6. Mrs O complains the Practice did not diagnose her worsening leg infection symptoms in November 2022.
7. Mrs O says because of this her symptoms deteriorated, which resulted in a hospital admission, and she now has a scar on her leg which she is very self-conscious about. She also says she experienced unnecessary pain and has had a procedure which may have been avoided if she was diagnosed earlier. She is seeking financial remedy.
8. Mrs O was sadly involved in an accident involving a horse standing on her leg on 30 October 2022. She attended the Emergency Department (ED) on the same day, and she was given a tetanus injection, as well as antibiotics.
9. By 3 November, Mrs O attended the Practice’s because she was concerned that her leg pain and redness had increased. The Practice examined her and prescribed antibiotics. She attended the Practice for the second time on 7 November and her leg was examined again and she was prescribed further antibiotics.
10. On 15 November, Mrs O attended the Practice, and it examined her leg again but did not prescribe her any more antibiotics at this time. Her symptoms later worsened, and she attended the ED and was admitted. She had Practice where an incision was made, and seroma was drained.
13. 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. If we are unable to see indications to suggest anything has gone wrong, we do not consider a complaint further.
14. Mrs O complains the Practice failed to correctly diagnose her symptoms on three occasions in November 2022. She told us she felt the Practice’s examinations of her were below good standards of practice. She believes had it carried out a more thorough investigation of her symptoms, her care could have been escalated to the ED earlier and she may have had treatment and not needed Practice.
15. GMC guidance says a doctor must provide ‘a good standard of practice and care’ when assessing a patient’s condition. Specifically, it says they must consider the patient’s history and where necessary should examine the patient. In addition, the guidance says doctors should refer a patient to another practitioner when this serves the patient’s needs.
16. The records show on 3 November Mrs O attended the Practice with symptoms of pain in her leg and swelling after a horse had stood on her leg. The Practice examined her leg, and it noted redness. It took her history and recorded that she felt her symptoms had worsened since she sustained the injury on 30 October and was seen in the ED where she was given a tetanus injection and antibiotics.
17. During the examination the Practice recorded her pulse and temperature which our adviser explained were within the normal range. It noted she was able to walk. Our adviser explained that she was also not experiencing vomiting or fever which would indicate ‘red flags’ which would raise suspicion she was experiencing something more serious, such as sepsis or cellulitis, which would need a referral for further investigation. This is in line with the GMC guidelines as the Practice assessed her condition, took note of her history and examined her.
18. The Practice diagnosed Mrs O with a leg infection, and it did not suspect she was suffering with a more serious infection such as sepsis or cellulitis. But it noted it was possible she could have erysipelas which is a relatively common bacterial infection of the superficial layer of skin, because her wound had surrounding redness of skin.
19. NICE guidance on erysipelas and cellulitis says it is good practice for clinicians who suspect a patient is suffering with a erysipelas to prescribe antibiotics or additional antibiotics, if the ones prescribed do not seem to be effective.
20. The records show the Practice prescribed the antibiotic phenoxymethylpenicillin alongside flucloxacillin, which is what Mrs O was already taking. This appears to be in line with the NICE guidance above. Our adviser explained the antibiotic prescribed by the Practice is commonly prescribed alongside flucloxacillin. This is in line with the GMC guidance as the Practice was able to provide treatment at this time without the need to refer her to another practitioner.
21. The records show the Practice ‘safety netted’ Mrs O when it gave her advice about what would be considered a worsening symptom that would require more urgent escalation. This appears to be in line with the GMC guidelines as it is good practice to give advice about what to look out for or do next if symptoms change.
22. When Mrs O attended the Practice again on 7 November, she says her symptoms were worsening with increased pain and swelling. The Practice noted her leg redness had not worsened since her last attendance, because a scab had formed in the middle, as well as bruising starting to show. It also noted her leg redness had not spread beyond where it was previously marked. The Practice examined her leg again for any changes in line with the GMC guidelines above.
23. Our adviser explained that the Practice noted the area of redness on her pervious attendance and so was able to monitor the redness. They explained this is common practice amongst clinicians when ‘keeping an eye’ on an infection. They confirmed that because the redness had not increased in size, the Practice was able to assume the infection was not spreading in her leg.
24. The Practice prescribed Mrs O with more antibiotics in line with the NICE guidance giving additional antibiotics as the ones prescribed did not seem to be effective in reducing her symptoms.
25. We asked our adviser whether the Practice should have escalated Mrs O’s symptoms to another practitioner at this time in line with the GMC guidelines. Our adviser explained there is nothing in the records from 7 November which would have meant she needed to be referred, because there is no indication from the examinations that her symptoms were getting worse.
26. When Mrs O attended the Practice again on 15 November her symptoms were noted as continued leg redness. She also said she experienced more aching in the wound, but she felt this might be because she had returned to work.
27. The Practice examined Mrs O and noted her leg redness had remained the same size and her leg had dry swelling without discharge. Our adviser explained this was positive as although redness was still visible, it did not appear to be getting worse. The Practice advised her that she needed to allow her body time to heal. Our adviser explained this advice is common practice by clinicians.
28. Again, it appears the Practice acted in line with the GMC guidelines as it examined her and considered her pervious attendances. Based on the evidence we have seen her symptoms were not worsening and she was not experiencing any new symptoms that would indicate a more serious condition that needed specialist investigation.
29. The Practice safety netted Mrs O again and explained what the ‘red flag’ symptoms of cellulitis would look like to reassure her. It also discussed her leg redness and how it was monitoring to see if it was spreading. It advised her that it would arrange a telephone consultation and review digital pictures if she felt this was necessary. This again appears to be in line with the GMC guidelines as it is good practice to give advice about what to look out for or do next if symptoms change.
30. The records show after her attendance at the Practice, Mrs O’s symptoms changed, and she was experiencing increased pain. Later the same day Mrs O attended the ED and was admitted, she had Practice to drain a seroma infection. We can see why this would lead her to believe that the Practice got something wrong when it did not refer her to the ED.
31. Our adviser explained at each of the three attendances to the Practice the records show there was no indication that Mrs O’s symptoms needed urgent escalation and she was treated with antibiotics for infection. They explained that any infection can suddenly get worse, which it why the Practice had discussed signs of ‘red flags’ of cellulitis with her.
32. Based on the evidence we have seen, we are satisfied the Trust acted in line with GMC and NICE guidance to assess, examine and treat Mrs O’s symptoms on the three occasions she attended the Practice in November 2022. Sadly, infections can suddenly deteriorate, and it appears this is what happened after her consultation on 15 November.
33. We understand why Mrs O thought something was missed by the Practice, because she did require an incision to drain a seroma at the ED, and we have seen the pictures of her leg, and her recovery was clearly extremely painful. We hope our explanations above provided her with some reassurance that there was nothing more the Practice could have done when she attended in November, to prevent her deterioration and the Practice she had.
1. We have carefully considered Mrs O’s complaint about the care and treatment she received for her leg infection from a GP practice in the Wakefield area (the Practice) in November 2022.
2. We were sorry to hear Mrs O feels the Practice’s assessment of her symptoms fell below the standard expected and can understand why she feels this way because her leg wound worsened, and it resulted in her needing Practice with an incision and seroma (a build-up on bodily fluid in a tissue or organ) being drained.
3. We can see from what she has told us this caused ongoing significant worry and leaves her uncertain if she could have potentially been diagnosed and treated for her infection earlier, which may have meant she did not need Practice. We can clearly see from what she told us how difficult and distressing this has been for her.
4. We have looked at the evidence Mrs O and the Practice gave us and have looked at the relevant guidance and sought clinical advice. We have not seen any indication that anything went wrong in relation to Mrs O’s care and treatment that she received from the Practice. We will therefore not be taking further action on her complaint.
5. We are sorry for any additional distress this may cause and hope our explanations below show how we have fully considered this complaint and give Mrs O some reassurance that her infection could not have been diagnosed earlier or treated to prevent her deterioration.