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Communication key to avoiding out-of-hours complaints

11 June 2007

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An analysis of complaints and claims from out-of-hours care in general practice, published in the latest edition of the MDU Journal, reveals that communication difficulties are usually involved in cases notified by GPs.

The Medical Defence Union (MDU) revealed it had been notified of 337 complaints and 41 medical negligence claims related to out-of-hours consultations by GP members in 2005 and 2006. The analysis highlights some of the factors peculiar to out-of-hours care and provides GPs with advice on avoiding difficulties.

Dr Stephen Green, head of risk management at the MDU, said: “Since the introduction of the new GP contract in April 2004, GPs have been able to opt out of providing out-of-hours care, with responsibility passing to primary care organisations. While it is too early to discern trends in the complaints and claims notified to the MDU under the new system, there are some common themes that we draw to our members’ attention.

“Difficulties with communication are invariably involved, such as out-of-hours doctors not having access to patients’ records. Accurate records are always important for communication in ongoing clinical care and never more so than when managing patients out-of-hours. It is also vital that there are reliable links between GPs at a patient’s practice and out-of-hours providers.”

Specific communication problems faced by GPs providing out-of-hours care, highlighted in the report include:

  • No access to medical records meaning valuable information may not be available when making difficult clinical decisions and that GPs are reliant on patients for accurate recall of medication history and known allergies.
  • Difficulties in arranging follow-up care for the patient if a consultation is required the next day with a GP from the patient’s registered practice.
  • Usually, no previously established relationship with the patient or family meaning, if an unforeseen outcome occurs, there will be no opportunity for patients to compare it with other episodes of care.
  • If things go wrong, there may be no early opportunity for the doctor to see the patient, explain what happened and offer an apology (if appropriate), as would usually happen with in-hours care.

In one example case, based on cases from the MDU’s files, a 34-year-old man with a chest infection and breathing difficulties was seen by a GP out-of-hours who prescribed an antibiotic and said he would ask a GP from the patient’s own practice to call the following day. The request was not passed on and the man was found dead the following night from pneumonia. The resulting claim was settled.