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Given the pressures that GPs experience in their daily practice, it is understandable that many fear being the subject of complaints or regulatory procedures. Such regulatory fear is driving GPs toward defensive medicine, where caution overrides clinical confidence. Constant anxiety over scrutiny from the General Medical Council (GMC) or Care Quality Commission (CQC) erodes morale, fosters burnout, and undermines trust in the system, shifting focus from patient care to self-protection.

Many GPs practice defensively, believing that it will decrease their risk of being sued or investigated. However, it is unlikely to be beneficial for patient care and may cause harm. Indeed, patterns of defensive practice resulting in harm to patients can raise concerns with regulators.

So, how should GPs respond to the ever-present threat of regulatory action or litigation in a way that avoids defensive practice?

In this article, we highlight the risks of defensive medicine and explain how to navigate these pressures, focusing on the patient’s needs, appropriate clinical judgement, clear documentation, early medico-legal guidance, and peer support networks to reinforce confidence, clarity, and resilience.

 

What is defensive medicine?

Defensive medicine refers to medical practices driven primarily by a clinician’s desire to reduce the risk of legal or regulatory action, rather than to optimise patient care.

Defensive medicine takes two main forms:

  • Positive defensive medicine involves overtreatment, such as arranging excessive diagnostic tests, referrals, and follow-ups, as well as over-prescribing, or providing interventions beyond what is medically necessary.
  • Negative defensive medicine involves undertreatment, such as avoiding high-risk patients or declining potentially beneficial but risky procedures.

 

Why is defensive practice common?

Surveys indicate that most doctors practice defensively at times. The main driver is fear of regulatory action, litigation, and reputational damage, which may be reinforced by prior negative experiences of complaints or investigations, and a culture of zero-risk tolerance.

Previous experience of regulatory proceedings, combined with a lack of professional support, may heighten defensive behaviours. The emotional toll often leads to anxiety, loss of confidence, and burnout, creating a self-perpetuating cycle of fear-driven care.

Other contributing factors include high patient expectations, relationship breakdowns between GPs and their patients, an increasingly litigious environment, media scrutiny, peer pressure, and system-related pressures, such as excessive workloads and stringent regulations.

 

What harm could defensive practice do?

This ‘culture of fear’ shifts GPs’ focus from patient-centred decision-making to self-protection in defensive practice, prioritising the GP’s legal safety over the patient’s best interests. Unfortunately, this may have several negative consequences:

  • Defensive practice risks compromising the quality and appropriateness of care. If defensive practice leads to unnecessary tests, overdiagnosis, and overtreatment, this can expose patients to avoidable risks, anxiety, and even harm. On the other hand, avoidance behaviours, such as refusing high-risk patients or procedures, may deny individuals potentially beneficial care. Such practices can also erode trust in the doctor–patient relationship.
  • It may also undermine the quality of care by fostering inappropriate treatment patterns, weakening antibiotic stewardship, and normalising excessive intervention as routine practice.
  • For GPs, the shift from patient-centred care to self-protection diminishes professional satisfaction, increases stress, and perpetuates a culture of mistrust.
  • Furthermore, diverting resources to unnecessary activity in defensive medicine drives up healthcare costs, reducing efficiency and availability for genuine clinical needs.

Ultimately, defensive medicine may harm patients, damage the integrity of medical practice, and burden healthcare systems.

 

How can GPs practice responsibly, not defensively?

The GMC has stressed that isolated mistakes, when met with insight, remediation, and apology, rarely lead to serious action. However, a consistent pattern of defensive practice that harms patients can raise concerns.

By prioritising patient interests, applying sound clinical judgment in accordance with Good Medical Practice, and working transparently, GPs can safeguard both their patients’ welfare and their own professional standing, without resorting to excessive or avoidant care.

GPs can reduce defensive behaviours by focusing on:

  • Their patients’ best interests: GPs have a duty to prioritise their patients’ care over any concerns about litigation or regulatory referral. All interventions and treatments should be appropriate to serve the patients’ needs.
  • Patient partnership: clearly communicating with patients and explaining clinical reasoning is crucial to build trust and enable partnership in making informed decisions about care. To support effective conversations with patients, the GMC provides guidance on ‘Decision-making and consent’.
  • Sound clinical judgement: applying professional judgement with the appropriate use of relevant guidelines, in line with Good Medical Practice, enables GPs to manage risks and provide protective, not defensive, care in the patient’s best interests.
  • Maintaining detailed and contemporaneous records: clear, accurate, contemporaneous and legible documentation, with a proportionate amount of detail, is essential to conform to Good Medical Practice, provide clarity, and support safe care. The records will also provide essential evidence in the event of any future regulatory proceedings.
  • Building peer support networks: support from colleagues and leadership can strengthen confidence and resilience under regulatory pressure, and is linked to reduced defensive practice and better mental wellbeing.
  • Early medico-legal advice and debriefing after incidents: obtaining timely and informed medico-legal advice is important to manage risk, de-escalate situations, provide reassurance, and find resolutions where possible. Expert medico-legal advice can provide clarity and support a GP’s wellbeing through what can be a highly stressful situation. In further guidance, the GMC stresses the importance of openness and honesty when things go wrong.
  • Indemnity protection: it is essential that all aspects of a GP’s NHS and private work are fully covered by indemnity arrangements.

 

Today’s GPs face scrutiny from every angle but fear shouldn’t define the consultation room. At Medical Defense Society, we equip our members with the protection, clarity, and expert support to stay focused on patients — not paperwork or investigations.

 

If you need advice about your practice or wish to discuss your indemnity cover, please contact the team at Medical Defense Society today.