50% of GPs Planning Early Retirement

According to alarming recent figures, more than half of all GPs are planning to hang up their stethoscopes before the age of 60. The reasons given by the family doctors for wanting to retire early are the conveyor-belt system of patient appointments, and underfunding in the NHS.

The BBC’s “Inside Out” programme surveyed 1,004 family doctors across the UK, and 56% of respondents said that they expected to leave the NHS or retire before they reach the age of 60.

Jeremy Hunt, the Health Secretary, said that the survey results were “worrying”.

The survey figures showed that a quarter of all family doctors said that they would definitely leave their jobs before the age of 60, and 32% said that they thought it unlikely that they would leave general practice or retire before the age of 60. Only 6% of GPs surveyed said that they were definitely not planning to leave general practice before the age of 60.

The main reasons for wanting to leave the profession include the sheer number of appointments a GP has to get through, working hours, professional reputation, pay, workload and the way GPs are portrayed in the media.

27% of GPs gave the volume of appointments as the main reason why fewer medical students and newly qualified doctors were choosing to go into the field of general practice.

19% of GPs blamed the long working hours as their main reason for wanting to leave, and 20% said their professional standing was the reason.

Mr Hunt said that in order to improve the National Health Service, the “centre of gravity” needs to shift from large hospitals to away from hospital care and general practice. His plan is to completely overhaul the way in which older people are cared for over the next five years, and to try to encourage more doctors into general practice.

According to the BBC programme, it costs an estimated £250,000 to fund a student through medical school. Between 2010 and 2013 the number of vacancies for GPs has gone up four fold, and in the last five years the number of patients being seen annually has gone up by an estimated 60 million.

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Potential Risks Posed by New Entrants to Medical Negligence Market

An increasing trend for personal injury or firms to start taking on much more specialist medical negligence work in an attempt to boost profits could seriously damage the profession.

A new report from consultants Citadel Law flags up the changes after the recent changes to regulations made in the Legal Aid, Sentencing and Punishment of Offenders Act 2012 (LASPO). As well as potential long term consequences for those working in the legal profession, the changes could also lead to an increase in the professional indemnity insurance premiums paid by law firms.

In April 2013, new regulations governing how clients are charged for personal injury work were introduced, but it is only now that we are beginning to see them take effect. Cases which had begun prior to the changes are now being concluded, and any new claims cases have to be taken on under the new fixed-cost rules. Fixed-fees are biting into the traditional “slip and trip” compensation companies’ revenue, and many are starting to diversify into other areas to maintain revenue, often without sufficient specialist expertise.

Why? Although more complex, medical negligence cases are not covered by fixed-fee rules and are therefore an attractive prospect to many law firms who see their current sources of work beginning to dry up.

The main problem with this growing trend is that many of the more generalist personal injury firms just don’t have the expertise they need for this kind of work. Medical negligence cases are often quite different to other types of personal injury, and require in depth medical knowledge. Medical negligence can cover complex conditions like spinal cord damage and birth complications, and often take far longer to resolve.

Citadel Law looked at the caseload of many firms and concluded that clients and law firms themselves are being put at risk. Using a junior non-solicitor to manage this sort of complex medical error claim increases the risk of under-settlement, the consequence of which is often financial hardship for the vulnerable clients, who may be under the impression that they are dealing with extensively trained and highly experienced experts.

These risks are not only relevant for the personal injury law firms themselves, and there is the possibility of long term consequences for the entire legal profession. Bad service results in more compensation claims for professional negligence for under settlement or mismanaging of a medical negligence claim, reduces trust in lawyers generally and certainly lowers the profession’s reputation. There has already been negative coverage about hefty legal fees and the cost to the NHS of negligence claims. This will only get worse if more non-specialist law firms take on medical negligence cases.

There is also likely to be increased charges for insurance premiums, and the competent firms are going to have to carry the cost of increased charges to cover for other companies’ poor practice.

We believe that general personal injury firms have to consider carefully whether they should be expanding into clinical negligence work. If they decide to take on this sort of work, they should think about what checks and balances they can put in place to minimise risk. This includes considering what staff they have available, whether to employ specialist solicitors, and what technical skills are needed.

If you are thinking about putting forward a claim for medical negligence, then don’t take the risk of employing a general personal injury claim. Search for one of the 180 solicitors in England and Wales who are members of both the Law Society’s medical negligence panel and the panel run by Action for Victims of Medical Accidents (AvMA). Our medical negligence team is led by Denise Broomfield, a solicitor who is a member of both panels and we also have a solicitor on the team who is a fully qualified nurse.

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Rising Cost of Medical Negligence Causes Alarm

NHS Trusts and other medical bodies fighting medical negligence claims have called for an overhaul to the system to try to put the brakes onto the rising number of compensation claims currently being made against the NHS.

According to the Medical Defence Union [MDU], the cost of medical negligence could easily top £1000 for every UK taxpayer if costs carry on increasing at the current rate.

After an upsurge of 18% in the number of medical negligence claims in 2013/14, the NHS Litigation Authority (NHSLA) has had to put aside over £25 billion to pay for claims in progress and those expected to be started in the future.

There were 10,129 claims in 2012/13 and the numbers had risen to 11,945 by 2013/14. It has been suggested that increase might be due, at least in part, to personal injury lawyers who have previously dealt mainly with accident claims, rather than issues surrounding clinical care, diversifying into medical negligence work.

The MDU provides professional insurance to medical professionals such as dentists and doctors and is calling for significant changes to the way compensation for clinical errors is claimed.

These suggested changes are fairly fundamental – they include, for example, repealing the 1948 personal injury legislation which bases calculations about the cost of future care on private provision. The MDU feels that the bodies forced to pay the compensation should have the option of providing the care through public organisations.

The MDU also wants to place a ceiling on the amount which can be awarded for loss of earnings (currently set at three times the average salary) and the amount awarded for future care. According to the MDU, the highest amount for an individual claim which has been paid out to date was £9 million, and given the current inflation, this could easily double in the next seven years.

The annual report published by the NHSLA raises concerns about non-specialist firms becoming involved in medical negligence, resulting in claims being poorly investigated. They indicate that out of the £1.2 billion spent on medical negligence claims in 2013/14, 22% went to claimant solicitors and 8% to legal costs for defence.

So what to make of all this? Well, the latest figures certainly give cause for concern. However the MDU’s position clearly shows that the medical profession is not prepared to accept responsibility for their failings. The MDU’s strategy is focused on keeping the costs of medical negligence claims to a minimum rather than tackling the root cause of the problem – that too many doctors from too many NHS Trusts are making mistakes. But sadly, the MDU, like many in the medical profession, refused to see their own failings, preferring to put all the blame on others – in this case personal injury lawyers. Let’s face facts – claims for medical errors simply don’t succeed if they are justified.

It’s also worth pointing out that one of the main reasons that the cost of medical litigation is so very high, is the reluctance of the NHS, and in particular the NHSLA to deal promptly with cases – they have a long-standing history of failing to respond promptly to issues surrounding compensation claims and failing to accept responsibility in many cases at an early enough stage – which requires much more work, some of it totally unnecessary, by the defendants solicitors.

This is all about keeping costs down for the MDU and them protecting their own. They should be thoroughly ashamed of themselves.

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Denise wins AVMA specialist solicitors panel re-accreditation

Here at Bonallack and Bishop, we are really proud to announce that the head of our Salisbury based medical negligence team, Denise Broomfield, has just received confirmation of her re-accreditation by the specialist medical negligence solicitors panel run by AvMA. Action against Victims of Medical Accidents is the national charity which represents the interests of people who have had an accident in a medical or clinical setting. AvMA provides advice to people who have had medical accidents and campaigns for the rights of those injured or their families. National campaigns run by the organisation in recent years include the introduction of a Duty of Candor (Robbie’s Law) and assisting with the Staffordshire Hospital enquiry.

As well as campaigning, AvMA also has a process of accreditation for solicitors who specialise in this work. Our membership is highly restricted and involves a really rigourous and strict process for selecting only the most specialist medical negligence solicitors. The facts speak for themselves. Currently in England and Wales, there are well over 100,000 qualified solicitors. Yet, just 180 of those are, like Denise, members of both the AvMA Specialist Solicitors Panel and the Clinical Negligence Panel run by the Law Society – the governing body for solicitors in England and Wales.

Solicitors who are on the panel are chosen because they have a high level of expertise in the field of clinical negligence and because they are known to be sympathetic to the emotional needs of people who feel they have been let down by one professional person who then have to immediately trust another to represent them.

As you will have gathered if you have read some of the other blogs on this site, we are big fans of AvMA and the excellent work they do. In fact, until the national press suddenly decided to pay attention, at long las,t to an ongoing series of scandals in the NHS, it looked like for many years that the only people who were taking the very real problems of medical negligence in the NHS seriously, were medical negligence solicitors and AvMA.

Denise has been a member of the AvMA panel since 1996 when she was, for a time, the youngest solicitor in the country on the panel.

As well as dealing with claims for compensation Denise also represents the families of those injured at Inquests. She has also helped injured persons or their families with applications to the doctors’ disciplinary body, the General Medical Council.

Well done, Denise.

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Whistleblowers Often Give First Indication of Risks at NHS Trusts

Recently published statistics from the Care Quality Commission (CQC), have shown that almost 25% of Britain’s NHS hospitals are performing so poorly that they can be classed as high risk, and have practices which could endanger patient safety. The report also shows that members of staff working within the Trusts have blown the whistle on almost every serious failure found by the report. The Health Secretary, Jeremy Hunt, stated that the CQC report showed that the government were getting tough on hospital standards and had nothing to hide. The Minister also said that the CQC report showed just how important it was to try to change the culture within the NHS and ensure staff members were listened to.

These set of statistics covering all NHS trusts in England is the first since systems were changed in the wake of a number of hospital scandals. There are 161 individual Trusts in England, and these were split into six different categories depending on how well they performed on a number of factors such as waiting times, death rates, infection control and hygiene. 44 of the 161 Trusts fell into the two categories for highest risk, and of these 44, 41 were Trusts where employees were so worried about what they saw going on at work that they had previously contacted the CQC.

The scale of the problem

Out of the 44 Trusts in the two highest bands, 24 were in the highest risk ranking, and 16 of those Trusts had high death rates. Many of these Trusts are also under investigation by the medical director of the NHS after well-publicised scandals. 6 have already been put in special measures to improve.

Although in many cases the CQC had had previous concerns about hospital Trusts which were ranked highly for poor practice, two had passed all previous inspections. The poor rankings by the CQC on this occasion were flagged up by whistleblowers, and in several cases concerns were about infection control and long waiting times for cancer testing, infection in women after childbirth and long waiting times in A&E.

One of the worst performing Trusts overall was the now-defunct South London Healthcare NHS Trust, which had 17 areas of risk identified, a high number of which were directly related to patient care. CQC found that in the three hospitals run by the Trust patients felt they were unable to voice their concerns and were left without adequate pain relief. Surveys at the nearby Croydon Health Services Trust found that patients did not trust nurses and had no confidence in their ability.

NHS culture criticised

In total, over 400 whistleblowers working within the NHS contacted the CQC over serious concerns over practices at their place of work. The Chief Inspector of the CQC stated that evidence and reports from whistleblowers was critical in uncovering problems in hospitals, and urged anyone working in the NHS who sees something they feel is unsafe to come forward immediately.

The culture within the NHS was also heavily criticised by the CQC’s chairman, David Prior. He called the culture “chilling”, and said that even the highest level surgeons were afraid to step over the line and point out problems with patient care.

New ratings for hospitals planned

The NHS regulatory system is being completely overhauled and is changing from the previous system whereby Trusts could do their own assessments and be rated highly without having to disclose critical statistics such as death rates.

In the future, hospitals will be rated by experts in the same way as schools are, and will be given ratings. Inspections will be targeted in the first instance at the poorest performing Trusts in the CQC report.

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Doctors and nurses found guilty of neglect may face jail sentence

The government is proposing that doctors and nurses who are found guilty of “wilful neglect” of patients should face jail.

Following a series of truly appalling scandals involving numerous horrendous clinical errors, such as that of the Mid Staffordshire NHS Foundation Trust, “wilful neglect” is to become a criminal offence in England and Wales and is to be modelled on one punishable by up to five years in prison under the Mental Capacity Act – consultation to determine what the penalties for this new criminal offence is still required.

This is the result of one of the central recommendations following a patient safety review that was commissioned in the wake of the Stafford Hospital scandal. The report, chaired by Robert Francis QC, actually made a staggering 290 recommendations in an attempt to make sure that such disastrous failings are not repeated, of which the government has accepted 281. Some in the medical profession have, however, expressed fears though that the very threat of criminal sanctions against medical professionals could create a climate of fear within the NHS.

In particular the British Medical Association have raised fears that doctors and nurses might become too scared to speak out about poor care in hospitals when the result could be that a colleague may potentially go to prison. The chief executive of patient safety charity Action Against Medical Accidents, has rejected such arguments though, stating that he had “more faith in the medical profession” than that. It’s also worth pointing out that these scandals took place under the watch of the BMA who, frankly, seem more interested in protecting the interests of their members than in genuinely ensuring patients receive optimal care.

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Cardiff Hospital – mistake may have caused women to have aborted healthy babies

A Cardiff NHS hospital that has been following “outdated guidelines” could have forced mothers to abort healthy babies.

Midwives investigating suspected miscarriages have been recommended to use an internal transvaginal scan opposed to the less accurate external Doppler Ultrasound procedure. However, at the University Hospital of Wales in Cardiff,, which delivers around 6,000 babies a year, this has not been the case – these flaws in hospital practice are thought to go back to 2006.

These problems came to the fore following the experiences of Emily Wheatley who went into the hospital for an ultrasound scan and was informed that her baby was dead. Accordingly, the hospital said she would need a ‘uterine evacuation’. Ms Wheatley, however, decided to go to another hospital and was told by midwives there that her baby was in fact still alive.

Following this incident the University Hospital of Wales has been ordered to pay Ms Wheatley compensation and to make immediate changes to the hospital’s practices following an investigation into clinical errors there by the Public Services Ombudsman of Wales which commented that clinical practices of midwives at the Cardiff Hospital in respect of diagnosis of miscarriage have been “potentially flawed”.

As a result of these findings a helpline has been set up for women who fear they have had terminations after being incorrectly informed that they had miscarried. Cardiff and Vale Health Board, that oversee the hospital, have offered an apology for their “unacceptable actions”.

This is, of course, not the first scandal to have recently affected the Cardiff Hospital. Data released last year, for the period covering October 2011 to September 2012 clearly showed the hospitals poor Risk Adjusted Mortality Index [which compares the number of deaths at a hospital with the number expected] – University Hospital of Wales, was easily the worst rated of all Wales’ district general hospitals.

The latest statistics also followed the earlier public criticism by Cynon Valley MP Ann Clwyd of the clinical care received by her dying husband at the University Hospital of Wales. The criticism was especially uncomfortable for the hospital given that Ann Clwyd is leading a review of how the NHS in England handles complaints.

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Blackpool Teaching Hospital Trust Underperforming on Key Indicators

You can’t fully judge a hospital based only on its mortality rates, but this is obviously a key indicator of the care that can be expected from specific hospitals and trusts. According to the Dr Foster Hospital Guide 2011, the Blackpool Teaching Hospitals NHS Foundation Trust is not performing as expected with regards to two key mortality measures looked at in the guide.

Even though the trust has achieved mortality rates in the expected range for the other two mortality measures – deaths after surgery and deaths in low risk conditions – the other two rates are showing higher than expected results.

Specifically, we are looking at the SHMI and HSMR measures. The SHMI looks at the deaths of patients following hospital treatment, and the Blackpool Teaching Hospitals NHS Foundation Trust has posted a rate of 117. This is significantly higher than many of the other hospitals and trusts included in the 2011 Hospital Guide.

The HSMR is a measure that looks at 56 conditions that make up 80% of hospital deaths. The Blackpool Teaching Hospitals Trust had a rate of 112, which again is higher than many of the other scores posted, some of which were as low as 67. This suggests that there are issues to be looked at with the trust in question in order to improve its mortality rates and ensure that patients are fully confident in the service that the trust provides.

So what, exactly, does this mean for you as a patient. Let’s hope that these awful wake Blackpool hospital up – so that they start introducing the sort of benchmark standards that the Dr Foster site recommends. However pending an improvement, it’s likely to mean that there will be a disproportionate number of medical negligence claims made against a Blackpool hospital. Furthermore, some patients, if they are able to choose, may prefer treatment at another hospital. The head of our medical negligence team has said to me more than once that there are some hospitals which she would not want to enter as a patient – my gut feeling is that currently, based on the Dr Foster survey, Blackpool Hospital may be one of them.

If you feel you have been the victim of medical negligence at Blackpool Hospital, phone or email our solicitors today for free initial phone advice and a free first appointment. Remember, wherever you live in England and Wales, our specialist medical solicitors can help – we can take your instructions by phone, email and Skype video.