A practice in the Telford and Wrekin area

4. Mr H complains that his GP failed to recognise and tell him about the potential side-effects that prescribed heart medication (bisoprolol) may be having on his mental health. He also complains that he had phone appointments, rather than face-to-face. Mr H believes the GP may have picked up on a link between his mental health and the medication if he was seen in person.

5. Mr H says he lost three years of his life because of the impact of bisoprolol on his mental health. He says he struggled to sleep and concentrate and was confused which led to ‘incidents’ at work. Mr H says he had hallucinations and nightmares. He puts all these issues down to the breakdown of a 20-year relationship, which has caused more stress and financial difficulties.

6. Mr H wants a financial payment and an apology.

7. In March 2019, Mr H’s cardiologist (heart doctor) prescribed bisoprolol for management of a heart condition.

8. Since then and up to October 2021, Mr H tells us he experienced depression, anxiety, confusion and interrupted sleep including nightmares. He feels this was a direct result of the medication.

9. In October 2021, Mr H says he stopped taking bisoprolol. He told us that many of the issues stopped, but also that unfortunately, he continues to have depression. Mr H joined another GP practice after raising these concerns.

10. Mr H saw his GP in January 2020 for his low mood. He had more appointments throughout 2020 and 2021. The Practice says he reported issues with his mood that were potentially linked, at least in part, to relationship and financial issues.

11. In its response to his complaint, the Practice explained why it was doing more phone appointments during the pandemic. It also explained that, given his history of mental health troubles and what was happening in his life at the time, it did not see a reason to look for other causes of his ongoing symptoms. It did say it would remind its GPs of the possibility of this type of medication causing depression.

13. Before we decide if we should investigate a complaint in more detail, 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. If what happened fell short of what should have happened, we call this a failing. When we see signs of a failing, we next look at whether it had a negative impact on the person. If we think it did, we look at what, if anything, the organisation has done to try to put things right.

14. If we think the failings had an impact that has not been put right, we will usually investigate in more detail. There are times where we do not think we will be able to reach fair, evidence-based decisions. When this happens, we will usually not investigate further.

15. We understand Mr H’s concerns and what he has gone through. Having carefully considered matters, we do not think it is possible to be able to decide that the medication was the cause of his mental health issues.

16. This is because it seems that Mr H has a history of mental health issues. He has told us that he has had problems with his mental health more recently. This means it would be very difficult, if not impossible, to say that the problems he had from 2019 to 2021 were down to the bisoprolol. We also know that Mr H had personal and financial issues at the time. We realise there is a link here, but this does not mean the bisoprolol was the cause.

17. British Heart Foundation studies show that 68% of people with heart conditions were affected mentally, emotionally or psychologically. Of those who said their heart condition had affected their emotional wellbeing, anxiety was the most common symptom. 51% said they had felt low, depressed or tearful. So it may be that some of his problems were down to this.

18. We do not know, even when considering Mr H’s symptoms, that his cardiologist would have recommended for him to stop taking bisoprolol. The benefit of the medication on his heart condition may have been more than any possible negative impact on his mental health.

19. In summary, we think there were a lot of potential reasons for Mr H’s mental health problems. We cannot say that bisoprolol was the major factor in his mental health getting worse. We are not critical of the GP for not picking up on the issue and it is unlikely that the outcome would have been any different if Mr H had been seen in person. We accept what Mr H told us and our decision is a reflection of the fact that all of the factors involved mean that we cannot reach a firm conclusion. We recognise this will be a disappointing decision for Mr H.

20. Mr H told us he is now looking to move on with his life and we wish him well with this.

1. We have carefully considered Mr H’s complaint a GP practice in the Telford area (the Practice).

2. We have decided not to investigate because it is not possible for us to say that Mr H’s mental health issues were caused by the heart medication he took, or that GPs should have identified a possible link between the two.

3. We recognise Mr H has had a difficult few years and our decision is not intended to take away from that.