A practice in the Hertfordshire area

3. Miss A complains that in February 2024 the Practice did not give her results for an ANA test.

4. Miss A says this has caused her stress and anxiety. She felt she had to move Practice and has not had the ANA result which she believes will mean she gets the correct referral. She is still unwell with underlying symptoms. In May 2024 she had peritonitis (inflammation of the abdomen) with an unknown cause which she believes possibly could have been prevented if she had seen a rheumatologist. Whilse she was in hospital she was nil by mouth for two weeks and developed a blood clot which has now moved to her lung.

5. Miss A is looking for the Practice to make service improvements to prevent these failings from happening again.

6. Miss A had two private ANA tests in 2023, both came back positive and suggested she see her GP for clinical assessment. She had persistent symptoms which she believes is due to an undiagnosed autoimmune condition (a condition when someone’s immune system attacks their own body).

7. She approached the Practice for an ANA test and clinical assessment in January 2024.

11. 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.

12. GMC guidance says doctors must promptly provide or arrange suitable advice, investigations or treatment where necessary. It also states doctors must consult colleagues where appropriate. Our adviser did not identify any more-specific guidance relating to this complaint.

13. The Practice ordered several blood tests on 16 January to investigate Miss A’s concerns. This included an ANA test.

14. On 1 February the laboratory returned results for her extractable nuclear antigen (ENA) antibody level and dsDNA binding antibody level (an antibody test usually used to check for lupus and some specific autoimmune conditions). Both of these tests came back normal.

15. Miss A queried this result on 9 February. On the same day the Practice contacted the clinical scientist at the laboratory to ask if it would also receive the ANA result, and whether the ENA and dsDNA results are more clinically relevant than the ANA result. It also told Miss A it was doing this.

16. The clinical scientist responded on 14 February. They said the Practice would not also get the ANA result. They explained that ANA is a basic screen, and that ENA and dsDNA have a higher specificity which provides them with more information about specific antibodies in a lot of autoimmune conditions. The Practice shared this information with Miss A.

17. There is not much NHS information available on ANA tests, but what there is also supports the Practice’s actions. For example, the South Tees Hospitals NHS Foundation Trust information page on ANA tests explains the ANA test is used as an initial screen to assess the need for more-specific tests. It explains the more-specific tests are ENA and dsDNA antibodies. It explains that if an ANA test comes back positive, a ENA and dsDNA test is normally the next step.

18. We see no indication the Practice did not follow GMC guidance. It referred Miss A for the ANA blood test to investigate her concerns. When the test came back not as expected, it consulted the appropriate specialist colleague to check and followed their guidance. The Practice also communicated this information to Miss A.

19. We do not see any indication of a failing in the Practice’s actions here so we will not investigate this complaint any further. We understand Miss A is concerned she did not get an ANA specific result, we hope our explanation has been reassuring.

1. We have carefully considered Miss A’s complaint about the Practice. We appreciate Miss A has felt anxious and stressed about not receiving her antinuclear antibody (ANA) test result.

2. We see no indication of any failings in the Practice’s actions. We will therefore take no further action on this complaint. We explain our decision in detail below.