Analysis of the data from the first year of an indemnity scheme for general practice has identified that quicker and more accurate diagnosis, and improved prescribing processes could result in better patient outcomes, a report from NHS Resolution published today has found.
The report provides a comprehensive review of the first year of the Clinical Negligence Scheme for General Practice (CNSGP). CNSGP is the indemnity scheme managed by NHS Resolution, which covers the NHS work of general practice in England for incidents occurring after 1 April 2019.
Although 90% of patient contact in the NHS is via primary care, the number of claims are proportionally very low. Healthcare professionals in general practice provide a very good service, despite difficult circumstances and rising numbers of patients with comorbidities. However any incident of harm experienced by patients is important and the NHS should strive to make improvements wherever they can.
Outputs from the report
This analysis also includes practical safety recommendations which aim to improve patient safety and prevent harm, thereby reducing the number and cost of harm events in general practice. The eight recommendations highlight the need for improved communication across primary and secondary care. They also recommend development of digital tools across the healthcare system, for example a ‘track and trigger’ system assessment tool for use in general practice to assist earlier identification of deteriorating patients.
Proportionally low claims numbers in general practice
A total 401 cases were reported to the CNSGP scheme between 1 April 2019 and 31 March 2020, and both open and closed cases were evaluated. Clinical negligence claims associated with general practice accounted for 3.4% of the new claims NHS Resolution received in that year.
Most common case notifications received
Cancer, sepsis and cardiac are the three most common case notifications. In nearly half the cases the cause was listed as delay or omission of diagnosis, and almost a fifth was down to medication errors. The report also shows the need to improve to healthcare provided in prisons.
Many of these claims relate to systems and processes which influence delivery of effective care in general practice.
This report aims to understand why harm occurs in general practice and share that knowledge with primary care colleagues, so healthcare can be improved, reducing opportunities for incidents to arise.
The vast majority of patient consultations happen within primary care and overall the care is excellent. The amount of claims that have come through in the first year is a very small proportion of the total number of claims we received in the period the report covers. However, behind each number there is a patient who has experienced harm. It is paramount that healthcare providers understand what has gone wrong and are open and transparent with patients at the time the incident occurs.Helen Vernon, NHS Resolution’s Chief Executive
The report was developed in collaboration with subject matter experts from royal colleges and other arm’s length bodies.
The Royal College of General Practitioners (RCGP) welcomes this report as a valuable learning opportunity. The themes identified, including missed or delayed diagnoses and medication errors, are not challenges unique to general practice, but ones which resonate across the healthcare system. They will prove useful to general practice and the wider health service in planning guidance and care.Professor Martin Marshall, Royal College of General Practitioners Council chair
Read the full report.
Notes to editors
- The CNSGP scheme launched in April 2019 to provide more stable and affordable indemnity cover for GPs. Cover is provided automatically and at no charge to GPs.
- Of the 11,682 new claims notified to NHS Resolution in the first year of the scheme, clinical negligence claims associated with general practice accounted for 401 (3.4%). One year’s worth of data only provides an indication of the cases NHS Resolution may expect to see in the coming years and no firm conclusions can be drawn from the first year’s data. However this number is expected to grow as claims are often reported many years after the incident has taken place.
- The most frequent common case notifications were for cancer (37, 9.3%), cardiac (29, 7.3%) and sepsis (21, 5.3%). The most commonly reported cause code was delay/failure to diagnose which features in 43.5% of CNSGP cases, followed by medication errors (18.5%) and delay/failure to refer (10%).
- There were 34 notifications from the prison healthcare sector, accounting for 8.5% of the total CNSGP notifications within year one of the scheme. The proportion of cases received does not suggest there is a particular problem and the data is insufficient to draw any conclusions at present.
- The number of formal claims (where a Letter of Claim has been received or formal proceedings have started) notified over this period was 81.
- There are some limitations to the conclusions that can be draws as some claims may not ultimately result in a finding that negligently caused harm has occurred. Irrespective of this, it is recognised that in each case someone has been harmed and understanding why this has occurred provides an opportunity for improvement. Therefore they are included in this report.
- Figures for 202/21 and 2021/22 are included on pages 36 and 37 of our annual report and accounts