Clinical guidelines, medical litigation, and the current medical defence system.

The introduction into National Health Service medical practice of guidelines designed to achieve more effective use of clinical resources is likely to encounter opposition owing to the increasing fear of litigation amongst clinicians. Hospital doctors are unusual amongst salaried professionals in being required to bear the cost of indemnity insurance themselves. The advantages for doctors commonly attributed to this arrangement are insubstantial. A system of no-fault compensation is unlikely to be implemented in this country in the foreseeable future. If guidelines are to achieve wide acceptability amongst clinicians, health authorities must accept full legal and financial responsibility for the actions of doctors in their employment, as they currently do for other health service staff.