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Warning to GPs on Signing 'Fit to Participate' Forms

The Medical Protection Society (MPS) has urged GPs to ensure that they have adequate professional protection when signing forms declaring that patients are fit to participate in high risk activities. It noted that such requests could surge in the summer, giving examples of a range of "more extreme challenges" including skydiving, marathon running, swimming challenges, polar water plunges, and mountain climbing.

The Society warned that there was a possibility of patients initiating compensation claims if they were injured in the course of such activities, and cautioned that signing such forms for patients was not included in England's state-backed indemnity scheme. 

Dr Sarah Townley, MPS deputy medical director, said: "Declaring patients fit to participate in extreme challenges can present some difficulty and risks to GPs – for example they may not have sufficient knowledge about the patient, the nature of the event, or have the clinical expertise on any past injuries or conditions."

She noted that GPs may well feel under pressure to sign fit to participate forms. "Many extreme challenges are once in a lifetime events, raising money for charities close to patients' hearts. They may have prepared for some time, invested in travel arrangements, and obtained sponsorship."

GPs Should Check They Have Unlimited Indemnity Cover 

While "GPs want to be able to support their patients as much as possible," she strongly advised GP partners and practice managers to check that all GPs in the practice had adequate indemnity, ideally without limits, in case a claim was deflected to the practice under vicarious liability or non-delegable duty of care. 

Such claims "could become very costly and stressful for the GP partners", she warned. "Although very rare, when extreme events go wrong, the injuries may be serious and the compensation sought if a claim is successful may be high – even into millions of pounds. GPs will struggle to pay this from their own pockets."

GPs should obtain protection from a medical defence organisation in case a clinical negligence claim is brought, the MPS advised. It added: "GPs should ensure protection is adequate, ideally with no limits to the compensation that will be paid in the event of a claim, otherwise the individual GP, or the practice, could be on the hook." An MPS spokesperson confirmed to Medscape News UK that its own coverage was "without limits".

Dr Townley said that even with adequate indemnity, the MPS would always advise GPs to "remain objective" when asked to sign fit to participate forms, to take a detailed history and review any relevant clinical notes. "They should feel confident that they have sufficient knowledge about the patient and the nature of the event, and should avoid undertaking assessments beyond their area of clinical competence.

If in Doubt Seek Advice 

"If they feel able to proceed, they should review the wording of any form and declaration carefully," she added. It might be prudent to provide a qualifying statement or offer factual information regarding a patient's medical history. "For example, the GP may wish to state that they have considered the information that is available to them on the patient's current and past medical history, which may be relevant to the event, and can see no known health conditions which render the patient unfit to participate."

If a patient's medical history is not straightforward, or they are under the care of a specialist, the GP may wish to obtain advice first, or refer the patient to a doctor with relevant expertise. In either case it is important fully to explain these actions and any concerns to the patient. "When in doubt, GPs should contact MPS or their medical defence organisation for advice."

The MPS spokesperson told us: "We are frequently contacted for advice on how to handle these requests, especially when the activity is deemed potentially high risk. It is not MPS' role to offer advice that is clinical in nature, but rather to suggest steps a GP could take to ensure they have sufficient knowledge about the event and the patient, and avoid medicolegal issues."

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