A medical practice in the Warwickshire area

2. Mr A complains about the care and treatment he received from a medical practice in the Warwickshire area. He complains the Practice:

· in June/July 2019, issued one box of the original diabetic testing strips and said it would put the strips onto his Patient Access but did not; · has referred to him as being a type 2 diabetic when he says he is type 1.

3. Mr A says the Practice informing him it would put his testing strips on Patient Access, and then not, has caused frustration. He feels the Practice are not willing to take his circumstances into account and he is extremely frustrated the Practice has him recorded as a type 2 diabetic when he feels he is type 1. He has lost all confidence in the Practice.

4. Mr A seeks the following outcomes:

· for the Practice to explain why a clear commitment to put his strips onto Patient Access was not kept, and to offer its assurance that commitments made by doctors will be kept going forward; · for the Practice to confirm he has type 1 diabetes, as per his original diagnosis from hospital A.

5. In 2011, after a period of time of feeling unwell, Mr A was diagnosed with type 1 diabetes. He was under the care of the diabetic clinic at hospital A. He says hospital A monitored his condition well and had a plan in place which included test equipment, insulin types, and an annual review with access to the nursing staff by telephone if needed. Mr A says he returned to good health within six months of being under the care of the hospital and was happy with the treatment it provided.

6. Hospital A managed his treatment plan, and the Practice were responsible for his prescriptions. Mr A says the management of his prescriptions has been extremely poor and dissatisfactory.

7. In 2014, Mr A tried to arrange an appointment at the diabetic clinic at hospital A. He was advised his care had been passed back to the Practice. Mr A says he had no idea the Practice had removed him from the care at hospital A, and he says he wasn’t consulted about this change.

8. Hospital A was willing to see him but said before an appointment could be made, it required a new referral from his GP. Mr A says he asked the Practice to arrange the referral on multiple occasions without success. Mr A says he has never had a diabetic review with the Practice since he was diagnosed in 2011, and the decision to stop the care he was receiving at hospital A was done with no regard to his medical needs, circumstances, or wishes.

9. Mr A made clear to the Practice, in April 2018, he wanted his original test strips restored to his prescriptions. To date, the Practice has not permanently restored his original test strips and he has continued to purchase them himself online.

10. At an appointment in June 2019, Mr A told the doctor he wanted his old test strips on prescription. He was told he needed to undergo a review, and a telephone consultation appointment was made for July 2019. During this consultation, Mr A says the doctor agreed to prescribe his original strips and told him they would be on Patient Access by the end of the week. Mr A says the strips were not put on Patient Access as promised, and to date, he has no form of testing strips available to him on prescription.

11. Mr A complained to NHS England on 1 November 2019. When the Practice responded, it referred to him as being type 2 diabetic. Mr A strongly disputes this and says he is type 1 as per the diagnosis he was given at hospital A while under its care.

13. Before we decide whether we should investigate a complaint, we look at whether we are able to achieve the outcomes the complainant is seeking. We have discussed this with Mr A to understand his circumstances and the outcomes he wants, and we are unable to achieve the outcomes he seeks regarding his testing strips.

14. We also consider whether there is an organisation better placed to deal with the complaint. With regards to Mr A’s testing strips, the Clinical Commissioning Group (CCG) has already been made aware of his concerns. It will be reviewing his circumstances and whether he should be provided with his original preferred testing strips. The CCG is better placed to make decisions regarding the equipment a patient is entitled to, in line with NHS budgets.

Diabetic testing strips

15. In July 2019, Mr A says the Practice issued one box of the original strips and said it would put the strips onto his Patient Access but did not. We understand Mr A wanted the Practice to honour its original agreement and put the strips onto his Patient Access. He would like the Practice to explain why a clear commitment was made but not kept, and offer assurance that commitments made by doctors will be kept going forward.

16. We discussed this complaint with the Practice. The Practice said the notes show Mr A had a consultation on 25 June 2019 where he requested his original strips. The GP put on the consultation notes that Mr A required a review. The GP issued one box of the strips, so Mr A did not go without, and another appointment was made for the 9 July 2019 for Mr A to undergo a medical review. The appointment on 9 July was a telephone consultation and the GP concluded they were not willing to prescribe the original testing strips Mr A had asked for due to costs.

17. Following our review of this complaint, we have decided we cannot achieve the outcome Mr A is seeking. We are aware Mr A would like the Practice to place the strips onto his Patient Access. As discussed with Mr A, the decision to prescribe his preferred strips is down to funding which is governed by the CCG. This issue should therefore be pursued with the CCG, following its process. If Mr A is dissatisfied following the CCG review, Mr A can come back to us to consider his complaint further. As a decision from the CCG has yet to be made, it would be too early for us to look into this at this stage.

18. In relation to what was agreed during the consultation, we do not have enough available information to determine what actually happened to make a decision on this aspect of the complaint. We are aware Mr A recalls being told he would be prescribed the strips during the consultation. The Practice says no promise was made to include the strips on his Patient Access.

19. In accordance with our service model guidance, it is not appropriate for us to take this part of the complaint further at this stage, as we cannot take one party’s version of events over another. There is no reference in the records regarding putting the strips on to Patient Access, or any reference to this being discussed between Mr A and the GP. We appreciate it is possible for things to be discussed during a consultation that might not necessarily need to be recorded. In such circumstances, we usually turn to other independent evidence to help us make a decision. In this case there is none, and it would be highly unlikely further investigation would bring forward any new evidence in this regard. We would not reach a satisfactory conclusion without independent evidence, and we would not be able to say what happened. It is therefore unlikely an investigation will get the outcome Mr A is seeking, which is to ensure the Practice acknowledges its previous agreement to provide the strips, and then to put this in place.

20. We also cannot achieve a further outcome Mr A is seeking, which is to have his preferred strips reinstated as this is a matter for the CCG, as detailed above. We therefore do not think it would be proportionate to look into this complaint any further and we are sorry for any upset this decision may cause Mr A.

21. As noted above, before deciding whether we should investigate a complaint, we look at whether we can achieve the outcomes the complainant is seeking. After discussing this with Mr A and proposing a resolution, which the Practice has agreed to do, Mr A still feels his diabetes diagnosis should be changed from type 2 to type 1. This is not something we can ask the Practice to do, and we feel the Information Commissioners Office (ICO) is better placed to deal with this concern should Mr A wish to pursue it.

Diagnosis

22. Mr A wants the Practice to confirm he has type 1 diabetes. Following our review, this is not an outcome we can achieve as it involves changing a diagnosis within Mr A’s medical records.

23. The ICO provides guidance for organisations on amending records. The guidance explains what should be done about data that may contain inaccurate information regarding a diagnosis. It gives the following example:

“If a patient is diagnosed by a GP as suffering from a particular illness or condition, but it is later proved that this is not the case, it is likely that their medical records should record both the initial diagnosis (even though it was later proved to be incorrect) and the final findings. Whilst the medical record shows a misdiagnosis, it is an accurate record of the patient's medical treatment. As long as the medical record contains the up-to-date findings, and this is made clear in the record, it would be difficult to argue that the record is inaccurate and should be rectified.”

24. In terms of what should be done about data that records a disputed opinion, the ICO says:

“Opinions are, by their very nature, subjective, and it can be difficult to conclude that the record of an opinion is inaccurate. As long as the record shows clearly that the information is an opinion and, where appropriate, whose opinion it is, it may be difficult to say that it is inaccurate and needs to be rectified.”

25. The UK General Protection Data Regulations (GDPR) does not give a definition of the term accuracy. However, the Data Protection Act 2018 (DPA 2018) states personal data is inaccurate if it is incorrect or misleading.

26. The Practice says it based this diagnosis on a clinic letter from hospital A, dated February 2013, which we have seen.

27. On the ‘diagnosis’ part of the letter it says probable type 1, however, in the body it says a glutamic acid decarboxylase ‘GAD’ test was performed. This test measures whether the body is producing a type of antibody which destroys its own GAD cells. The GAD test came back negative, suggesting he has type 2 diabetes. When speaking to the Practice, it explained the diagnosis of ‘probable type 1’ was a working diagnosis until Mr A had the GAD test. The GAD test results were negative, and so he was then diagnosed as having type 2 diabetes.

28. We do not have enough evidence to indicate an error has been made by the Practice in referring to Mr A as having type 2 diabetes. However, as a resolution, the Practice agreed to add an addendum to Mr A’s medical records to say he does not agree with the diagnosis of type 2, while also making it clear the Practice cannot change the diagnosis. Mr A feels the Practice has misinterpreted the diagnosis. He feels it is incorrect and should be changed.

29. In accordance with the guidance from the ICO, medical records cannot be changed unless they are factually incorrect. Based on this guidance, we are satisfied the Practice cannot change Mr A’s diagnosis as this was the clinical opinion at the time. The diagnosis was based on the information in the letter from hospital A, and the subsequent GAD test results. As we cannot achieve the outcome Mr A is looking for, it is not proportionate for us to look into this complaint any further.

30. Mr A does have the option to take this part of his complaint to the ICO if he wishes to pursue it further. We appreciate Mr A will be disappointed with this outcome, but we hope we have been able to give him answers to the concerns he has raised and provided an alternative means to pursue his complaint regarding his diagnosis, should he wish to.

1. We have carefully considered Mr A’s complaint about a medical practice in the Warwickshire area (the Practice). We are sorry for the evident upset this matter has caused Mr A. We have carefully reviewed the complaint and decided:

· the Practice has done enough to explain the way they categorised his diabetes, as type 2 rather than type 1. We are also satisfied the Practice attempted to further resolve the issue Mr A had regarding this diagnosis; · it is not suitable or appropriate to investigate the complaint concerning the diabetic testing strips not being put onto Patient Access, in June/July 2019, as an investigation into this complaint will not provide a satisfactory outcome; · we cannot achieve the outcome Mr A is seeking in wanting assurances the Practice will put the testing strips onto Patient Access going forward.