Monthly Archives: January 2016

General Practice is “a house of cards….”

The looming closure of a local GP practice in Cardigan and the recruitment crisis in General practice across Pembrokeshire may well lead to a Domino effect on surrounding practices already at breaking point in terms of GP morale and staffing levels ! It reminded me of this post from Pulse magazine in the same vein…..

 

Changing the rules of the game

General practice has become a house of cards. I am constantly hearing about practices handing back their contracts to NHS England, citing recruitment or financial issues, or a combination of both. What is even more shocking is that these are not in locations you’d be sent to for bad behaviour – they are leafy suburbs with relatively affluent surroundings.

My own home town of Bristol, the gateway to the South-West, has long been an extremely desirable part of the country in which to live and work. It is one of the most competitive areas for GP training places, but even we couldn’t manage to fill them at the last round of recruitment – and the situation is likely to worsen next year. The town has also seen one of the most recent casualties of the falling cards, when partners at the Northville Family Practice handed back their contracts in October.

Our partnership contracts belong somewhere in quaint Peter and Jane books

So how can we find the glue to stick these cards together so they don’t tumble down one after another?  In spite of the RCGP propaganda that ‘It’s never been a better time to be a GP’, we all know the sad truth. No one wants to be a GP because the pay and conditions suck. And if you are a partner, they suck even more  …………

Our partnership contracts belong somewhere in quaint Peter and Jane books, while all around us we see the rise of APMS contracts, marketisation of the health service and AQP. We are being asked to compete within a corporate business world, yet we are still shackled by the independent contractor rules of 1948. How many accountants or lawyers are personally responsible for their firm’s liabilities if it goes bust?  The answer is that they are all part of a limited liability partnership, or LLP. This has the same structure as a GP partnership but limits liabilities in the same way as a limited company. The reason GPs can’t change to this structure is simple – it does not allow you to hold a GMS contract or be a vehicle for NHS pensions.

Now, I may be naïve about business and corporate matters, but it is baffling to me that our representatives at the RCGP and GPC have not campaigned for this simple rule change, which might just help us to glue the remaining cards in place and even rebuild.

Yet in this brave new Tory world, the practices that are handing back their contracts will potentially be taken over by companies on an APMS contract with limited liabilities and nothing to lose. And the house of cards will keep falling.

Dr Shaba Nabi is a GP trainer in Bristol

Also included  an article from the Guardian along similar lines.

http://www.theguardian.com/society/2015/mar/08/life-of-a-gp-we-are-crumbling-under-the-pressures-of-workload

The new model GP army

The following article is from the Guardian it provides an insight into the new vision of GP that JH and DC would like us to buy into the problem is it too will be subsumed by the Tsunami of demand unless the model of care provision and the way that care is funded is altered ……time for an honest debate ?

The new model GP army: on-site vasectomies and Facebook diagnosis

The Haxby group of practices is innovative, collaborative and expansionist. But the old NHS ethos is at its heart, its GPs insist

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“In Dr Myers’ day it was a lot more NHS-ish,” says Geoff, 69, recalling Haxby and Wigginton surgery’s GP when he first became a patient in 1975. That was long before it was one of 10 practices in the Haxby group and occupied these functional, unpretty premises.

What does NHS-ish mean? “You sat still and you said nothing,” says Kris Holliday, 74. “The doctor was more on a pedestal, whatever the doctor said went,” adds Paul Jackson, who at 50 has also been using the surgery in York for 40 years, often accompanying his wife, Jayne, 57, while she had kidney dialysis and finally a transplant. “You’re dealing with a practice now,” says Holliday. “I’m surprised to hear myself say it, but doctors have become team players and we, as patients, are part of the team.”

The Haxby group is the new model GP army. They work with other “like-minded” surgeries, as senior partner Dr David Hayward puts it. This may not sound particularly novel or political, but Dr Fiona Scott, in one of the Hull surgeries, says briskly: “When we arrived in Hull, nobody talked to anyone.” “There’s still a lot of one-man bands in Hull,” adds her colleague Dr Laura Balouch, ruefully. Many of the Haxby GPs have acted on the clinical commissioning group (CCG) boards – which under Andrew Lansley’s reforms were meant to have GPs at their heart. Every doctor I met had stood down, citing time pressures when asked about it, in a resolute “that’s all I want to say on the matter” tone of voice.

The real innovation – the bit that might ring alarm bells of privatisation with some – is not so much their commissioning relationship with hospitals as their expansionist nature. They have six surgeries in York, run along traditional partnership lines with a general medical services (GMS) contract with NHS England; and four in Hull, for which they won the newer alternative provider of medical services (APMS) contracts, devised in 2013. These have to be run as limited companies – partnership was not an option in the bidding process. Other innovations, such as two on-site pharmacies they have set up, are also limited companies…………….

  • Some patient names have been changed.

Juniors offer Hunt statistics aid

Junior doctors bring mirth to the strikes with a fitting gift to Mr J Hunt MP from the Doctorsnet website 

Juniors offer Hunt statistics aid 1922/01/2016

Junior doctors have urged health secretary to brush up on his statistics, accusing him of misquoting medical research on weekend working.

A group of doctors made their point yesterday by delivering an eight foot high version of a classic medical text book to the Department of Health.

The book “How to Read a Paper” is by GP Professor Trisha Greenhalgh.

The doctors delivered a letter with the book – stating there is “no objective evidence” to link weekend mortality rates to medical staffing.

Anaesthetist Nadia Masood told the Daily Mirror: “With the doctors’ strike, the NHS is in the news everywhere and government ministers – not just Jeremy Hunt but the Prime Minister too – have been using statistics incorrectly.

“The public are being led to believe weekend care in hospitals is not safe and if they have a stroke they won’t be safe to come in. p> “We’re beginning to see patients avoiding and delaying coming to hospital at the weekend and coming to harm.”

Professor Greenhalgh said: “To use data uncritically is irresponsible. To use data irresponsibly for political purposes is unethical and could lead to deaths.”

A Department of Health spokesman said: “There is clear clinical evidence that standards of care are not uniform across the week – the Freemantle study in the BMJ and clinical evidence from NHS England show that stroke patients have a 20% greater risk of dying if admitted at the weekend.”

Clinical excellence may become impossible in state provided health care.

NHSreality wants the now regional health services to succeed, but this is not possible in the current climate of denial by politicians, and distrust by doctors. Yes there have always been Perverse Incentives in either system, public or private, but as things get worse in the state provision, the temptation to go private will increase. So will the health divide. NICE knows the truth.. Clinical excellence may become impossible in state provided health care in the average DGH.

Paul Hobday for “open democracy” comments on the “Seven things the private healthcare insurance adverts won’t tell you”

The NHS financial crisis is being used by healthcare insurers to try and sell their products – but what are the risks?

Like any big business the UK’s £5 billion medical insurance industry has to sell its product to satisfy share-holders. An abundance of advertising and websites extoll the virtues of private health insurance. Their message can usually be summed up thus:

“You can jump queues, have a TV in your room, choose your specialist and appointment, and perhaps have treatment unavailable on the NHS”. What such messages fail to tell us is the following.

  1. Private medicine over-investigates and over-treats and you may get surgery that is not in your best interests. In the US it is estimated at least a third of all healthcare activity brings no benefits to patients. Every link in the chain has a financial incentive to do more to you and that can be dangerous.
  2. Private hospitals do not have the same level of scrutiny of safety as NHS facilities. In fact it is very difficult to get worthwhile information from them. As you cannot find out properly about safety and risk, what value is there in being able to select your specialist?
  3. Increasingly, you won’t have that choice anyway. Some companies are increasingly restricting the hospitals and specialists used. If you want your cataracts done, some companies now send you to Optical Express.
  4. The price of private health cover has nearly quadrupled over the last decade. And premiums rise even more sharply as you get older. But even with the most expensive policy, full reimbursement of all costs is not guaranteed. You might have to fight for it – not much different from insuring your car. New terms and conditions have been introduced that exclude policyholders from claiming, apply ‘excesses’ or co-payments, find excuses not to reimburse certain fees and limit how much can be claimed in a year. Complaints have surged.
  5. Companies will encourage you go for NHS treatment if your care is expensive. BUPA have been criticised for offering ‘bribes’ to policyholders to use the NHS rather than their private hospitals.
  6. Care can be very “fragmented” when it is vital that it is integrated well, for example with cancer care that requires a good team approach. Some companies boast of being able to supply cancer drugs – but the drugs only materialise if all NHS routes have been exhausted first, and patients often have to plead with your insurer to keep supplying the drugs longer than a year.
  7. Private medicine in the U.S.A. spends 36% on administration. The Institute of Medicine estimates that an astonishing $750 billion a year of healthcare expenditure is wasted through fraud, overcharging, unnecessary treatment and other leakages. 62% of US personal bankruptcies are due to medical bills – and of these, 78% had insurance (but it found ways not to meet their costs). Insurance companies control everything and often dictate who your doctor is. If you want to help push us in that direction, then support private medicine.

Private medical care is expensive – so the healthcare firms admit their big hope is a failing NHS. As Spire told its shareholders recently: “Growing NHS deficits will put increasing pressure on waiting lists and drive increased formal and informal rationing of NHS procedures, which will over time significantly grow demand for private care”.

In other words, the private sector is licking its lips at the idea that underinvestment in the NHS, bed closures, hospital downgrades and rationing of services will drives patients to private hospitals (either funded by insurance, or pay as you go).

And the NHS is paying them large sums, too, as government underinvestment forces NHS hospitals to ‘outsource’ patients to private hospitals to plug the gap between supply and demand. In West Kent, the new expensive PFI Pembury hospital has only one MRI scanner and so has had to “outsource” requests to local private hospitals. Mental health patients are now routinely sent long distances to private sector beds because there are no NHS beds available. The trend is only likely to increase as we face the worst NHS underinvestment in a generation.

If you want healthcare’s prime raison d’etre to be not a service, but a business making some people very rich, like in the USA, then you can help by taking out private health insurance. You can please the numerous MPs who have a financial interest in private healthcare companies. If you think a future where your health is looked after in the same way as your car is worth aspiring to, then sign up today.

If however you see the benefits of us truly all “being in this together”, helping each other, and want to support rather than run-down the most cost-effective healthcare system in the world, then forget private health insurance. Don’t waste your money, or risk your health – but demand politicians change direction back towards a publicly funded, publicly provided and publicly accountable health service.

NHS heads for catastrophic failure

Do as I do? NHS agency splashes out on private healthcare for staff

Do we all need to move to “private”? Nigel Farage: Choose private healthcare if you can afford it

“That’s the standard technique of privatization: defund, make sure things don’t work, people get angry, you hand it over to private capital.”

The risks of private care… overstated?

Paid for by the NHS, treated privately

The pride of ownership and self employment: Opening general practice to private providers ‘may have worsened patient care’. The partnership model has been killed off..

Michael Sheen, who lives in Los Angeles, and will have private cover, defends the (Welsh) NHS

Lets sell the family silver – abandon your Health Service to market forces and covert rationing

Will Wales’ professionals be tempted to take out group private medical insurance?

Patients are ready for privatised care, health chief claims

Private hospital ‘putting patients lives at risk’

GP private firms grab NHS cash

Private: Modernise or vanish, Google warns NHS

Charges are acceptable – at last the ideology of 1948 is challenged

Kent NHS ‘to send surgery patients to France’ – setting a precedent? Can the fragmented UK health services recover without some form of zero-budgeting and revolutionary reconfiguration based on overt rationing?”

 

 

The Tories messed up with junior doctors. Here’s what they should have done

Here is an article on the Junior Doctors strike from John McTernan, he  was Tony Blair’s director of political operations from 2005 to 2007. He was also a former chief of staff to Jim Murphy. Published in the Spectator. however it makes little mention of the need to ensure that extra resources would be needed to run a 7 day service ( the current staffing levels of nurses and juniors are skeletal hence the high levels of burnout and sickness) ,£53k … tube driver £49k…. enough said. I agree go after the consultants but beware they are a global commodity and their value is respected elsewhere ….. ” Come to Queensland …..no weekend working! “, as for the idea that the way people work has changed should affect doctors is a complete nonsense , doctors have worked flexibly and taken advantage of technology wherever possible ( the vast majority of technological hold ups are due to Government big IT projects reinventing the wheel). However there is an element of truth in the notion that the correct battleground is over what is needed to run a 7 day service and not over salary , most Juniors would probably be persuaded against strike action if they had the slightest  shred of faith in this Government unfortunately is speaks with a forked tongue and has probably lost their confidence forever.

I t would seem the vast majority of  Junior doctors and the  majority of consultants already work weekends usually for very little extra in terms of salary , so lets have an honest debate about 7 day working and the resources it will require …… or watch our very expensive to train medical workforce emigrate or retire. Trying to stretch resources that struggle with  5 days into 7 may prove impossible  , the Junior doctors strike may be just the beginning  of  discontent and industrial action in the Health Service.

The Tories messed up with junior doctors. Here’s what they should have done

12 January 2016

It takes some skill to turn the BMA into the NUM – but Jeremy Hunt has done just that. It takes nearly as much skill to persuade the public that people on £53,000 a year are scions of the oppressed working classes – but the BMA, aided by Hunt, have done that too. …….

First, they have told the wrong story. The government are making this about patient safety – they say that a move to a seven-day NHS is needed because too many people die at the weekends when they shouldn’t. This they attribute to the lower levels of staffing and assert that the solution is a change to junior doctors working patterns. There is a fundamental problem to this position. On the one hand, while there are what are known in medical jargon as ‘excess deaths’ related to weekend admissions, there is no evidence they are a consequence of staffing levels. And to complicate matters further, the ‘weekend’ for these purposes includes Fridays and Mondays. On the other, who do you suppose the public trust on matters of patient safety – doctors or politicians? Well, only one group of workers wears a white coat to work.

The better argument would have been the unassailable one that the world of work has changed. Mobile phones, tablets and laptops mean that for many white collar workers the boundaries between work and home life have blurred. Service industries offer seven-day access. And the millions of self-employed workers in the UK – a group now larger in size than all public sector workers – do not have traditional nine to five, five-day-a-week jobs. They work when the client wants or when the job comes through. The dividing line should have been modern life – that would have put junior doctors on the old-fashioned, protectionist, trade union side of the argument. They would have been portrayed as luddites, much like the rail unions who are trying to stop the 24-hour Tube.

Second, the government have chosen the wrong fight with the wrong enemy. You don’t need to make junior doctors work at weekends; they do that already. The staff who are actually needed at weekends to provide the same cover on Saturdays and Sundays are all the others – the staff who run diagnostics, do the blood-work and, of course, the consultants. The last of these groups are the ones who will fight against a seven-day NHS to the very last – the very last junior doctor. Why are consultants so anxious to back their junior colleagues? Because, as cruel NHS leaders put it, consultants want to spend more time playing golf. The government should have picked the fight with them. A change in their working patterns is essential to seven-day working. There are fewer of them, and they would have very little public sympathy.

Third, the government have made this a dispute between themselves and the junior doctors. This is a schoolboy error. The NHS is an independent arms-length body. The Tories have an electoral mandate for a seven-day NHS but they should simply have passed that on as a condition for the extra cash the NHS has received. The outcome should have been prescribed but the means left open to NHS England Chief Executive Simon Stevens, who has already made great strides in modernising the health service by allowing a range of variation across the country. If you can’t win a big fight then make it a series of smaller fights. If this was a hospital-by-hospital dispute rather than a national one, it wouldn’t make the headlines. There would be local battles not national demonstrations. And local solutions too.

The government are losing, and losing badly, because they have picked the wrong fight on the wrong grounds with the wrong people. If they seriously want to win they need a wholesale change in strategy and tactics.

NHS heads for catastrophic failure

The funding cuts to Primary start to bite as CCGs fail to support Practices across England, prepare for no GP service as the NHS heads for catastrophic failure 

GP provider ditches 11,000 patient contract as 20% funding cut looms

A GP provider company has announced it is handing back a joint contract for five GP surgeries after it was told it faces funding cuts of up to 20%.

The Practice Group, whose five GP surgeries across Brighton – including one for homeless people – have 11,400 registered patients combined, said it would be ‘impossible’ to continue running them after the proposed funding cuts.

Hazardoushealthcare-1

But the local CCG said the PMS contract is currently funded at a higher rate than GMS practices and that discussions were continuing.

A spokesperson for NHS England South said it has ’written to patients to reassure them that we are working to secure alternative arrangements for their care’.

NHS England regional teams and CCGs have until the end of the 2015/16 financial year to conclude reviews of all PMS contracts across England.

Last week Pulse reported that four senior partners at a practice rated ‘outstanding’ by the CQC were forced to quit a practice in Essex after an NHS England PMS review saw funding for the surgery cut by £400,000.

A spokersperson from NHS Brighton and Hove CCG told Pulse that The Practice Group had given NHS England ’notice of termination of contract’ prior to their funding review’s conclusion.

 Outsourcing_tcm18-35208

The PMS contract that the company holds covers the Brighton Homeless Healthcare, the Whitehawk Medical Centre, the Willow House Surgery, the Hangleton Manor Surgery and one based in Boots in North Street,

A CCG spokesperson said that ’a proposal had been put forward to reduce the extra funding the current PMS agreement provides these practices in a staggered way over four years’ but that it was ‘subject to further discussions and not a definite decision’.

She added: ’This extra funding equates to 20% more than the funding received by other practices in the city via GMS contracts.’

Although neither party has revealed what the funding proposal entailed……..

The Practice Group said in a statement: ’The planned significant reduction in funding going forward that follows from the PMS review means that, in our view, it will be impossible to run these surgeries under present contractual arrangements.’

A spokesperson for NHS England South said it has ’written to patients to reassure them that we are working to secure alternative arrangements for their care and are continuing to work with NHS Brighton and Hove CCG to identify the available options’, with all patient feedback to be ‘taken into accunt in reaching a final decision about how to guarantee their future care’.

The Green MP for Brighton Pavilion Caroline Lucas has also waded into the row, arguing it was ’vital that established GP surgeries should not be dismantled because contract negotiations with private companies falter’.

She urged NHS England to review the merits of each of the five practices individually, with the contracts ‘put out to tender so that other local GPs can run them as branches or GPs can bid to run them themselves’.

She said: ’It’s the responsibility of NHS England to find a solution to allow the surgeries to remain open, and that’s what I’m urging them to do.’

NHS Brighton and Hove CCG chair Dr Xavier Nalletamby said: ‘Patients registered at these practices do not need to take any action at this point and will continue to receive care at their surgery as normal.

Out of hours provider faces problems after safety report leak

Out of hours provider faces safety leak1 21/01/2016 article from Doctorsnet

A leaked report has revealed “significant” safety concerns about an out of hours GP care provider, it has been reported.

Health officials in Norwich are currently resisting calls to publish the full report into the services provided by IC24.

The report was compiled by the Norwich Clinical Commissioning Group after conducting a series of unannounced inspections on IC24 sites in East Anglia.

It reveals incidents of patients waiting for longer than 12 hours for a call, GP shortages and staff concerns about the skills of locum doctors.

Reportedly it speaks of “significant risks to patients.”

The inspections came a few weeks after the company – a clinically led social enterprise – took over the out of hours contract for Norfolk.

Chief operating officer Lorraine Gray claimed the problems were linked to the handover, which was “stressful” for everyone – and that new measures had been introduced to tackle the problems.

She told regional television: “You need to understand the whole detail behind everything that is said in there and all our policies and procedures behind it and everything we are doing to address the issues.”

But local MP Norman Lamb, a former health minister, said it was “outrageous” the report had not been published.

Accident and Emergency – departments understaffed – report suppressed

Report shows why A&Es lack nurses 021/01/2016 article from Doctorsnet

A&E departments may suffer repeated nursing shortages because of systems used to determine numbers, according to a leaked document.

The report, compiled for the National Institute of Health and Care Excellence, suggests that departments may be short of staff 50% of the time because of the error.

According to the report, which was intended to be published as guidelines, staffing levels are based on historical data.

It says these predictions should be adjusted upwards by one standard deviation – and that this would reduce periods of excess demand to 15%.

The report is one of several draft guidelines compiled by NICE for an abandoned project on nurse staffing levels and obtained by the Health Service Journal.

It said that it was now common for A&E departments to be overcrowded and this was “linked to poor outcomes such as increased waiting times and missed care.”

The guideline would have instructed trust boards to review A&E nurse staffing levels once every six months.

Donna Kinnair, from the Royal College of Nursing, said: “These guidelines were put together by experts, looking at strong evidence who found a very clear relationship between the number of registered nurses and patient care.

“The evidence for the importance of having the right number of nurses, and the right ratio of nurses to health care assistants, would have led to new recommendations and guidance on the safe range of nurse staffing levels.

“These recommendations would have exposed shortages, and this would have had financial consequences. It is concerning that these consequences may have been a factor in the decision to scrap this important work.”

The public will only miss what they had – when its gone. GP indemnity fees spiral out of control with 25% rise last year..

Independent self employed General Practice is on it’s way out if the trend in cost of insurance continues. If nothing is done the geese who layed the golden eggs of the old former NHS will be extinct. They are already being deskilled in emergency and Out of Hours (OOH) care. Many trusts who use their GPs for OOH cover them on their own policies. Many GPs, demoralised and disengaged, will welcome a salaried service. But the public will only miss what they had – when its gone.

Sofia Lind reports 21st Jan 2016 in Pulse: GP indemnity fees spiral out of control with 25% rise last year

‘Out-of-control’ GP indemnity costs have increased by more than a quarter in a year, show the results of a Pulse survey.

Indemnity fees rose by an average of 25.5% in the last 12 months leading up to November last year, according to an analysis of responses from over 900 UK GPs.

But the increase could be even higher, as a large number of GPs said their fees had decreased because they had had to reduce the number of shifts they worked.

Over one in ten respondents said their fees had more than doubled, and more than a quarter saw hikes of more than 40% in the last year.

Medical defence organisations (MDOs) said that the figures were not representative, and they were seeinfg rises of around 10%.

However, these figures currently represent the best estimate so far of the rising burden of legal indemnity as medical defence bodies have refused to provide comparable figures to Pulse.

Dr Zishan Syed, a GP partner in West Kent said his indemnity costs have increased by 60% in the past 12 months and said the MDOs needed to do more to challenge individuals who engage in campaigns of vexatious complaints against clinicians.

He added: ’Furthermore, the fact that they pick and choose what case to defend can leave a GP who has paid year after year of fees in the lurch with no defence.’

Dr Graham Scott, a GP locum in Warrington, said his fees had more than doubled, adding: ’‘I think that it is out of control and unfair. It needs serious regulation.’

Dr Ishwar Bhatia, a GP locum in Ipswich and East Suffolk, said: ’Compared to sessions worked, the amount has increased to double. A regular four sessions in surgery cost £5,100, and out of hours is more.’

Several GPs commented it was ’not worth increasing hours of work’ as the cost of indemnity was so high and that they felt helpless to question fee rises.

A GP who did not want to be named said: ’There are no clear understandable rules for charges and because I don’t know how they work it out, I don’t have evidence for whether the charges are correct or not. I can’t complain as it is compulsory and we can’t work without indemnity.’

However another GP who also wanted to remain anonymous, who saw a 20% increase in fees in the last year, said: ’When you’ve been through a complaint you realise how worthwhile it is, the support you get.’

The Medical Defence Union (MDU) disputed the survey findings, claiming that average member subscriptions increases were lower at around 10% a year. A spokesperson said: ’Long term, GP claims inflation has been running at over 10% year on year. Inevitably, this affects the subscriptions we need to collect to ensure our members’ peace of mind. Average subscription increases for our members reflect these trends rather than the figures your survey found.’

MDDUS also said most of its increases were smaller than 25%. A spokesperson said: ’MDDUS were able to limit subscription increases for the vast majority of our GP members to well below 20% this year. The numbers seeing increases at the level you quote were small – far smaller than the number of our Scottish members whose subscriptions were held stable.’

NHS England recently said it would reimburse GPs who take on extra out-of-hours shifts over winter under a temporary £2m scheme. A Pulse survey last year revealed that already a year previously half of GPs were turning down out-of-hours shifts because the cover is too expensive.

The last LMCs Conference voted in favour of a motion for all GP indemnity costs to be covered all year round and the Government has looked into capping legal costs for small value claims.

GPs not to blame for increase in negligence claims

GPs not to blame for increase in negligence claims

Soaring indemnity costs are crippling GP practices across the UK , Jeremy Hunt would do well to sort this out and stop pestering Junior Doctors over their contractual issues !

GPs not to blame for increase in negligence claims writes Ingrid Torjeson for OnMedica

Ingrid Torjesen Friday, 15 January 2016

GPs are definitely not to blame for the increasing numbers and costs of negligence claims, the Medical Defence Union (MDU) says.

'Your insurance doesn't cover acts of God, like age related illness and accidents.'

‘Your insurance doesn’t cover acts of God, like age related illness and accidents.’

A wide variety of factors are the cause, and in particular legal changes to ‘no win no fee’ arrangements in April 2013, the defence body said in written evidence about indemnity for the parliamentary Health Committee into primary care. These legal changes led to 20% more claims funded by these conditional fee arrangements in 2012 and 2013, and the number of claims continued to rise during 2014.

Dr Michael Devlin, head of professional standards and liaison at the MDU, said: “GPs are definitely not to blame for the dramatic increase in claims. The rise is a result of many factors which GPs can’t influence, yet this is an issue which affects them personally, professionally and financially. The main reason is the legal changes to ‘no win no fee’ arrangements which led to a surge in cases. Other factors include the worsening economic climate and a general environment that promotes litigation over resolving concerns through alternative routes.”

The increase in frequency and size of claims has resulted in an inflation rate of 10% a year for the last few years. It is no longer unusual for claims involving GPs to settle for more than £5 million. The MDU’s highest payment on behalf of a GP was £7.5 million following missed diagnosis of subarachnoid haemorrhage and in another case £6.5 million (plus £300,000 costs) was paid for missed diagnosis of meningitis in a 6 month old infant.

Dr Devlin said: “It is telling that at the same time as claims numbers have increased, so has the number of claims that the MDU successfully rebuts. In 2015 the number of claims we defended without settlement increased from 70% to 80%. This means the great majority of claims against GPs are without merit and that number is rising. While this should be comforting to GPs going through the stress of responding to a negligence claim, the costs of investigating and responding robustly to the increasing number of claims, as well as paying compensation in the minority of cases settled, are shouldered by our members via their subscriptions. Worse, unless the government takes swift action there is no sign that things will improve.”

The MDU believes urgent legal reform is needed. Dr Devlin said: “The only workable solution to the current problem of rising indemnity subscriptions is for the government to introduce a package of reforms to the way compensation is awarded. This is something we have seen put in place as an effective solution to indemnity crises in other parts of the world such as in some US states and Australia. Patients who are negligently damaged must be compensated, but the current system is unsustainable for GPs and for the NHS more widely. The reforms the MDU advocates would see patients compensated appropriately but in a fairer and more affordable way.”