In a career spanning approximately 40 years, a GP can expect several claims of negligence to be made against them. In 2016 the Medical Protection Society (a medical defence organisation) examined their claims data and identified five errors which result in the largest claims for compensation. The list they created certainly ties in with our own experience of dealing with such cases.
1. Failure/delay in diagnosis of cauda equina syndrome (CES)
Cauda equina syndrome is a little known spinal injury which involves damage to the nerves at the base of the spinal cord, responsible for activating the bladder, bowel, sexual organs and legs. If pressure is being exerted on these nerves, often by a slipped disc, doctors have only a few hours in which to operate to relieve the problem, otherwise the damage is likely to be permanent. Doctors must be on alert for it, and act as soon as they identify the red flags, which include numbness around the bottom and thighs, along with nerve pain down both legs, and pins and needles.
These tend to be expensive claims for the NHS because the condition can strike those who are young, leaving them needing a lifetime of care and disability from their CES immobility and loss of function of the bowel/bladder and sexual organs. Not only that, the patient may be unable to work again and suffer a loss of earnings, for which they must be compensated.
Despite attempts at increasing awareness of the condition within the NHS, we continue to see clients such as Jayne, whose GP failed to correctly spot her “red flag” symptoms. Boyes Turner were able to secure her £400,000 in compensation to help her rebuild her life.
2. Failure/delay in diagnosis of meningitis or encephalitis
Meningitis is a far more widely known condition, in which the lining of the brain becomes infected. Encephalitis is lesser known, but refers to swelling of the brain itself, again as a result of infection. Generally treatment is required in hospital using IV antibiotics or anti-virals. Failure to treat the patient quickly enough can have devastating consequences, including permanent brain damage, amputations, and even death, generally as a result of sepsis (the body’s immune response over-reacting to the underlying infection). Claims against GPs typically arise as a result of a failure to spot the symptoms and refer the patient to hospital.
We help our clients rehabilitate as fully as they possibly can. This may include facilitating access to therapies and working to restore mobility, whether that be via prosthesis or provision of adapted vehicles. We have also helped clients with vocational rehabilitation aimed at enabling them to return to work, often with the input of a vocational occupational therapist.
3. Failure/delay in diagnosis, referral and treatment of patients with cancer
GPs have a duty to investigate suspicious symptoms, act upon abnormal test results or screening, and refer patients in accordance with national guidelines. A delay in diagnosis or treatment of cancer can not only make the difference between life and death, but can also result in the patient needing more aggressive or unpleasant treatment, or for them suffering long-term symptoms which should have been avoided.
The cases we see often relate to cervical, bowel and breast cancer and our clients’ compensation can help alleviate the hardship caused by loss of earnings, pay for help with pain management or counselling, and generally improve the client’s quality of life.
4. Delayed/missed diagnosis and inadequate treatment of peripheral ischaemia
Peripheral ischaemia is a condition affecting the limbs in which blood flow is restricted either by a narrowing, or obstruction of the arteries. If a GP fails to diagnose or manage the condition, patients may lose the affected limb.
Compensation can be awarded following amputation to promote independence. This may include provision of appropriate accommodation, an adapted vehicle, or specialist equipment, including prosthetics. A programme of rehabilitation can also be planned to assist with both physical and psychological recovery. In some cases, carers will be required, and funds can be used to pay for this, providing a sense of independence for the injured person and reducing the strain on family members who may have taken on this role. Loss of earnings can also be claimed if the patient is no longer able to work, either permanently, or on a temporary basis.
5. Failings in chronic disease management
As people in the UK live longer, the NHS is increasingly required to provide patients with long term management of chronic, and often multiple, conditions, particularly diabetes. Diabetes is a condition involving elevated blood glucose levels and it requires extremely careful management, without which a whole host of associated conditions can develop. These include cardiovascular disease, damage to the eyes, feet and kidneys, and problems with the nerves and circulation.
GPs play a pivotal role in disease management, including recognising symptoms and making an appropriate diagnosis, referring promptly, prescribing suitable medication, communicating clearly so that patients can understand and take responsibility for managing their own condition, and advising on lifestyle changes. They must also provide ongoing monitoring and follow-up. If a GP fails in any one of these roles, their patient may suffer serious harm.