GP Medical negligence Expertise

The burden of proof in medical negligence cases is based on the level of care that would be expected from a reasonably competent clinician. For a GP to offer expert opinion, they must, therefore, be very familiar with current clinical evidence and current standard practice. They would be expected to reflect a high standard of care and ability, although their expert comments would only need to be directed to whether care was below or above a reasonable standard.

Qualifications

1. The GP should be in active practice and preferably a principal, or at the least, have equivalent experience.
2. One would expect that they would hold Membership or Fellowship of the Royal College of General Practitioners (MRCGP or FRCGP) and additional diplomas in areas of specific interest.
3. It is beneficial to look for experience in the areas of clinical leading or designing and appraising clinical pathways or protocols. These GPs may be involved in educating trainee GPs, working with local primary care trusts, working with the Royal College of General Practitioners (RCGP) or working in national organisations, e.g. the National Institute for Health and Clinical Excellence (NICE).

Context of expertise

General practice is, by its very nature, a very wide spectrum of care covering many medical disciplines. GPs are expected to have reached a minimum standard in their training, but may also have then gone on to further sub-specialise. It is therefore very important to establish whether the care offered by an alleged negligent GP was care that they would routinely be expected to offer as an ordinary GP or whether they had claimed specific expertise in a particular area, in which case a similarly qualified expert should be instructed. The choice of expert may therefore be a well respected, highly qualified GP offering routine broad-based clinical care or, if relevant, a GP with acclaimed expertise in a specific relevant branch of general practice.

Duty of Care

To bring a successful medical negligence claim, one must establish a breach of duty of care and also establish that this breach in care has caused damage. Areas of breach of duty of care may involve:

• standard of care
• unethical behaviour or
• failure to maintain adequate medical records.

However, often the most relevant breaches are those that are specific and have a specific consequence which can demonstrate a causal link with the claim, for example:

• failure to diagnose or treat
• failure to investigate further, or to refer to a specialist in a timely manner

A GP expert will comment on duty of care with the GP setting, but in the vast majority of cases, a specialist of a relevant discipline should be instructed to comment on causation.

In cases such as unethical behaviour or standard of care, the expert would be asked to comment on what reasonable standard of care should be expected. The General Medical Council (GMC; www.gmc-uk.org) sets the standards of expectation for medical practice in the UK. The Royal College of General Practitioners (www.rcgp.org.uk) sets quality standards for GPs. In these cases, one would look for an expert who had some experience working with these organisations, and one would expect them to reference the relevant publications from these organisations.

In cases such as failure to diagnose, treat, or refer, the expert will be drawing from their own area of expertise but should be expected to reference current literature or national guidance, from, for example, NICE (National Institute for Health and Clinical Excellence)