A medical practice in the Cambridgeshire area

3. Mrs P complains about Mr P’s care and treatment from the Practice, following a referral from a senior physiotherapist to his GP on 27 September 2020. She says the GP failed to do a referral to the neurological rehabilitation team, so the team could review Mr P and give him Botox injections in his arm.

4. As a result of the delay, Mrs P says Mr P did not get any treatment from the neurological rehabilitation team for over 12 months and suffered a severe deterioration in his condition. She explains Mr P’s arm is now permanently fused to his body, and he cannot move his hand.

5. Mrs P wants service changes so this does not happen to anyone else.

6. In May 2020, Mr P experienced a stroke. On 27 September 2020, a senior physiotherapist sent a letter to Mr P’s GP to refer him to a neurological rehabilitation centre, for Botox injections and other treatments. On 23 August 2021, the GP sent a letter to neurological rehabilitation to say the referral was overlooked and asked for an urgent referral to be made for Mr P.

9. GMC guidance (paragraph 15b) says, ‘if you assess, diagnose or treat patients, you must promptly provide or arrange suitable advice, investigations or treatment where necessary’.

10. Mrs P explained she saw the physiotherapist’s letter and believes it is clear the letter suggested the GP should have made the referral to a neuro consultant.

11. The Practice told us the GP understood the letter to mean the physiotherapist was going to action the referral, so they did not need to.

12. The letter states:

‘In summary I suggest his-

• Baclofen dose could be increased from 1mg x 3 daily to 15mg x 3 daily • Prescribe regular analgesia for shoulder joint pain and steroid injection for shoulder (if this can be offered by a GP) • Refer to rehab clinic at [Hospital A] to see [neuro rehab consultant] for review for upper limb Botox injections’

13. We have seen the letter and think it was not clear which actions were meant for the GP. We cannot look at the actions of the physiotherapist in this complaint, as Mrs P has told us she believes the error is only down to the GP’s actions. She says she does not want to complain about the physiotherapist’s care and treatment. However, we think the delay in referral could have been prevented if the GP had checked with the physiotherapist what action they needed to take.

14. To resolve the complaint, we asked the Practice to advise its GPs to check with the referring party (who sends the referral instructions) when the actions are unclear, and to monitor this for a period of time to check it is being done.

15. As Mrs P wants service changes, so this does not happen to anyone else, we consider the actions we have asked the Practice to take will achieve this outcome. We discussed our approach with Mrs P and she told us she was happy with this.

16. The Practice confirmed in writing it will tell GPs to get additional advice from the referring party when actions are unclear. It explained it will monitor this to check the GPs are doing this.

17. Our principles say, ‘remedies should also be offered, where appropriate, to others who have suffered injustice or hardship as a result of the same maladministration or poor service.’

We consider that the agreement we have made with the Practice is an appropriate remedy to put what happened right. As an agreement has been reached which meets what Mrs P was wanting to achieve, we are not investigating this complaint further.

18. We thank Mr and Mrs P for bringing their concerns to our attention and we hope Mr P’s health condition improves.

1. We have carefully considered Mrs P’s complaint about a medical practice in the Cambridgeshire area (the Practice) and its handling of information from a physiotherapist. We are sorry to hear how Mrs P and her husband, Mr P, have been deeply affected by Mr P’s ill health.

2. Our view is the GP who got the physiotherapist’s letter could have taken steps to find out what action they needed to take. We have discussed this with Mrs P and the Practice and have achieved a resolution to this complaint.