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Written on 24th August 2022 by Susan Brown

The NHS defence organisation, NHS Resolution, has reported on its first year of defending new claims  by patients who have been harmed by negligent GP care

“Clinical Negligence Scheme for General Practice: An overview of the first year of the Clinical Negligence Scheme for General Practice (CNSGP) including a high level thematic analysis of the cohort of cases from year one of the scheme, 2019–2020” reviews the expected claims, and their causes, which were notified to NHS Resolution by GPs during the CNSGP scheme’s first year.

The review identifies that missed, incorrect and delayed diagnosis, poor prescribing, and delays or failure to refer most often lead to patients suffering avoidable harm from conditions such as heart disease, cancer, sepsis and cauda equina

Under the CNSGP scheme, NHS Resolution take responsibility for handling and defending negligence claims upon behalf of GPs, and paying compensation to patients who are injured, or whose condition is significantly worsened, as a result of negligent GP care.

Professor Martin Marshall, Chair of the Royal College of General Practitioners (RCGP) welcomed the report as a valuable learning opportunity for GPs, contributing to the important work of ensuring patient safety.

What is the Clinical Negligence Scheme for General Practice (CNSGP)?

CNSGP is a state-backed indemnity (insurance) scheme which covers GPs and their staff for medical negligence compensation claims arising from injury to patients during NHS GP care.

The CNSGP scheme was launched in April 2019 and was intended to provide more stable and affordable indemnity cover for GPs than they obtained through membership of the medical defence organisations, such as the Medical Protection Society (MPS) or the Medical Defence Union (MDU). The CNSGP, and all NHS GP negligence claims since the launch of the scheme, are managed by NHS Resolution. GPs and their staff, including registered nurses, receptionists, and GP practice-based pharmacists automatically receive free and unlimited indemnity cover for claims arising from negligent NHS care under the CNSGP scheme. GPs still rely on their medical defence organisations for support with matters which fall outside the CNSGP scheme, such as inquests, disciplinary or regulatory matters or claims arising from privately paid, non-NHS, clinical care.

In addition to the CNSGP scheme, which covers GP negligence claims since April 2019, NHS Resolution has also taken over the handling of some (but not all) older GP negligence claims, under the Existing Liabilities Scheme for General Practice.

Key findings from NHS Resolution’s review of GP negligence claims notified to CNSGP in 2019/2020

401 potential claims were reported to NHS Resolution under the CNSGP scheme between 1st April 2019 and 31st March 2020. General practice (GP) claims accounted for only 3.4% of all new NHS medical negligence claims reported to NHS Resolution that year.  This figure is remarkably low, given that 90% of all patient contact in the NHS takes place in primary care, and the overall total of 11,682 new NHS negligence claims which were notified to NHS Resolution, across all areas of NHS care, in the same year. NHS Resolution warned that they believe this figure is disproportionately low, reflecting the first year of the scheme, and the expected delay in reporting of higher value claims involving more severe injuries and higher value compensation for needs such as care. They say that no conclusions can be drawn from the very low number of reported claims and that the number of CNSGP claims is expected to rise in future years.

14 of the new CNSGP claims were linked with claims arising from secondary (e.g, hospital) care, under NHS Resolution’s  Clinical Negligence Scheme for Trusts (CNST). 

NHS Resolution points out that many of the claims featured in the review relate to systems and processes which affect the delivery of effective care in general practice.

Nearly half (48.1%) of the 401 notifications for potential new CNSGP claims were subsequently closed, without payment of compensation. In 81 cases, formal letters of claim were sent or court proceedings started. Compensation payments have been made so far in only five out of the 401 notified claims.

NHS Resolution estimates that the total cost of the CNSGP scheme GP negligence claims arising from incidents in 2019/20 will be £307 million.  However, the actual amount that was spent by NHS Resolution on handling and settling new CNSGP claims in 2019/20 was only £59,000. Again, NHS Resolution warns that payments under the CNSGP scheme in future years will increase. By way of comparison, a total of £61 million was paid out for GP negligence claims in the same year, almost entirely for in older GP negligence claims which NHS Resolution has taken over from medical defence organisations.

CNSGP negligence claims in 2019 to 2020 most commonly affected patients with serious conditions, including:

  • cancer (across 19 types of cancer) in 37 or 9.3% of claims;
  • cardiac (heart) conditions in 29 or 7.3% of claims, including myocardial infarction (heart attack) and cardiac arrest;
  • sepsis  in 21, or 5.3% of claims;
  • cauda equina in 10 claims.

Failings in care, or negligence, in the notified CNSGP claims commonly included:

  • medication or prescription errors in 74 or 18.5% of claims; 
  • delay or failure to refer in 40 or 10% of claims; 
  • failure to monitor, in 27 cases;
  • failure relating to follow up arrangements in 26 cases; 
  • failure to recognise complications;
  • failure to act on tests results.

Delayed or lack of diagnosis contributed to 68% of cancer-related claims, 81% of sepsis-related claims and 38% of cardiac claims, and was also commonly seen in cases relating to pulmonary embolism (PE) and/or deep vein thrombosis (DVT). 

70 of the claims reported between April 2019 and  March 2020 related to the patient’s death, reflecting 18% of all CNSGP notifications. Fatal GP negligence claims most commonly involved cardiac conditions ( 26%), deep vein thrombosis (DVT) and/or pulmonary embolism (PE) (11%),  and medication error (11%). 

NHS Resolution’s review includes eight recommendations to improve patient safety and reduce the cost of patient harm in general practice, such as the development of digital tools to help GPs identify deterioration in their patients more quickly and improving communication between GPs and secondary care.

Helping injured patients and bereaved families obtain compensation following negligent GP care

NHS Resolution’s review of potential claims reported during CNSGP’s first year suggests that relatively low numbers of patients brought claims arising from harm caused by negligent GP care. NHS warns that, however encouraging, these figures are expected to rise in future years. The surprising fact that these claims, combined, only resulted in £59,000 of ‘cost’ (from legal fees and compensation payments), also suggests that the number of claims and interim or settlement payments to patients for the year were disproportionately low.

Whilst acknowledging the commitment and contribution that GPs and their practice staff offer their patients in primary care, there must be an equal commitment to make right the harm suffered by mistakes in that care. Avoidable suffering from cancer, sepsis, cardiac disease and cauda equina and in some cases fatal injury, have irreparably altered lives, leaving many unable to work, or live independently without additional care. When a patient has suffered serious harm as a result of medical negligence, the primary purpose of an NHS indemnity scheme should be to provide financial relief to the patient as early as possible through substantial interim payments and compensate them fully for their disability, financial losses and the cost of meeting their disability needs in the years to come.

Boyes Turner’s clinical negligence team help individuals and their families who have suffered severe injury and disability or the loss of a loved one rebuild their lives through their entitlement to compensation.

You can talk to one of our experienced solicitors, free and confidentially, to find out more about how we can help you make a claim by contacting us here.