A practice in the Suffolk area

4. Mrs A attended a medication review at the Practice on 20 May 2022. She said the doctor who she saw at first was not qualified enough to do a diazepam review. She said a second doctor, who joined the appointment later, did not introduce themselves and belittled and humiliated her. She said they declined to prescribe diazepam.

5. Mrs A said on 24 May another doctor agreed a treatment plan with her which included diazepam, but that they later declined to prescribe it. She said the doctor did not discuss it with her.

6. Mrs A explained these events caused her significant anxiety that affected her OCD which she was able to manage on her own before. She said the Practice’s actions and attitude ‘broke’ her and she became suicidal. She said this meant she was not able to safely care for herself which led to her family having to care for her and this was distressing for them.

7. Mrs A wants an apology and service improvements.

8. Mrs A has long-standing mental health conditions of anxiety and OCD. She takes, among other medication, diazepam to control her anxiety.

9. On 20 May 2022, Mrs A had an appointment for a medication review. The Practice declined to prescribe her diazepam but arranged another appointment to discuss it.

10. On 24 May, a GP had an appointment with Mrs A. They discussed the risks of addiction to diazepam but recognised it helped Mrs A cope. They prescribed her diazepam. The GP also made some changes to her other medication.

11. In June and July, Mrs A requested more diazepam and the GP offered her alternatives. When Mrs A did not want these, they prescribed her diazepam. On 21 November, the GP agreed to a repeat prescription of diazepam every six weeks.

Medication review on 20 May 2022

15. Before we investigate further, 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.

16. We have done this and have not seen any signs that something has gone wrong with the medication review on 20 May. This is because the Practice seems to have acted in line with the guidelines.

17. Mrs A told us the doctor she saw on 20 May was not qualified enough to deal with a diazepam review. We are very sorry to hear she had concerns about this and recognise how distressing this was for her.

18. The Practice said a GP registrar saw her and that they were later joined by a GP. This was because the GP registrar felt they were not experienced enough to manage the consultation on their own.

19. The GMC guidance says a clinician must recognise and work within the limits of their competence.

20. We recognise it is common practice for doctors in training to lead appointments with patients. We think the GP registrar would not have known before the appointment that they may need help. We note they recognised this during the appointment and requested the supervising GP’s help.

21. We think this is in line with the GMC guidance. This is because the GP registrar asked the supervising GP for help when they found they needed it. We see no reason why Mrs A should not have seen the GP registrar at first to review her medication.

22. Mrs A told us the Practice declined to prescribe her diazepam as before. The Practice said it did not prescribe her diazepam because it was concerned about the combination of medication Mrs A was taking at the time.

23. The GMC guidance says a clinician must prescribe drugs, including repeat prescription, only when they are satisfied that the drugs serve the patient’s needs. It says when a clinician is treating a patient, they must consider their views.

24. The NICE guidance says anxiolytics should not normally be used to treat OCD. Anxiolytics are medications that can treat anxiety symptoms. Diazepam is an anxiolytic.

25. Mrs A started taking diazepam because of the anxiety she was experiencing. We do not doubt how distressing it must have been for Mrs A to be told the Practice had concerns about a prescription that she found helpful.

26. We note the Practice highlighted the risks of diazepam in combination with other drugs Mrs A was taking. It recognised Mrs A said diazepam helps her cope. It noted she declined a referral to psychiatry, getting advice from psychiatry and a mental health review.

27. Mrs A agreed to have an appointment with a GP she knew. The notes recognised she had enough diazepam to manage until then. The appointment took place on 24 May.

28. We think the Practice considered the prescription of diazepam in line with the GMC and NICE guidance. This is because diazepam is not normally used to treat OCD. The clinicians did not think it was safe for Mrs A to continue taking it as before. Our adviser also told us it is better to avoid ongoing use of diazepam.

29. As the Practice could not reach an agreement with Mrs A about her medication, it agreed to have another appointment with her. This time with a GP who had known her for many years. This is in line with the GMC guidance because the Practice considered Mrs A views.

Doctor’s attitude on 20 May 2022

30. Before we investigate further, we look at whether our investigation can reach a satisfactory conclusion. We have done this and can see the Practice has already apologised, which is what we would expect it to do.

31. Mrs A and the Practice have different views of what was said during the appointment. Mrs A said the GP who joined the appointment belittled and humiliated her. The GP disagreed.

32. Mrs A described to us the GP’s threatening body language and the rude comments they made about her condition. The GP said they tried to be empathetic but transparent in their explanations. They apologised if their intentions were misinterpreted and for the distress this had caused.

33. We do not underestimate how difficult this appointment was for Mrs A and how long it continued to affect her. We do not doubt her recollection of what happened and what was said.

34. We think it is unlikely that we would be able to achieve more from investigating this complaint further. There is conflicting evidence about what happened during the appointment. And, how one person sees behaviour or words is subjective and we would not be able to say how the GP intended to come across.

35. We also note that despite the difference of opinion, the GP apologised and this is what we would have expected to happen. We will not investigate this further because we do not think we could achieve anything more. We recognise Mrs A may find this disappointing.

Stopping diazepam and communication

36. Mrs A told us that on 24 May a doctor agreed with her a treatment plan which included diazepam. She said they later stopped it without discussing it with her. The Practice said it tried to encourage her to try alternatives which she declined.

37. The GMC guidance says a clinician must give the patients the information they want or need to know in a way they can understand.

38. We recognise that on 24 May the GP agreed with Mrs A to prescribe diazepam on request. This meant diazepam had to be approved by a clinician every time Mrs A requested it.

39. The Practice issued a prescription for diazepam on 24 May, 14 and 23 June and 22 July, on Mrs A’s request. We have seen the Practice offered alternatives and made changes to other medication Mrs A was taking to lower the risk.

40. On 21 November, the Practice agreed with Mrs A to prescribe diazepam every six weeks. This repeat prescription started that day. We have seen no evidence to show the Practice stopped prescribing diazepam at any point.

41. We have also seen that Mrs A was involved in the treatment plan decision-making at all times. We have seen the Practice explained risks to her and worked with her to lower the dose. The notes also recognise that on 21 November she expressed she was happy with the repeat prescription.

42. We think this is in line with the GMC guidance. This is because the Practice communicated and agreed all changes to medication with Mrs A while balancing the risks of prescribing diazepam. We have seen no sign of a failing here.

43. We recognise Mrs A may find our decision disappointing. We recognise how much distress she experienced because of these events. We hope she will find at least some reassurance in our above explanation.

1. We have carefully considered Mrs A’s complaint about a GP practice in the Suffolk area (the Practice). We understand her concerns and are very sorry to hear about how severe her distress was and how severe her obsessive compulsive disorder (OCD is a condition where a person has obsessive thoughts and compulsive behaviours) and anxiety are.

2. We have seen no sign that anything went wrong with the overall review and prescription of diazepam (medication that can be used to treat anxiety). We have also seen no reason to suggest that Mrs A should not have first seen a GP registrar on 20 May 2022.

3. We think a further investigation into the GP’s attitude would not show anything more because of the conflicting evidence. It is also unlikely to lead to any further action because the doctor has already apologised.