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Take control of your risk

GPs are experiencing unprecedented levels of claims and complaints. Sarah Whitehouse explains what you can do to reduce your risk – and how MPS can help

The number of claims against Irish GPs has more than doubled between 2007 and 2012. The total size of these claims is increasing, too. This is made worse by the courts awarding ever higher settlements and a legal system that lacks a speedy and predictable process for handling clinical negligence claims.

MPS has lobbied both the Health and Justice Ministers on your behalf and we will continue to do so. We have made it clear that the current claims environment is causing severe difficulty.

We place a strong emphasis on risk management and want to help you reduce your risk. Last month, MPS held a number of roadshows across Ireland for members, looking at why patients sue – and what you can do to reduce the risk of it happening to you.

MPS also conducts Clinical Risk Self Assessments (CRSAs) to assess risk levels in practices. Last year, we visited more than 150 practices across the UK and Ireland – below, we reveal our findings of the top five risks in general practice:

  1. Communication 100%
  2. Confidentiality 100%
  3. Health and safety issues (including security) 97.4%
  4. Prescribing 95.4%
  5. Record keeping and visits 89.5%

Communication

Communication figure

Risks associated with communication were found in 100% of the practices visited. The top three communication issues were:

  1. Issues re emails/texts with patients 77.1%*
  2. Issues with staff/primary health care team 72.5%
  3. No/inadequate practice leaflet/practice website 52.9%

Fundamental to patient care is communication – between all members of the practice team and the patient. Problems often arise in a practice because of a breakdown in communication systems within the practice. Having clear communication systems can help to avoid this. Practice meetings are essential to help communication between staff and to discuss problems. Ideally, they should be held regularly with an agreed agenda and minute taking to ensure that any problems or ideas can be discussed and followed up in a formal way.

*Figures presented as % of total practices visited in 2013.

Confidentiality

Confidentiality figure
  1. Overhearing receptionist (phone/face-to-face) 77.8%
  2. Faxing issues 68%
  3. Issues re staff confidentiality agreement 51.6%

It is important that staff are trained around issues of confidentiality and the message is regularly reinforced. Overhearing conversations at the reception desk is a common concern. Strategies such as avoiding identifying patients by name on the telephone (which can be overheard by other patients in the reception area) and offering patients the availability of a private room in order to speak more confidentially would help to mitigate this risk.

Health and safetyHealth and Safety

  1. Training 68%
  2. Security and personal safety (including extended hours/lone working) 58.8%
  3. Premises, fixtures, furniture, etc 48.4%

The Safety, Health and Welfare at Work Act 2005 requires “every employer and every self-employed person so far as is practical, to identify the hazards and assess the risks at their place of work, and to prepare a written safety statement”. This would include ensuring that staff know what to do in the event of a fire, staff have been trained in health and safety, workstation assessments are undertaken for staff who use a VDU, and staff are protected from violence at work.

Prescribing figurePrescribing

  1. Issues re uncollected scripts 52.9%
  2. No/not robust repeat prescribing policy 49.7%
  3. Issues re anticoagulant management 33.3%

Many medication errors are preventable. Common examples include wrong dose, inappropriate medication, and failure to monitor for toxicity and side effects. Having a robust repeat prescribing protocol is a good way of improving effectiveness and safety of medication.

Record keeping figure

Record keeping

  1. Issues re home visit consultations 49%
  2. Issues re scanning 43.1%
  3. Admin not updating records 35.9%

Complete and contemporaneous records are essential to maintain good quality patient care and are needed if a complaint or claim is made. Courts sometimes take the quality of the record as an indication of the care provided to the patient. It is important from a continuity of care aspect, and also medically, that a record is made after every encounter with the patient. Ensure that home visits are fully recorded as soon as possible in the medical record, and medication prescribed should be added in the normal way to the prescribing screen.

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