The Medical Defence Union (MDU), the body which represents 22,000 GPs, hospital doctors, nurses and dentists, says almost half of all settlements concern delays in diagnosis of illness.

The MDU report, Problems in General Practice, says 186 of 409 claims it has settled in the last two years are due to the delays.

The main causes are GPs' failure to examine patients properly, lack of appropriate tests, misplaced reports, bad record keeping and poor communication.

The most commonly missed illnesses include breast, cervical and bowel cancer, meningitis, malaria and orthopaedic injuries such as trapped nerves in the spine.

Early stages

The MDU says not all failures to spot diseases are due to clinical negligence.

In some cases, diseases might be in the very early stages where symptoms are difficult to diagnose.

The MDU, however, says doctors must address problems caused by negligence and hopes its report will help doctors to avoid the pitfalls.

It gives case histories and risk management guidelines.

GP Rupert Lee, clinical risk manager at the MDU, said: "We are saying that keeping records of samples sent to laboratories, reviewing test results more thoroughly and keeping better records would prevent some of these claims."

The MDU said it was particularly important that the problems be addressed given that, with the imminent setting-up of primary care groups, GPs would have more responsibility to govern themselves.

Inevitable

Dr John Chisholm of the British Medical Association said that, with 300 million consultations a year, it was "inevitable" that mistakes would occur sometimes.

Dr John Chisholm: workload pressures have to be acknowledged

But he added that GPs could learn some lessons from the MDU report.

And he said: "We also need to acknowledge the workload pressures on family doctors at a time when recruitment to general practice is poor and more GPs are needed.

"The average GP has over 10,000 consultations a year with patients and the average length of time of each consultation is only eight minutes.