A practice in the Bradford area

4. Mrs O complains about aspects of care and treatment the Practice provided to her on 13 October 2023 when she attended the Practice for a steroid injection in her wrist for carpal tunnel syndrome. She says the GP did not give her a consent form prior to the injection, and they carried out the procedure incorrectly and hit a nerve.

5. Mrs O states she could not use her hand properly for three weeks after the injection and her middle finger is still slightly numb to this date. She says she had three ulcers on her hands where the nerves were damaged which lasted for several weeks, and it took three months to get the feeling back in her hands. She also had to attend the ED twice and the trauma clinic.

6. By bringing her complaint to us Mrs O would like:

• the named GP to be retrained or the Practice to stop administering steroid injections for carpel tunnel syndrome • service improvements, including the Practice to provide patients with a consent form prior to injections • an apology from both the named GP and the practice • Compensation in line with level three of our severity of injustice scale.

7. On 13 October 2023, Mrs O attended an appointment at the Practice. The GP administered a steroid injection to provide pain relief in her right hand for her carpel tunnel syndrome.

8. Mrs O states immediately after the GP administered the injection, her hand went white and became very painful. The GP massaged her wrist to get the blood flowing and advised her to go home, and if her symptoms did not improve to attend the ED.

9. Mrs O attended the ED the same evening. ED staff provided her with morphine and put her arm in a sling. Mrs O says she returned to the ED on three other occasions in the three weeks following the injection.

The GP did not provide Mrs O with a consent form

13. Mrs O complains on 13 October 2023 when she attended the Practice for a steroid injection in her wrist for carpal tunnel syndrome (a condition where there is pressure on a nerve in the wrist), the GP did not give her a consent form prior to the injection.

14. In its response, the Practice explained it informed Mrs O of possible side effects prior to the injection.

15. Mrs O’s medical records show the Practice documented verbal consent prior to the procedure. The records state:

• ‘Consent given for minor surgery procedure. Verbal consent for steroid injection; patient advised about risks of allergy, pain, infection and depigmentation’

16. Our adviser explained there is no national guidance for carpel tunnel injections. They explained some clinicians take written consent, and some verbal, and it is very common to gain verbal consent.

17. GMC guidance on consent states:

• ‘Obtaining a patient’s consent needn’t always be a formal, time-consuming process. While some interventions require a patient’s signature on a form, for most healthcare decisions you can rely on a patient’s verbal consent, as long as you are satisfied they’ve had the opportunity to consider any relevant information’

18. Mrs O was advised she could experience increased pain following the injection, which she did have. Overall, she did unfortunately develop a complication, however our adviser explained this can happen, and she gave consent for the injection in line with GMC guidance. Considering the evidence above, we have not found any indications of failings.

The GP carried out the procedure incorrectly

19. Mrs O also complains the GP carried out the carpel tunnel injection incorrectly and hit a nerve.

20. In its response, the Practice explained it is confident the injection was carried out safely and in line with protocols, but sometimes side effects can happen which the GP informed Mrs O about prior to the injection.

21. The records do not show us the injection technique. Even when the correct technique is used, there is a chance the needle could touch and temporarily injure the nerve, which is what we can see is likely to have happened in Mrs O’s case as she had increased pain and colour change in her hand following the injection.

22. Our adviser explained we will never be able to say if the injection was carried out correctly, it is impossible to comment on technique from the records. Our adviser said even if we were to get more information from the Practice, such as training records, there is no national training requirement or programme for GPs to administer carpel tunnel injections.

23. In this instance, it would not be proportionate for us to carry out further investigation. We will never be able to determine if the injection was carried out correctly. We are unable to reach a balance of probabilities decision about what happened. We hope this does not cause any further upset for Mrs O as this is not our intention.

24. Even if something had gone wrong, in its response, the Practice acknowledged Mrs O experienced side effects and apologised for this.

25. We therefore feel there is no unremedied injustice regarding this element of Mrs O’s complaint as the Practice has acknowledged and apologised for the impact caused. It also informed her that side effects could potentially happen. As above, we are unable to investigate if the injection was carried out correctly as we would not be able to reach a conclusive decision due to the lack of available evidence.

26. We appreciate Mrs O has been through a difficult time. We hope our explanations go some way to reassure her we have taken her concerns seriously.

1. We have carefully considered Mrs O’s complaint about aspects of care and treatment a practice in the Bradford area (the Practice) provided to her. We are sorry to hear how Mrs O was affected by the events that happened.

2. We have seen no indications that anything went wrong in relation to the GP not providing Mrs O with a consent form prior to injection.

3. We have also decided the Practice has done enough to put right the impact of the side effects Mrs O experienced after her injection.