3. Mrs U complains the Practice did not send her husband to hospital when it examined his symptoms in July 2022.
4. Mrs U says her husband was not sent to hospital until eight days later and he died soon after this. She says the death of her husband has been devastating.
5. Mrs U would like to know if the outcome would have different.
6. Mr U was in his seventies at the time of the events. He had pre-existing diagnoses including some rare diseases.
7. Mr U went to the Practice after having had two weeks of leg oedema (swelling) and mild dyspnoea (shortness of breath). He was examined, prescribed a diuretic, given advice and told to return for a follow up in a week.
8. Mr U went back to the Practice eight days later because his oedema had not improved. It was noted he looked poorly, was breathless, pale and had a fall the day before. He was admitted to hospital.
9. Mr U died soon after this.
13. Mrs U complains the Practice did not treat her husband appropriately. She says the Practice should have sent him to hospital straight away. Mrs U says she does not know if the outcome would have been different if the Practice had done this.
14. The Practice said that at the first appointment a management plan was agreed based on Mr U’s symptoms. The Practice said its management plan was in line with NICE guidance.
15. The records show that Mr U was seen face to face by a GP. The GP took his history. His symptoms were two weeks of leg oedema and mild dyspnoea.
16. Mr U was examined and the GP recorded his blood pressure, respiratory rate and temperature. The GP listened to Mr U’s chest and reviewed the swelling to his legs.
17. Mr U was given advice to raise his leg and prescribed furosemide (a diuretic used to treat high blood pressure, heart failure and oedema).
18. It was noted that Mr U had recent cardiac (heart) investigations but the Practice did not have the results. The GP noted they would review Mr U face to face in a weeks’ time. They gave safety netting advice and said if his shortness of breath, heart rate or chest pain got worse or he had any new concerns, to call 999 or go to his local emergency department.
19. GMC guidance says:
‘15. You 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 • promptly provide or arrange suitable advice, investigations or treatment where necessary • refer a patient to another practitioner when this serves the patient’s needs’.
20. In line with this guidance, we can see the Practice assessed Mr U’s condition and gave suitable advice. The Practice planned to get the recent cardiac investigation information and see Mr U again the next week.
21. We asked our adviser if this first appointment and the actions taken were appropriate. They agreed a history was taken, an examination was completed and suitable treatment was prescribed. They said it was appropriate for the Practice to get the recent cardiac results and see Mr U again the next week. Our adviser agreed the consultation was in line with GMC guidance.
22. We have considered if the decision to send Mr U home was appropriate. The records show that under diagnosis the Practice noted heart failure and gave a one-week prescription of furosemide.
23. Our adviser explained the symptoms Mr U complained of are features of heart failure.
24. The NHS website says:
‘The main symptoms of heart failure are: • breathlessness after activity or at rest • feeling tired most of the time and finding exercise exhausting • feeling lightheaded or fainting • swollen ankles and legs’.
25. We have reviewed NICE guidance and it explains:
‘1.6.1 Diuretics should be routinely used for the relief of congestive symptoms and fluid retention in people with heart failure, and titrated (up and down) according to need following the initiation of subsequent heart failure therapies’.
26. In line with NICE guidance, we can see the Practice prescribed a diuretic (furosemide).
27. Our adviser explains there is no guidance for GP’s admitting patients to hospital. They explain that Mr U’s examinations results were not abnormal enough to need hospital admission. They agreed the prescription of furosemide was in line with guidance.
28. We have seen in the records that when Mr U went back to the Practice, it noted he seemed quite poorly, pale, was breathless and he had fallen the day before. The Practice noted there had been no improvement after one week of furosemide. Our adviser explains this was a clear deterioration from his last appointment and he was correctly admitted to hospital.
29. We understand Mrs U wants reassurance that her husband had appropriate care and to know if anything could have gone differently, to change the outcome for her husband. We have seen the Practice provided care in line with guidance and we hope this offers some reassurance to Mrs U that it did not do anything wrong.
1. We have carefully considered Mrs U’s complaint about a GP practice in the Warrington area (the Practice). We have seen it provided care and treatment to her husband, Mr U, in line with standards and guidance.
2. We understand the death of a partner is devastating. It is natural to have unanswered questions and be concerned about the care a loved received. We know this complaint is very important to Mrs U. We are sorry to hear of her experience.