published by a leading medical protection organisation.
In the survey of over 1300 UK GPs by the Medical Protection Society (MPS), 87% said they are increasingly fearful of being sued. 84% said the fear of being sued has resulted in them ordering more tests or making more referrals and 41% said it has resulted in them prescribing medication when not clinically necessary.
The survey results follow research by Imperial College London showing that four in five doctors who have been the subject of a complaint also now practise more ‘defensively’.
MPS, a not for profit organisation supporting 300,000 healthcare professionals worldwide, said
GPs routinely order tests and make referrals to other specialists to confirm a diagnosis, and may naturally be more cautious in a litigious environment. However, it warned that if the fear of legal action is driving decisions on additional tests and referrals that are not necessary, this is different and a potential societal concern.
MPS said a range of measures* are needed, but pointed to the ‘cultural acceptability’ to sue when only minor injuries or inconveniences are sustained, and there is no loss of income. It called for a minimum threshold for these types of cases which would mean the financial loss caused by an injury would have to exceed a minimum threshold before a claim could be made. In a YouGov survey of over 2000 adults, 65% said it has become easier to make a claim for clinical negligence than ever before, and 33% said they should have access to compensation when something goes wrong regardless of whether harm was caused.
Dr Pallavi Bradshaw, Senior Medicolegal Adviser at MPS, said: “These survey results raise concerns about how the fear of being sued is manifesting itself across the country, and we call on the Government to undertake more in-depth, definitive research to fully understand the issue and its impact. Unnecessary tests or investigations are not in the best interests of patients and may use up limited NHS resources.
“Doctors should be able to exercise their clinical skills and judgment without the fear of claims affecting their decision-making. A full-time GP can now expect to receive two clinical negligence claims over their career; the environment is challenging and the temptation to over prescribe or over investigate is understandable.
“We must get to the heart of why so many patients sue their doctor. This includes making continual improvements in patient safety to prevent adverse incidents, but we must also look at legal reform to tackle the cultural acceptability to sue for minor injuries or inconveniences. In 2016/17 there were 817 clinical negligence claims against the NHS for minor injuries, where the compensation paid was less than £3,000.
“While those who suffer serious and long term harm due to clinical negligence should be reasonably compensated, it is right that we question the extent to which those who sustain minor injuries can recover compensation. We are calling on Government to consider a minimum threshold for these types of claims and we stand ready to work together on what we recognise is a difficult debate.”
Notes to editors
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According to NHS Resolution there were 646 NHS clinical negligence claims with damages paid out under £3,000 in 2015/16. In 2016/17 there were 817.
Examples of minor injuries (General Practice and the NHS):
Alleged delayed diagnosis of a foot injury. The patient made a full recovery.
The claimant was paid £1,500 in damages. £627 was paid out for claimant legal costs.
Alleged delayed diagnosis and negligent prescription of fusidic acid cream, instead of eye drops. Minor irritation caused; no long term damage. The claimant was paid £850 in damages: £1,150 was paid out for claimant legal costs.
A needle-stick injury after a nurse accidently lost grip of the vial containing the blood and tried to catch it. The claimant was paid £1,500 in damages and £4,250 was paid out for claimant legal costs.
The patient underwent a knee arthroscopy. It is alleged they were given the wrong sized TED stocking post-operatively, which caused problems. The claimant was paid £2,500 in damages and £7,500 was paid out for claimant legal costs.
When a patient was being transferred to a bed the bed raised very quickly trapping their hand, resulting in a broken finger. The claimant was paid £2500 in damages and £2,625 was paid out for claimant legal costs.
Anonymous quotes from UK GPs surveyed in spring 2017 by MPS:
“The fear of being sued leads to increased referrals, investigations and unnecessary follow up appointments which in turn drive the cost of healthcare up.”
“The stress anxiety and sleepless nights this causes us is terrible and disproportionate - time that could be spent caring for patients and reviewing process and protocol to improve future care is spent worrying about this. It also leads to defensive practice, over investigating and that itself incurs more cost to the NHS.”
“I now practice in a world where I am frightened at the beginning of each day, and because of this, I am retiring early.”
“I worry about claims which are inappropriate, patients threatening complaints if not given the tests they want, and more professionals managing cases driven by fear of litigation as opposed to what is in the best interests of the patient.”
MPS full recommendations:
- The Government should introduce a package of legal reforms to create a more proportionate and sustainable system. This includes considering a minimum threshold for cash compensation relating to claims where only minor injuries or inconveniences are sustained - to help tackle the cultural acceptability for claims to be made for minor injuries
- The Government should undertake in-depth research on how the fear of being sued is manifesting itself across the UK, and any impact on resources
- The Government should undertake comprehensive, qualitative research on the drivers of clinical negligence claims in the UK and what patients are hoping to achieve through litigation
- MPS and organisations across the wider healthcare system should work together more closely to increase awareness of the medical cases that bring the most claims and look at how tragedies may be prevented
- The healthcare community should work together to tackle the barriers to an open, learning culture where doctors are encouraged to be open with patients when things go wrong, and offer an apology. This shift in culture would encourage more reporting and learning from incidents - helping to enhance patient safety, and avoid many complaints from escalating into claims.
- The Government should work with patient groups and MPS to instigate an honest debate about the inherent risks involved in healthcare and develop a common understanding that despite doctors’ best efforts, medicine is not an exact science and mistakes do happen. Patient’s expectations are increasing and cannot always be met, and this is a driving factor for claims.
- GP survey statistics referenced are from a survey of 1374 UK based GPs, undertaken by MPS in Spring 2017
- Public survey statistics referenced are from a YouGov survey of 2034 adults in Britain, undertaken on behalf of MPS in Feb 2017.
- The Imperial College London research referenced was published on 22 November 2017.
The Medical Protection Society (“MPS”) is the world’s leading protection organisation for doctors, dentists and healthcare professionals. We protect and support the professional interests of more than 300,000 members around the world. Membership provides access to expert advice and support together with the right to request indemnity for complaints or claims arising from professional practice.
Our philosophy is to support safe practice in medicine and dentistry by helping to avert problems in the first place. We do this by promoting risk management through our workshops, E-learning, clinical risk assessments, publications, conferences, lectures and presentations. MPS is not an insurance company. All the benefits of membership of MPS are discretionary as set out in the Memorandum and Articles of Association.