3. Mrs O complains the Practice ignored her requests for an emergency appointment on 20 September 2021 and gave her unsuitable information.
4. Mrs O says she experienced excruciating back pain. She says she was scared and suffered emotional stress which led to her having an emergency operation in hospital. She explains she felt ignored and upset at how the Practice treated her. Mrs O wants an apology, improvements to service and financial compensation.
5. On 16 September 2021 a hospital treated Mrs O and prescribed a week of codeine for pain relief. It advised her to contact her GP for ongoing pain relief or if she experienced numbness in both legs or became incontinent of bowels and/or bladder.
6. Mrs O started to experience a burning sensation in her back, thigh and seat area. Mrs O called the Practice on at 8am on 20 September as she was unable to cope with the pain and to do most normal daily activities. She wanted an emergency appointment and some pain relief.
7. Mrs O then completed an online consultation form saying she had back pain and needed pain relief. The doctor replied within the hour saying, ‘you are describing mechanical back pain and have a few options on further management’. They went on to advise her to contact the Practice for a review with the physiotherapist. The doctor gave a link to an NHS website on back pain and advised they would not arrange an appointment.
8. Mrs O read the NHS information, and because her symptoms were getting worse she thought she needed medical attention. She called the Practice again at 10am and spoke to the receptionist. She described why she needed an emergency appointment and painkillers despite what the doctor had said earlier. The receptionist said she would pass this information to the doctor. The doctor did not speak to Mrs O or give her an emergency appointment. The receptionist apologised and advised her to call back the next day at 8am.
9. Mrs O’s pain continued and she called 111 who advised her to go to hospital straight away. She went to the emergency department and was admitted with suspected Cauda Equina Syndrome (CSE), a rare condition affecting the nerves at the base of your spine. She had emergency surgery at another hospital on 23 September.
12. Before we decide if we should do a detailed investigation of a complaint, we look at if there are signs the organisation got something wrong. We do this by comparing what should have happened with what did happen. If we see signs that something went wrong, we look at how this affected the person and what the organisation has done to put this right.
13. When Mrs O completed the online consultation form she described she had ‘pins and needles with burning in the centre of her lower back and across her buttocks and right thigh.’ She said she had sciatica (where the sciatic nerve, which runs from your lower back to your feet, is irritated or compressed) before and had experienced that pain for four to six days.
14. GMC guidelines say doctors must provide a good standard of practice and care. Doctors must ‘adequately assess the patient’s condition, taking into account of their history’, which the GP did in this case. GMC guidelines includes guidance for remote consultations and says these are appropriate if the needs of the patient are straightforward and the doctor has access to the patient’s medical records. It says if the doctor can give the patient the information they need about treatment options and they do not need to examine the patient, then this can be done remotely.
15. It seems at this time Mrs O was not describing new symptoms other than increased pain, which could be managed initially without being seen and assessed face-to-face. The doctor advised a review by the Practice physiotherapist and advice on back pain. Our adviser felt the GP’s advice at this time was correct.
16. The consultation form completed had 15 questions designed to highlight any red flags with symptoms for back pain. Mrs O answered all these questions with ‘no’, indicating no red flags to alert the doctor to her worsening condition. Our adviser said the doctor made the correct diagnosis of ‘mechanical back pain’, based on the symptoms provided, and in line with the GMC guidelines.
17. Our adviser told us that online consultations are used by practices to improve patient access and efficiencies. They highlighted the risks of communication issues with this type of consultations - the doctor has to rely on what the patient has recorded to make a judgement on what treatment is needed.
18. Mrs O contacted the Practice later in the morning. She told the receptionist she disagreed with the doctor’s diagnosis and wanted an emergency appointment. The receptionist passed the message to the doctor, but they would not give her a telephone consultation or an emergency appointment.
19. Our adviser says at this point the doctor did not establish why Mrs O disagreed, and whether her symptoms had changed. Our adviser said the doctor should have done a telephone consultation with Mrs O in line with the GMC guidelines, to give a more detailed assessment of her condition. This suggests a failing in the care. We have looked at how this affected Mrs O.
20. Our adviser said Mrs O had been to hospital on 16 September, where doctors would have examined her fully and there were no signs of CSE then.
21. On 20 September, Mrs O reported increased back pain and was given correct NHS information about this. She only realised later her symptoms had changed after reading the NHS guidelines. She then called the Practice to explain why she needed an emergency appointment. Our adviser explained this change would have been a red flag to the doctor and they would likely have advised Mrs O to go to hospital.
22. We thought carefully about how the delay in being seen and going to hospital would have affected Mrs O. We discussed this with our adviser and we think it would have had little impact on her condition.
23. The Practice has apologised to Mrs O and accepted the triage and consultation system caused problems with communication between herself, as the patient, and the doctor. The Practice has made changes and employed two new members of staff to deal with online consultations. It has also employed two new nurses to give a more efficient service.
24. Our ‘Principles of Remedy’ say when things have gone wrong, we expect organisations to put things right. This includes considering an ‘apology, explanation and remedial action’ to put things right.
25. We are satisfied that the Practice’s actions are in line with our Principles and it has done what we would expect to put things right.
26. While we did see evidence of some failings in communication, we saw no evidence of these having a more severe impact on Mrs O.
27. We understand Mrs O’s experience has caused her great distress and we are sorry to hear this. We hope this statement clearly explains our decision not to consider her complaint further, and gives her some reassurance that the Practice has taken her complaint seriously and addressed what went wrong.
1. The Parliamentary and Health Service Ombudsman has carefully considered Mrs O’S complaint about a practice in the Stockton-on-Tees area (the Practice). We understand Mrs O was in excruciating pain and distress, and she felt the Practice was ignoring her request for an emergency appointment. We are sorry to hear about how she was affected by what happened.
2. We have carefully considered Mrs O’s complaint and we have decided not to take any further action. This is because we have seen the Practice has already accepted it was wrong not to give Mrs O an emergency appointment. The Practice has already taken action to put things right. We hope our decision below explains how we have reached this conclusion.