Dr Sarah Jarvis analyses medico-legal files involving private GPs and advises on how to manage risk.
Online services such as Livi, Babylon and Push Doctor have increased the profile of private general practice in recent years and it is likely that the pressures of the pandemic on NHS practices may tempt more patients with the disposable income to pay for their GP appointment.
The Medical Defence Union (MDU) recently reviewed files featuring requests for advice and assistance from private GP members over a recent four-year period to see if there were any concerns specific to this group.
Nearly half of these GPs were seeking medico-legal advice to help them manage a particular situation and pre-empt problems.
Just over a third involved patient complaints and 10% concerned the GMC and coroner. There were a handful of claims which are ongoing.
Unsurprisingly, the advice files involving private GPs largely echo the pre-occupations of their NHS colleagues.
For example, we saw a spike in contacts regarding data protection law at the time the General Data Protection Regulations came into effect in 2018 and another in 2020 regarding practice during the pandemic.
We were also struck by the robust clinical governance procedures in evidence. Practices were up-front and transparent in responding to complaints and held regular meetings to discuss the learning points from unusual cases and adverse incidents.
However, we did uncover some themes that were more common among this group of members, which enabled us to put together our top risk management tips for private GPs:
Fewer complaints about communication
Allegations by patients of poor communication are a relatively common feature of complaints, but we saw a smaller proportion in the private GP files.
It is likely that this was because of the lack of time pressure on private GPs, which allows for longer appointments, and also because patients were able to see the same GP at each visit, which supported continuity of care.
According to a report by the Royal College of General Practitioners in 2019, the number of patients able to see their preferred GP in England fell by 27.5% between 2012 and 2017.
Requests for help with phlebotomy complaints from NHS GPs are rare but there were more than we expected among private practitioners, including several patients who experienced bruising or soreness after their blood was taken.
This may reflect that private GPs carry out fewer blood tests than NHS services where this task is more commonly done by a dedicated phlebotomist in the practice or local hospital.
Finally, in the MDU’s experience, levels of expectation are likely to be higher in patients who are paying for medical services.
While bruising is a common side-effect of having blood taken, it is possible that the patients who complained did not expect this to happen. It highlights the importance of warning patients about risks when obtaining their consent, so they have realistic expectations.
Mental capacity cases
We saw several cases involving patients whose capacity was in doubt. These included queries about self-neglect in a frail elderly patient, how to assess a patient’s capacity in particular situations, and the authority of someone who had been awarded lasting power of attorney.
Information-sharing with family members was another common aspect to these cases, including whether the GP should still try to obtain consent and what disclosures were in their best interests.
A complicating factor when a family member was paying the bill was that they often expected to be kept informed as a matter of course.
Records and disclosure
There were more general information-sharing concerns too, including patients who objected to certain information being shared with their own GP practice, such as mental health or addiction problems.
Members sought advice on how to balance their own duty to share information for continuity of care and the need to obtain appropriate consent.
Finally, several files concerned doctors’ responsibility for private patient records, including GPs who were planning to retire and wanted to know how long they needed to retain their clinical records and their responsibilities concerning secure storage and disposal.
Dr Sarah Jarvis (right), a medico-legal adviser at the MDU, was a GP principal and sat on – and later chaired – the GMC and Medical Practitioner Tribinal Service’s fitness-to-practise panels for ten years