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Four in five GPs fear delayed referrals will lead to investigation

by Jess Hacker
15 February 2021

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More than three quarters (77%) of UK GPs responding to a survey said they fear they will face investigation if referrals delayed by the pandemic lead to poorer patient outcomes.

The survey of 688 GPs, conducted by Medical Protection and published on Friday (12 February), also found that GPs were worried about the impact remote assessments could have on prognosis and diagnosis.

The organisation said it expects ‘a significant number’ of disputes, complaints and investigations where delayed referrals to secondary care have seriously impacted on patients’ prognoses and outcomes due to circumstances beyond their doctor’s control.

The survey also highlighted concerns from GPs about accountability and the quality of care they can provide during the pandemic.

One respondent commented: ‘Routine referrals for investigations are being rejected and sent back to GPs and it is then left up to us to explain to the patient why the investigation has not been done.’

They added that remote consultations have meant that GPs ‘will inevitably miss important pathology’.

‘There is a whole spectrum of undiagnosed pathology that will come to light once this pandemic is over and my worry is that GPs will then be at the coal face of this undiagnosed pathology and will undoubtedly be in the firing line for blame,’ the respondent said.

Other respondents highlighted that patients felt GPs had not ‘highlighted the urgency of their situation’ and that was the reason for a delayed referral.

Dr Rob Hendry, medical director at Medical Protection, said: ‘Before the pandemic, there were already long-standing concerns about the extent to which individual doctors are held to account for delayed diagnoses and other incidents that occur due to system pressures or failures.

‘Covid-19 has had a serious impact on the availability of services, and this has severely exacerbated the problem.’

Advice for practice managers

Practices have seen a reduction in consultations during the pandemic, with a Health Foundation study showing that the number of consultations per person per year had fallen by around 30% by June 2020 compared to pre-March levels.

Meanwhile a study by Macmillan Cancer Support, published in October, also found that around 50,000 cancer diagnoses have been missed because of the pandemic.

Diane Baylis, clinical risk educator at Medical Protection, told Management in Practice that practice managers will often be the first to hear about a patient’s complaint, and that there will ‘currently be a high volume of complaints relating to delays in referral appointments’.

She said: ‘When working with limited resources and under increased pressure it is important to try and communicate in ways that are clear to the patient about what is and isn’t realistic.’

She added that it was important for practice staff to manage patient expectations early when they know there is likely to be an extended delay for a secondary care referral. ‘An effective way to decrease risk involves respectfully correcting patients’ unrealistic expectations and assisting them to understand what they can reasonably expect. This is more effective if done at the time of the consultation with the doctor and can be reinforced by the practice team,’ she said.

‘Many patients who complain or take legal action report having experienced not being listened to, a lack of empathy, and not being understood or taken seriously.’

She also advised practice staff to provide clear information regarding the practice’s process of dealing with complaints and to check patients’ understanding of this ‘while showing empathy with their current situation’.