14. Before we decide if we should do a detailed investigation of 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 have done this and have not seen any signs that something has gone wrong.
Referral
15. Miss O says she had several appointments at the Practice between November 2021 and March 2022 to discuss stomach cramps and urine and bowel urgency. She complains the Practice did not refer her to a urologist which she asked for more than once because of the concerns she had with the diagnosis she had as a child.
16. In response to Miss O’s complaint, the Practice said the results of her home testing did not give the GPs cause for concern.
17. The Practice also told Miss O its GPs had completed the correct blood tests. It said the GPs referred her to specialists for ultrasound (high frequency sound wave imaging) investigations, chased up a referral to gynaecological services and referred her to a bladder and bowel specialist nurse.
18. We considered whether Miss O’s GP should have referred her to a urologist earlier.
19. The NICE guidance says, ‘In women with urinary incontinence, indications for consideration for referral to a specialist service include...associated faecal incontinence’.
20. The GMC guidance says doctors:
‘must provide a good standard of practice and care.
If you assess, diagnose or treat patients, you must 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 and promptly provide or arrange suitable advice, investigations or treatment where necessary.’
21. On 4 February 2022, a GP looked at Miss O’s medical history including her urinary and bowel symptoms dating back to when she was a child. The GP referred her to a continence specialist. Our adviser confirmed that this action was in line with NICE guidance. Our adviser told us NICE guidelines do not say a referral should be made to urology when a patient has the same symptoms as Miss O.
22. Our adviser also reviewed appointments from 8 February, 14 February, 8 March and 14 March 2022. They told us each GP completed examinations and blood or urine testing in line with GMC guidelines. Our adviser confirmed there was nothing to suggest a urology referral should have been made sooner.
23. The records show the Practice followed GMC guidelines by providing advice and examining Miss O quickly. It referred her to specialist services and chased up an endometriosis (disease of the female reproductive system) clinic referral, where she had pelvic investigations and keyhole surgery to try and find what was causing her pain and distress.
24. Miss O saw a GP on 14 February 2022 because she experienced intermittent kidney pain which stopped within one hour. The GP completed a urine dipstick test which was negative and noted her temperature was normal. The GP asked for the opinion of other GPs at the Practice, who thought the pain was musculoskeletal (bones and muscles).
25. We have decided to take no further action because we have seen nothing to suggest the Practice failed to follow the relevant guidelines. There was no sign that the GPs should have made a urology referral sooner.
Language
26. Miss O complains a GP wrote that she was ‘clearly a hellraiser’ in her summary of records (SCR). Miss O told us the GP’s actions caused her stress and affected her mental health.
27. The Practice apologised for the language its GP used in her SCR and removed it. The Practice said this happened because of a language barrier between herself and the GP.
28. Our Principles say:
‘where poor service has led to injustice or hardship, public bodies should try to offer a remedy that returns the complainant to the position they would have been in otherwise[..] appropriate remedies include: an apology, explanation and acknowledgement of responsibility.’
29. GMC guidance says:
‘You must be polite and considerate. You must treat patients fairly and with respect whatever their life choices and beliefs. You must not unfairly discriminate against patients or colleagues by allowing your personal views to affect your professional relationships or the treatment you provide or arrange’.
30. The Practice agreed it had not met this standard. The GP did not treat Miss O politely or fairly and respectfully, as their personal view and opinion was added to her records.
31. The wording the GP used understandably upset Miss O. We looked at whether the Practice has done enough to put things right for her.
32. The Practice apologised to Miss O and removed the wording from her SCR. The Practice and the GP reflected on her experience and apologised for how she had been affected. Removing the language from her records means it will not influence any health professionals in the future.
33. The Practice acted in line with our Principles by taking responsibility for the error, correcting the mistake and giving appropriate apologies. We would not expect the Practice to do anything more than it already has because we think it has done enough to put things right.
34. We are sorry to hear about Miss O’s concerns and the issues she brought to us. We are grateful to her for telling us about her experience which we appreciate will have been difficult. We hope she is reassured by what we have seen.