3. Mr E complains that on 26 May 2021, at an appointment at the Practice, the GP was aggressive and refused to make referrals to an irritable bowel syndrome (IBS) specialist or for a biopsy.
4. Mr E says the refusal left him upset and disappointed with increased stress levels, anxiety and depression. He says the GP’s attitude caused him distress.
5. Mr E would like the Practice to accept its mistakes, apologise and make service improvements.
6. Mr E booked an appointment with his GP after experiencing an increase in his IBS symptoms. At that time, he already had an IBS diagnosis.
7. When he arrived, he says the GP was dismissive and did not listen to him. He says the GP spoke to him very loudly and aggressively.
8. Mr E says he asked the GP for a biopsy and to be seen by a specialist doctor, but they refused.
Care and treatment
12. Before we decide if we should do a detailed investigation of a complaint, we look at whether there are signs the organisation got something wrong. We do this by comparing what should have happened with what did happen. We have done this and did not see any signs that something went wrong.
13. Mr E says when he asked his GP for a referral to a specialist (this is also known as secondary care) and for a biopsy for his symptoms of IBS, they refused saying treatments provided by a GP (primary care) needed to be exhausted first.
14. NICE guidance on IBS explains how doctors should help patients manage IBS in primary care. It says a patient's care should be managed through the GP first. It says a patient should be referred for secondary care if they had inflammatory markers. These include anaemia and an increased C-reactive protein (CRP is an indication of infection).
15. NICE guidance on cancer referrals explains a patient should be referred for secondary review if cancer is suspected. This NICE guidance says cancer might be suspected if a patient has symptoms of unexplained abdominal pain, an abdominal mass or bleeding.
16. Mr E’s records do not show any signs he should have been referred to a specialist. Mr E did not have inflammatory markers or anaemia and his CRP was not noted as raised. The records also include an entry saying the GP tried to discuss options to manage Mr E’s IBS.
17. We reviewed the medical records and discussed this with our adviser. We did not identify any evidence of suspected cancer. It is also important to note Mr E has not told us he had cancer or that the GP missed signs of cancer.
18. Referral for a biopsy is not specifically mentioned in NICE guidance on IBS. We asked our adviser when a GP would refer a patient for a biopsy. Our adviser explained this is a decision made by a secondary care specialist not a GP.
19. The evidence we have seen shows the GP acted in line with NICE guidance and there were no signs they should have referred Mr E to a specialist or for a biopsy. The evidence suggests the GP attempted to manage Mr E’s IBS in primary care, which is what the NICE guidance on IBS recommends. This means there are no signs of failings in this part of the complaint.
20. We appreciate the distress Mr E’s IBS symptoms caused him and realise this must have been a very difficult time for him. We hope this helps reassure him of the GP’s decision-making.
GP’s attitude
21. Before we decide if we should do a detailed investigation of a complaint, we look at whether the organisation has done enough to put right any negative effect a person experienced as a result of a failing. We have done this and have decided the Practice has done enough to put things right.
22. In the complaint response the Practice says it feels Mr E’s complaint comes from ‘a feeling that [Dr A] was in a bad mood and was rude to you. He professed he was very sorry this was the case and that it was never his intention’.
23. The response also says, ‘I apologise for the series of events that led you to be dissatisfied, and hope, that as the clock cannot be turned back, you will be able to look forward to us putting it right in the future’.
24. The GMC guidance comments on communication saying, ‘Doctors must treat patients politely and considerately’. We recognise the Practice response suggests the GP did not treat Mr E politely.
25. Our Principles say, ‘There is a wide range of appropriate responses to a complaint, these include an apology, explanation and acknowledgement of responsibility’.
26. We are sorry to hear what happened and we have thought about how this affected Mr E. The Practice has apologised, explained what happened and taken responsibility for it. This action meets what is expected in our Principles. We have decided the Practice has done enough to put things right. We do not think any further action is needed.
27. We appreciate Mr E’s complaint is important to him and we are grateful to him for bringing it to us. We hope we have clearly explained the reasons for our decisions.
1. The Parliamentary and Health Service Ombudsman has carefully considered Mr E’s complaint about a practice in the Stockton-on-Tees area (the Practice). We are sorry to hear how Mr E says he has been affected and appreciate it has been a difficult and challenging experience for him.
2. After reviewing the available evidence, we have decided we do not need to consider the complaint further. This is because we have not seen any evidence to suggest the Practice failed to refer Mr E to a specialist or to have a biopsy. The Practice accepted the GP’s behaviour was not as it should have been, and it has taken action to put this right. There is nothing more we need to do with this issue. We explain our decision in more detail below.