4. Miss P complains that between September 2021 and February 2023 the Practice did not refer her to neurology despite suffering from a loss of function in her left arm and experiencing weight loss.
5. Miss P says this means she was not diagnosed with MND for several years. Mrs P has told us she felt unheard and dismissed. She said she went to the Practice many times knowing she was not well.
6. Miss P would like service improvements and a financial remedy as an outcome for her complaint.
7. On 10 September 2021 Miss P reported to the Practice through an e-consultation that she had lost weight over the past three months. The Practice arranged an appointment for 13 December to discuss Miss P’s symptoms. Miss P then cancelled the appointment and went to hospital. She was diagnosed with an ovarian cyst.
8. On 22 September Miss P had a telephone appointment at the Practice and she discussed her abdominal pain.
9. On 18 November Miss P reported weight loss and the Practice carried out a telephone consultation on 26 November to discuss this. It arranged investigations to look for the cause of the weight loss.
10. On 25 January 2022 Miss P complained of loose stools and weight loss. She reported she had lost over 12kg in the past year, and she wanted to see a private gynaecologist. The Practice arranged a face to face appointment on 1 February to discuss the weight loss and referred Miss P for investigations on the two week wait suspected cancer referral pathway.
11. The next consultation was face to face on 21 June. Miss P complained of insomnia and ear wax.
12. On 24 October the Practice physiotherapist carried out a telephone consultation. In this call Miss P reported muscle wasting and weakness in her arm that had been ongoing for two to three years. The records say she could not lift or grip things and had loss finger dexterity. The Practice attempted to make a face to face appointment but she was unable to attend due to work commitments.
13. A face to face consultation took place on 25 November. At this appointment the GP referred Miss P to Musculoskeletal (MSK) services. MSK carried out investigations and referred Miss P to neurology where she was diagnosed with MND.
17. 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.
18. The Practice said it reviewed the GP and physiotherapist consultations during this period. It said the symptoms Miss P reported could have been signs of a number of potential issues. It said the GP referred her to MSK which then led to a neurology referral. The Practice said this was an entirely correct referral process.
19. NICE guidance on MND says: ‘be aware that MND causes progressive muscular weakness that may first present as isolated and unexplained symptoms. These symptoms may include: • functional effects of muscle weakness, such as loss of dexterity, falls or trips • speech or swallowing problems, or tongue fasciculations (involuntary twitching) • muscle problems, such as weakness, wasting, twitching, cramps and stiffness • breathing problems, such as shortness of breath on exertion or respiratory symptoms that are hard to explain • effects of reduced respiratory function, such as excessive daytime sleepiness, fatigue, early morning headache or shortness of breath when lying down.’
20. We have carefully considered what Miss P has told us and reviewed the GP records for this period. We can see the first time she mentioned muscle weakness in her arm was on 24 October 2022 during a telephone consultation. In this call she mentioned muscle wasting and weakness. These are symptoms of MND as described in the NICE guidance. The guidance does not list weight loss as a symptom.
21. GMC guidance on good medical practice says clinicians must provide a good standard of practice and care. If clinicians assess, diagnose or treat patients, they must assess the patient’s conditions and arrange suitable investigations including referring patients to another practitioner where it will meet their needs.
22. In this case we can see the Practice physiotherapist discussed with Miss P her symptoms and medical history, they recommended a face to face appointment. The records say they offered her an appointment the next day but Miss P could not attend due to work commitments. The face to face appointment took place on 25 November with a GP. Miss P has told us at this time she was worried about losing her job and did not feel able to take time off to attend an appointment.
23. The GP assessed Miss P’s symptoms and considered her medical history. The GP referred her to MSK for investigations. Our adviser said that this was appropriate. We consider this was in line with GMC guidance on good medical practice.
24. We understand Miss P is very concerned she presented to the GP numerous times between September 2021 and February 2023 and the GP did not suspect her symptoms were related to MND. We have not seen evidence to support the view Miss P presented to the Practice with symptoms related to MND until 24 October 2022, as described in the NICE guidance on MND.
25. Over this period, we have seen she presented with various other symptoms including weight loss and abdominal pain. Our adviser said the Practice arranged suitable investigations for these symptoms, including a referral under the two week wait suspected cancer pathway. We consider this is in line with GMC guidance on good medical practice.
26. Miss P has complained the Practice went months without assessing her in person and if it had seen her, this may have led to earlier investigations into her neurological concerns. We have seen evidence the Practice assessed Miss P face to face in February 2022. At this point she was referred for investigations for suspected cancer. There is no reference to her arm or other symptoms that would have indicated MND in the notes from this consultation.
27. We have also seen evidence the Practice carried out a face to face appointment on 21 June 2022. This was related to problems Miss P was having with sleep and wax in her ear. Again, there is no reference to her arm or muscle weakness. Our adviser said each consultation Miss P had, both over the telephone and face to face, were appropriate. We consider the care was in line with GMC guidance on good medical practice.
28. We do not underestimate how frustrating it must have been for Miss P to undergo numerous investigations before a diagnosis was reached. We have not seen indications the Practice should have done anything differently and consider it referred her appropriately throughout. We have not seen indication the Practice should have referred her to neurology any sooner, or that the referral to MSK was inappropriate. For this reason, we will not take her complaint any further.
29. We would like to take this opportunity to thank Miss P for bringing her complaint to us. We hope our decision provides her with some reassurance about the care she has received.
1. We have carefully considered Miss P’s complaint about the Practice. We have decided not to take any further action because we have seen no indication that anything went seriously wrong.
2. Miss P has complained about the care she received from the Practice in the year leading up to her diagnosis of motor neurone disease (MND). She has told us of how she suffered over this period and how devastating it has been to receive this diagnosis. She has told us how stressful the diagnostic process was, and this has caused her to distrust medical professionals.
3. We are truly sorry to hear what Miss P has been through and we hope our work helps give her reassurance about the care she received from the Practice.