4. Mr O complains the Practice and the Trust failed to diagnose him with a stroke in October and November 2021.
5. Mr O says the delay in diagnosis resulted in weakness on his right-hand side that has also affected his speech. He says this affects him both physically and emotionally. He wants the Practice and the Trust to accept failings and make a payment to him.
6. On 1 October 2021, Mr O contacted the Practice because he was experiencing numbness in his right hand. The GP felt his numbness might be due to damage to the nerve. It referred him to the orthopaedics department at the Trust for a hand surgeon’s opinion.
7. Mr O went back to the Practice on 29 October because his symptoms had got worse. The Practice wrote a letter to speed up the orthopaedic appointment. It also decided to organise a chest X-ray to rule out a pancoast tumour (cancer that starts in the top part of the lung) because Mr O was an exsmoker.
8. Mr O saw an orthopaedic surgeon at the Trust on 18 November and they referred him for nerve conduction study (NCS) that measures how fast an electrical impulse moves through your nerve.
9. On 28 November, Mr O attended the emergency department (ED) at the Trust because his symptoms had worsened. CT scan results showed he had experienced a transient ischaemic attack (TIA or mini stroke). The noticeable symptoms of a TIA usually end in less than an hour.
10. After this, Mr O attended more appointments and had an endarterectomy, a surgical procedure to remove fatty deposits that cause narrowing of the artery.
11. On the 26 May 2022, Mr O was diagnosed with ischaemic stroke (when blood vessels leading to the brain become blocked), carotid artery disease (when the arteries that carry blood to the brain become blocked) and right-hand weakness – all likely from the stroke.
The Practice 15. Mr O complains the Practice failed to diagnose him with a stroke while he was under its care in October 2021.
16. The NHS website says the signs and symptoms of a stroke vary from person to person, but usually begin suddenly. As different parts of the brain control different parts of the body, symptoms will depend on the part of the brain affected and the extent of the damage. They include that the face may have dropped on one side, the person may not be able to smile, or their mouth or eye may have drooped. The person also may not be able to lift both arms and keep them there because of weakness or numbness in one arm and their speech may be slurred or garbled.
17. Mr O’s medical records show he attended the Practice on 1 October and the GP noted his symptoms as right-hand weakness over a three-week period. Our GP adviser explained as Mr O’s symptoms were over a three-week period, this did not suggest a stroke as set out by the above NHS guidelines. His symptoms were not sudden, but developed slowly, which our GP adviser explained is unlike a stroke.
18. There is no suggestion in the records that Mr O had difficulties with speech or any facial weakness at this time or at his next appointment in October. Our GP adviser said this is very uncommon for stroke.
19. GMC guidance says doctors should use specialist knowledge, experience and clinical judgement and the patient’s views and understanding of their condition to identify the options for investigating, treating, or managing the patient’s condition. This includes the option to take no action if appropriate.
20. The Practice seems to have acted in line with this when it thought his symptoms might be due to nerve damage and it completed a referral to the Trust’s orthopaedic department so he could be seen by a hand surgeon for further investigation.
21. When Mr O attended the Practice due to worsening symptoms on 29 October, the Practice wrote a letter to speed up the orthopaedic appointment and organised a chest X-ray to rule out a pancoast tumour. This means the Practice was acting in line with the GMC guidelines to investigate his symptoms further.
22. Based on the evidence we have seen the Practice seems to have acted in line with NHS stroke symptom guidelines and GMC guidelines on getting specialist advice. We have not seen anything to say the signs of a stroke were missed by the Practice in October 2021.
The Trust 23. Mr O complains the Trust failed to diagnose him with a stroke while he was under its care in November 2021.
24. After getting the Practice’s referral, the Trust referred Mr O for a nerve conduction study to investigate further.
25. In October and at the appointment at the Trust in November, Mr O was not experiencing symptoms in line with the NHS guidelines to say he was having a stroke. Our consultant adviser explained Mr O had no symptoms during the consultation in November 2021 to suggest he was having a stroke, because he did not have difficulties with speech or any facial weakness. They explained it is rare for a stroke to present with the isolated symptoms of hand weakness.
26. The National Library of Medicine guidelines say looking at different possible diagnoses is essential in cases that are not typical and should include conditions like a pancoast tumour.
27. In line with these guidelines the Trust did consider different diagnoses like a pancoast tumour. Our consultant adviser also explained that referring Mr O for a nerve conduction study was in line with the GMC guidelines about making further investigations into symptoms.
28. Based on the evidence we have seen, we do not think the Trust missed signs of a stroke.
29. It is understandable from what Mr O has told us that he felt let down by both the Practice and the Trust when later getting a diagnosis of an ischaemic stroke and being advised his hand weakness was probably due to this. This has clearly been a very difficult time for him and we are sorry to hear this.
30. We hope our explanation gives him reassurance that the Practice and the Trust followed the relevant guidelines and did not do anything wrong.
1. We have carefully considered Mr O’s complaint about a GP practice in the Stockport area (the Practice) and Stockport NHS Foundation Trust (the Trust). We are sorry to hear about Mr O’s experience and the impact this continues to have on his physical and mental health. We recognise the stressful time he has had since having the stroke and we do not wish to underestimate how difficult this is for him.
2. We have seen that the Practice and the Trust followed the relevant guidelines in the care it gave Mr O before he got his stroke diagnosis. We do not think anything went seriously wrong and we will not be investigating the complaint further.
3. We are sorry for any upset this decision may cause and hope our explanation below explains how we have reached this decision.