The Medical Defence Union (MDU) has paid out "well over" £30 million in compensation and legal costs on behalf of GPs working in out-of-hours and unscheduled care settings in a three-year period.

The figure includes a number of high value cases that settled for over £1 million, it said.

The Union reviewed claims cases to determine why this area of GPs' work carries a higher indemnity risk when compared to practice-based care and to help minimise risk to patients.

"There are some additional challenges for GPs working in unscheduled care settings which result in claims that are, on average, higher value and more difficult to defend than claims arising from routine care," said Dr Pierre Campbell, MDU head of underwriting.

"These challenges include assessing unfamiliar patients who are more likely to be suffering from an undiagnosed and potentially deteriorating condition. Often doctors will be trying to make the correct diagnosis based on limited information and little or no access to the patient's medical records. Added to that, GPs may also be triaging and diagnosing patients over the phone or internet, or supervising other health professionals that are doing so".

The review found that the most common reason for claims was a delay or failure to diagnose a condition, accounting for 71 percent of cases while in 18 percent of cases there were allegations about a failure to make a referral or an incorrect referral.

Claims involving medication issues accounted for 9 percent of cases, which included the wrong drug, dose or regimen prescribed or a failure to appreciate the patient was suffering from known side effects.

Many cases involved patients with serious and life threatening conditions such as heart attacks, meningitis, septicaemia and appendicitis, and the death of a patient was a feature seen in a quarter of the settled claims reviewed, the Union noted.

"We are seeing unprecedented increases in the cost of claims from general practice overall. However, nowhere is this more apparent than in the provision of emergency unscheduled care," said Dr Campbell.