A Series: COVID-19 and its Impact on the NHS – GPs

A Series: COVID-19 and its Impact on the NHS – GPs

General Practitioners

Since COVID-19 hit the UK early last year, healthcare providers and professionals have faced unprecedented challenges, testing the very limits for the safe and effective delivery of healthcare services.

In this special COVID-19 series, THEMIS explores how COVID-19 has impacted the delivery of healthcare services and the potential implications this may have for future litigation.

GP Care and COVID-19

The Coronavirus has completely changed the face of how general practice runs, practically overnight.

General practice was historically a predominantly face-to-face experience, with consultations and care provided in-person. Since the first national lockdown in March 2020 however, consultations have largely been carried remotely out over the telephone or video-chat (something relatively new, certainly on such a widespread scale for the NHS).

New guidance from the Royal College of General Practitioners advises GP’s to try and limit the physical footfall of patients, by triaging all patients over the telephone and only offering in-person consultations when absolutely necessary.

Some GP’s however, have taken this a step further, and have not carried out any face-to-face contact, including consultations and home visits, to try and prevent catching the virus themselves or spreading it to others.

With a non-contact line of prevention measures however, there is a certain amount of risk to patients who still require face-to-face care. By not physically examining a patient, this can open up the possibility of symptoms, injuries or other complications being missed, bringing perhaps a further risk to the patient than what a physical visit itself would bring.

In addition to the above, many patients who have been referred to hospital for further assessment or care have been facing increasing referral times, spanning weeks, months or even in some cases, it has been reported, over a year long wait for a hospital appointment.

Already, litigation has been brought against healthcare providers in relation to GP delays; in one case a GP 2-week wait referral took several months, with it being subsequently alleged that the patient’s cancer advanced, leaving limited treatment options.

As the pandemic continues to surge, the strain on healthcare providers and practitioners will continue. Even with a vaccination programme in place, it will take some time to return to pre-Covid-19 level of care.

Litigation Risk

THEMIS has analysed specific COVID-19 cases and interviewed practising GP’s to determine what the emerging litigation risks are arising from COVID-19, in order to explore whether there is a way to prevent these from developing.

Litigation Risks Identified:

1. Physical Consultations

Understandably, practitioners and patients alike wish to prevent the spread of the virus and both try to limit their time with other people. However, when concerning other medical issues that need to be addressed, the fear of catching or spreading the virus should not prevent patients from receiving face-to-face care from their GP as this can lead to missed diagnoses, developed symptoms or further issues occurring down the line.

Recommendations are therefore needed to assist GP’s in weighing the balance of seeing patients in person with their concerns against the risk of spreading or catching the virus. As practices have already limited their physical footfall, clinicians should remember that some patients will require physical consultations or treatment which should not be prevented by COVID-19.

2. Referral Delays

Referral delays were a common theme amongst clinical negligence claims pre-COVID-19, therefore it is suspected this will now only be amplified with the already strained systems now subjected to additional, unprecedented stresses.

Delays to assessment or treatment can easily result in symptoms and diseases continuing to develop, resulting in missed opportunities to be treated and sometimes even leading to palliative options. Many cases that have so far arisen hold ‘delays in appointments/referrals’ as the focal point of the claims, which both impact the GP’s and the hospital team.

Therefore, GP’s should act in partnership with the hospitals to keep track of urgent referrals, with all healthcare professionals bearing in mind standard appointment times are very likely to be delayed, with it being seen that some patients are now facing a year for some appointment types such as colonoscopies and orthopaedic treatment.

Patients should also be encouraged to become responsible and aware of their own referral process, especially in light of unpredictable delays, with GP’s explaining that in urgent situations (and even routine ones) that they should enquire with their GP if the referral has not been acted on within an expected timeframe, ensuring an additional safety net is in place to catch lost or seriously delayed referrals.

Concluding Comments

This article has demonstrated how GP care has evolved as a result of the COVID-19 pandemic, predominately by pushing the healthcare into a virtual world, perhaps with future benefits yet unseen (shorter waiting times, etc.). However, this article demonstrates that litigation risks are also evidently evolving and may continue to do so along with COVID-19.

References

  • Co-authored by the THEMIS Clinical Defence Publishing Team and Ms Kayley Newman, TMLEP Analyst.. (2021). A Series: COVID-19 and its Impact on the NHS – GPs. The THEMIS Clinical Defence Case Studies. 1 (1), 1.

Important Note

This article is intended to raise awareness to clinical risk issues in an effort to reduce incidence recurrence and improve patient safety. This is not intended to be relied upon as advice. Facts have been altered to ensure this case is non-identifiable, albeit clinical learning points remain applicable. To request an independent clinical review, please contact admin@tmlep.com or call +44 (0) 203 355 9796.