10. Before we decide if we should investigate a complaint, we look at whether there are signs the organisation has got something wrong. We do this by comparing what should have happened with what did happen. We use relevant standards, guidance and law to inform us of what should happen.
Should the Practice have done more sooner?
11. The GMC guidance says: ‘clinicians must give a good standard of practice and care. If they assess, diagnose, or treat patients, they should:
a) adequately assess the patient’s conditions, taking account of their history (including the symptoms and psychological, spiritual, social and cultural factors), their views and values; where necessary, examine the patient b) promptly provide or arrange suitable advice, investigations, or treatment where necessary c) refer a patient to another practitioner when this serves the patient’s needs’.
12. The NICE guideline says a clinician should ‘refer people with suspected mesothelioma (a cancer associated with exposure to asbestos) within two weeks for an appointment using a suspected cancer pathway referral’.
13. Mr O says from 2017 onwards he developed a dry cough. He says between 2018 and 2021, he had six X-rays for lung problems.
14. In its complaint response the Practice accepted a delay in confirming the diagnosis but says an earlier diagnosis would not have changed how the condition was managed.
15. Our adviser explained the X-ray from May 2020 made a recommendation for a CT scan to be done only if it was necessary. The CT scan was only a suggestion in case Mr O’s symptoms continued, or if he returned showing new or concerning symptoms.
16. From the medical records we can see Mr O went to the Practice with a cough in October 2018. As there are many reasons for a cough, the Practice gave Mr O antibiotics and diagnosed him with an infection. It told him to told contact it again if the cough continued. Mr O did not mention a cough again and his March 2019 records show his infection was successfully treated.
17. Mr O’s July 2020 X-ray showed his infection cleared up, due to the antibiotics he was prescribed in May 2020.
18. Mr O did not tell the Practice about any new symptoms between 19 July 2019 and February 2021.
19. Our adviser explained pleural plaques are a marker of asbestos exposure and usually do not develop until 20 to 30 years or more after first exposure to asbestos. Pleural plaques alone are not harmful to your health and are non-cancerous. They often do not cause any symptoms, but because they are evidence of asbestos exposure there may be a risk of getting asbestosis or other asbestos related diseases later.
20. After Mr O was assessed, it was found there were no symptoms that needed a CT scan of his lungs. His cough/infection was treated, and Mr O did not have any new symptoms until February 2021.
21. Based on this evidence we have seen no signs of the Practice failing in Mr O’s care and treatment in deciding not to arrange a CT scan.
22. Next, we went on to consider the second part to Mr O’s complaint.
Priority treatment because of being a veteran
23. The NHS Constitution for England is a common set of principles for patients and care providers. These set out the values for the NHS in England.
24. Within these principles it says the NHS is available to all and under domain four of the constitution it states, ‘…as part of this, the NHS will ensure that in line with the Armed Forces Covenant, those in the armed forces, reservists, their families and veterans are not disadvantaged in accessing health services in the area they reside’.
25. The Armed Forces Covenant that the NHS constitution refers to is a government commitment that those who serve or have served in the armed forces, and their families, are treated fairly. The Armed Forces Covenant is designed not to give priority treatment to veterans, but to help in removing disadvantages to accessing healthcare services. Based on this guidance we do not think the Practice should have given Mr O priority treatment as a veteran.
26. We thank Mr O for bringing his complaint to us for our consideration.