3. Mrs O complains that between 24 November 2022 and 10 February 2023 the Practice did not diagnose or give the right treatment for her UTI.
4. Mrs O says she experienced unnecessary pain for three months and got shingles in May 2023 because of the amount of antibiotics she had taken in the months before this. She would like the Practice to improve its service.
5. Between November 2022 and February 2023 Mrs O says she had quite a few facetoface and phone consultations with doctors at the Practice. At first (before Christmas), she reported symptoms of head and neck pain and nasal drip. Later, she reported symptoms including smelly urine, swollen ankles and stomach and a rash on her thighs.
6. Between November 2022 and January 2023, the Practice made referrals to physiotherapy, the ear, nose and throat clinic and asked for a chest and spine X-ray. It also prescribed five courses of antibiotics and did blood tests.
7. Mrs O attended the A&E department at her local hospital on 20 November for neck pain, on 27 December for a skin condition and on 9 January for general weakness.
8. On 17 January Mrs O attended an appointment at the Practice and reported strong smelling urine and passing urine more often. The GP prescribed antibiotics (nitrofurantoin).
9. On 1 February Mrs O attended an appointment at the Practice and reported feeling unwell and like there was something wrong with her. The GP prescribed antibiotics (penicillin) for sinusitis (when your sinuses are swollen and blocked).
10. On 7 February she had a phone consultation then a face-to-face appointment and reported stomach swelling and pain at the top of her legs. The GP diagnosed a UTI, took a urine sample and prescribed antibiotics (nitrofurantoin).
11. On 10 February the antibiotics were changed to pivmecillinam after the results of the urine test.
12. On 14 February Mrs O saw a GP while she was on holiday. The GP contacted the Practice to check the results of the urine tests and to see what antibiotics had been given before they prescribed cefalexin.
13. Mrs O says that when she took the cefalexin, all her symptoms went away. She thinks the head and neck pain was caused by the UTI and it should have been diagnosed and treated sooner.
18. 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.
19. Mrs O says the Practice should have diagnosed and treated her UTI much sooner than it did. She explains she had been reporting symptoms since November 2022. She also says the Practice should have tested her urine for a UTI.
20. The NICE guidance explains when a doctor should suspect a UTI. It says typical features include painful urination, passing urine more frequently, a strong desire to empty the bladder, changes in the appearance of the urine, passing urine more often than normal at night and suprapubic (lower stomach) tenderness.
21. The first time Mrs O reported symptoms that suggested a UTI was on 17 January 2023 when she says she had strong smelling urine and was passing urine more often.
22. Before this, Mrs O had reported head and neck symptoms. Our adviser explained that in line with the NICE guidance these are not symptoms of a UTI. This means we have not found anything to say that a UTI should have been diagnosed sooner than it was.
23. On 17 January 2023 the GP diagnosed Mrs O with a UTI and prescribed a course of antibiotics (nitrofurantoin 100mg one capsule twice a day for three days). Mrs O says the Practice should have tested her urine then.
24. Our adviser explained there are two types of urine testing. Dipstick testing that can be done at the Practice and laboratory testing where a urine sample is sent away for more tests.
25. The NICE guidance says the first time someone shows UTI symptoms, treatment can be based on the symptoms alone without doing urine testing. And, it explains that dipstick testing should not be used in women aged over 65 as the results are often unreliable with this patient group. The Practice’s decision not to do testing at this time was in line with this guidance.
26. Our adviser says the type of antibiotic prescribed at this time (nitrofurantoin) is the usual first line antibiotic for a UTI and was prescribed in line with the NICE guidance. Mrs O next reported symptoms of a UTI on 7 February. The Practice prescribed antibiotics (nitrofurantoin) and took a urine sample for laboratory testing. On 10 February the antibiotics were changed to pivmecillinam after the results of the urine test.
27. The GP that Mrs O saw while she was on holiday prescribed a third type of antibiotic (cefalexin). Mrs O says that after this all her symptoms, including her head and neck pain, went away. She would like to know if the GP at the Practice could have used a different antibiotic sooner.
28. We spoke to our adviser about this and they say the Practice’s prescriptions of nitrofurantoin followed by pivmecillinam when it got the urine test results, was in line with the NICE guidance. This guidance explains the first and second choice antibiotics that should be prescribed.
29. Our adviser says the cefalexin antibiotic was only prescribed after consultation with Mrs O’s GP about what they had already tried. Our adviser says this antibiotic would not be used as a first or second choice as it can increase the risk of getting clostridiodes difficile (a type of bacteria that can cause diarrhoea).
30. We understand this was a difficult time for Mrs O, she was unwell for a long time and worried there was something seriously wrong with her. We hope this information gives her reassurance that the Practice acted correctly when treating her symptoms.
1. We have carefully considered Mrs O’s complaint about a GP Practice in the Bradford area (the Practice). We understand how important this complaint is to Mrs O and we are sorry to hear that she experienced head and neck pain for such a long time.
2. We have not seen any signs that anything went wrong with how the Practice diagnosed and treated Mrs O’s urinary tract infection (UTI).