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NPA Insurance (NPAI) has seen a 125 per cent increase in vaccination-related claims in the last five years, the Avicenna Conference heard on Sunday (September 20).

Lisa Banks, managing director of pharmacy insurance at NPAI, told the conference there has been a “significant change in claim trends” since 2020, with more cases involving vaccinations, prescribing, failure to refer and private services such as weight loss and ear microsuction.

Common factors in vaccination claims have included additional doses or expired doses being administered and allegations of incorrect vaccine administrations leading to shoulder injury – which Ms Banks said can lead to “high damages” if arm function is lost and are “costly to defend”.

She warned pharmacists against providing private prescriptions to treat condition areas outside their competency.

She also warned contractors of the potential risks in prescribing drugs off-label, making “commercially driven” decisions to switch patients to “cheaper medicines” or recommending “inappropriate washout periods” when swapping a patient onto an alternative brand.

And she said that while technological tools such as robots and barcode scanners are likely to reduce dispensing errors, there is “potential for complex claims and mass systemic errors” if the system malfunctions or there is human error in how machines are loaded.

Product liability claims, criminal investigations and police station interviews are all now less common than they were in 2015, she said, adding that dispensing errors such as look-alike-sound-alike errors continue to be the most common factor in patient claims.

Risks of poor note-taking

Ms Banks said that with the launch of more NHS-commissioned services, NPAI has seen an increase in “complex claims” and “high-value claims” relating to an alleged failure to refer a patient onwards appropriately or provide them with adequate safety-netting advice.

A common denominator in such cases is “poor or no medical notes,” she said, giving the example of a patient who was referred to a pharmacy by their GP via the now-defunct Community Pharmacist Consultation Service (CPCS).

The doctor’s referral notes indicated the patient had suffered from mid-ear pain since the previous night. The pharmacy spoke to the patient’s representative by telephone and was told the patient had a sore throat, difficulty swallowing and speaking, and a stabbing pain in their ear.

The patient’s representative said the pharmacy had advised they take paracetamol and use Difflam spray without providing safety-netting advice. The following day, the patient developed breathing difficulties, cardiorespiratory arrest and airway obstruction, which led to a hypoxic brain injury.

It was alleged that the claimant was not adequately assessed, triaged or signposted by the pharmacy, resulting in their brain injury.

It was found that the pharmacy had accepted the CPCS referral on PharmOutcomes but not completed the form, and while telephone records showed there had been a six-minute call the pharmacist had no recollection of this and did not make any records of the conversation.

“Lack of contemporaneous notes makes the case very difficult to defend,” said Ms Banks, adding that there is a higher risk of a claim being brought if a consultation is carried out with a representative and not the patient themselves.

She said all consultations must be documented either contemporaneously or as soon as possible afterwards, with notes made of any advice given or referrals made and summary care records (SCR) accessed where possible.