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Limiting Risk in General Practice

IN THE UK health care has been traditionally divided into primary care and secondary care. Nowadays health care is seen as a continuum allowing a patient to move easily from each domain to the other, the deciding factor being the level of expertise and the facilities needed. Nevertheless, primary care does retain some special features which make it different: for example, comprehensive care for all ages, the first professional contact by the patient, multi-disciplinary team work and a gate-keeping role. Well over 90% of medical transactions occur in primary care. Primary medical care is provided by general practitioners (GPs), supported by nurses and other health professionals. The wide variety of problems presented by patients has meant that general practice is a branch of medicine characterized by high levels of uncertainty and hence clinical risk. Grey areas exist where it is not possible to provide exact diagnoses, and both patients and doctors are frustrated when clear-cut answers to questions cannot be given. Such frustrations can lead to complaints and legal action. The fear of such action is one of the principal causes of stress amongst GPs. It is timely therefore to consider the nature of clinical risk in primary care and examine strateges for risk containment. Vocational training schemes need to include arrangements for this in their courses, so that future GPs will be able to understand and deal with the fact of risk. Clinical risks are not the only ones affecting the GP. There are those concerned with being an employer and also with the environmental hazards and aspects of health and safety that result from operating from premises with public access. However, this paper will confine itself to issues of clinical risk, the other aspects having been discussed elsewhere.’