GP clinical negligence reports
Independent reports from doctors on the GMC GP Register about referral, prescribing and follow-up decisions in general practice, prepared to CPR Part 35 for courts in England and Wales.
Many claims against GPs are about a diagnosis that was delayed: a cancer not referred on time, meningitis or sepsis in a child not recognised, cauda equina syndrome missed, or a heart condition put down to something else. Others concern prescribing and monitoring errors, abnormal test results that were not acted on, and the advice a patient was given about when to come back.
Expert Medical Examination arranges independent reports from general practitioners on the GMC GP Register, and if the instructing solicitor needs a specialist on causation, we can arrange that too.
Test results and follow-up
Some GP claims turn on systems rather than a single consultation: an abnormal blood test, scan or smear result that was not acted on, or a patient who was not recalled. The report considers whether the handling of results and follow-up met the standard of a reasonably competent general practice at the time.
Prescribing and monitoring
Prescribing claims include medicines given despite a recorded allergy or interaction, and drugs such as warfarin, lithium or methotrexate prescribed without the monitoring they require. The expert addresses whether the prescribing and monitoring met a reasonable standard for general practice at the time.
Safety-netting advice
Where a patient is sent away with a working diagnosis, the advice on when to come back can matter as much as the diagnosis. The report considers whether the safety-netting advice given, and the way it was recorded, met a reasonable standard in the circumstances.
An independent GP view of general practice care
Where several consultations are criticised, the expert takes each in turn, judged on what was known, or should have been found, at the time, and leaves the decision to the court.
- Delayed cancer referral
- Missed meningitis and sepsis in children
- Missed cauda equina syndrome
- Delayed diagnosis of heart conditions
- Abnormal test results not acted on
- Prescribing and medication monitoring errors
- Safety-netting and follow-up failures
- Breach of duty reports on general practice care
GP clinical negligence reports: FAQs
Can a hospital consultant criticise a GP's care?
Not usually on breach of duty. The question is whether the care fell below the standard of a reasonably competent GP at the time, so the breach expert should be a GP. A hospital consultant can explain what should happen once a patient reaches their specialty, but is not the right expert to say what a reasonably competent GP would have done in the consultation.
How is a GP's decision not to refer judged?
On what the GP knew, or should have found, at the consultation, without hindsight. Under Bolam, a decision is not negligent if a responsible body of GPs would accept it as proper, and under Bolitho that opinion must have a logical basis. The court will also consider whether the expert has addressed any clinical guidance in force at the time, such as referral guidelines for suspected cancer, and placed the GP's decisions in that context.
Who says what an earlier GP referral would have changed?
Usually a specialist in the condition rather than the GP expert, who deals with breach of duty: a spinal surgeon where cauda equina syndrome was diagnosed late, for example, or a surgeon or oncologist where cancer was. Causation must be proved on the balance of probabilities, so the specialist says what was more likely than not to have happened with a timely referral.
Is a summary of the GP record enough?
No. The expert needs the complete GP record: every consultation entry, test results, referral letters and hospital correspondence, and any older paper notes. Where the timing or content of an entry is disputed, the practice system's audit trail, which usually has to be requested separately, can show when it was made or changed. The letter of instruction should list the consultations criticised and the questions the expert is asked to answer.
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