A practice in the Kent area

4. Mrs L, represented by her daughter, Miss L, complains about a practice in the Kent area (the Practice) not processing her rheumatology referral on 7 February 2023.

5. Mrs L says she has had to apply for PIP and cut down her hours at work due to the pain in her hands. She adds due to being unable to work as many hours this has significantly impacted her mental health.

6. Mrs L says at the moment she is not receiving any treatment for her Raynaud’s syndrome and her pain is worsening.

7. Mrs L is looking for service improvements, an apology and financial remedy.

8. On 7 February 2023, the Practice sent a rheumatology referral following an appointment with Mrs L.

9. On 6 March 2023, the Practice chased this referral and asked for it to be expedited.

10. On 27 March 2023, Mrs L submitted an e-consult request for an appointment due to pain in her hands and arms and asked if the referral has been sent. The Practice reviewed this and booked a telephone appointment for 19 April 2023.

11. On 28 March 2023, Mrs L contacted the Practice by telephone and a member of staff completed an e-consult for her. The e-consult said Mrs L was not happy with her appointment being on 19 April and the pain in her hands and arms was affecting her mental health.

12. The Practice therefore cancelled Mrs L’s appointment on 19 April 2023 and made a new face to face appointment with a paramedic.

13. On 31 March 2023, Mrs L attended her appointment with the paramedic. She told them was unhappy she had not heard anything following the referral. The paramedic confirmed the referral has been sent.

14. On 3 April 2023, Mrs L contacted 111. Mrs L was contacted by an out of hours surgery who said she could attend A&E, but Mrs L declined this and was told to contact her GP in the morning, but if symptoms worsened to go to A&E.

15. On 6 April 2023, Mrs L’s daughter completed an e-consult for her to discuss the referral and pain management.

16. The Practice booked an appointment with a doctor for 28 April 2023.

19. Before we decide if we should conduct 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 found any indications that something has gone wrong.

20. Miss L has raised concerns on behalf of her mother, Mrs L, about the Practice not processing her rheumatology referral appropriately.

21. We understand following an appointment on 6 February 2023, the Practice agreed to send a referral to a rheumatology specialist due to the pain Mrs L was suffering in her hands.

22. Miss L believes this referral was not appropriately sent by the Practice and therefore, her mother is still suffering with the pain. We understand her and her mother chased the Practice about this referral on 27 February, 27 March and 6 April.

23. Within the Practice’s response dated 1 June 2023, it says following the request to prioritise her referral, the referrals dated 7 February 2023 and 7 March 2023 were printed and sent again.

24. We can see from Mrs L’s medical records the referral was sent and dated 7 February 2023 and this was chased and expedited by the Practice on 7 March 2023.

25. The GMC guidance says, ‘You must recognise and work within the limits of your competence.’ It also goes on to say a clinician should, ‘promptly provide or arrange suitable advice, investigations or treatment where necessary’ and ‘refer a patient to another suitably qualified practitioner when this serves the patient’s needs.’ We therefore consider it was appropriate for the Practice to refer Mrs L for further care and treatment by a specialist.

26. We have been unable to see any evidence the Practice did not appropriately send the referral following Mrs L’s appointment on 7 February 2023. We are sorry to hear she has still not received an appointment following this referral and understand how distressing and upsetting this will be for Mrs L.

27. We therefore consider there has been no service failing with the Practice sending the referral. We will take not further action on this complaint.

1. We have carefully considered Mrs L’s complaint about the Practice. We have seen no indication that anything went seriously wrong.

2. Miss L has raised concerns her mother’s rheumatology referral was not processed correctly and she has still not received an appointment to see a specialist. We understand how frustrating this has been for both Mrs and Miss L and we are sorry to hear Mrs L has still not received an appointment. Based on the information we have seen we think the Practice appropriately processed the referral from 7 February 2023 and then chased this on 7 March 2023. Therefore, we do not consider the Practice has done anything wrong here.

3. We are very sorry to hear Mrs L has still not received an appointment following this referral. We understand how stressful this is for her considering the pain she experiences daily. We hope this report reassures Mrs L the Practice have appropriately referred her to a rheumatoid specialist.