12. To 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.
Referral to the long COVID clinic 13. Miss Q says she asked the Practice to refer her to the long COVID clinic in April 2021 and complains it only did so in September 2022. She feels the Practice did not acknowledge how severe her condition was and missed opportunities to get her specialist help sooner.
14. The NHS has published information online about the long-term effects of COVID-19. It says, ‘Your doctor will ask about your symptoms and the impact they're having on your life. They may suggest some tests to find out more about your symptoms and rule out other things that could be causing them.’
15. GMC guidance sets out a doctor should assess a patient’s condition by taking account of their history and symptoms, and examine the patient where necessary. They should provide or arrange suitable advice, investigations or treatment promptly when necessary. They should refer a patient to another practitioner when this serves the patient’s needs.
16. The Practice’s complaint response explained Miss Q first mentioned having COVID-19 in September 2021. The GP initially gave advice on how to manage her symptoms, and told her they often get better with time.
17. In March 2022 Miss Q reported her condition had not improved. The GP organised blood tests and a chest X-ray. It explained these were necessary as the long COVID service would not accept a referral until the GP had investigated other potential causes of the symptoms.
18. The Practice said Miss Q’s blood test results showed low vitamin B12 and low folate (B9) levels. Both these problems can cause some of the symptoms Miss Q associated with long COVID. The GP arranged treatment for these problems at the time.
19. Miss Q spoke to the GP about her COVID symptoms again in July and August, but these appointments were cut short when she hung up the phone. Following another appointment on 26 September the GP referred Miss Q to the long COVID.
20. The adviser we spoke to explained it was appropriate for the GP to investigate Miss Q’s symptoms further. Guidance on vitamin B12 or folate deficiency anaemia is when the body produces abnormally large red blood cells that do carry oxygen very efficiently. The guidance sets out Miss Q’s symptoms could reasonably have been caused by this problem.
21. When the GP treated Miss Q’s vitamin B12 or folate deficiency anaemia her symptoms remained. Therefore, it was appropriate to consider long COVID might be responsible at this point. When this happened the GP referred Miss Q for specialist care.
22. We consider the GP acted in line with relevant guidance when dealing with Miss Q’s long COVID.
23. We understand Miss Q feels the GP’s actions have affected her health, and acknowledge she feels unheard. We recognise how this has affected her mental health. We hope this has reassured Miss Q the GP took her problem seriously and did what they were meant to.
Blood pressure monitoring 24. Miss Q complains the Practice did not monitor her blood pressure following discharge from hospital in October 2022. Miss Q says the hospital’s discharge letter warned her GP of ‘varying blood pressure throughout admission’ and advised she ‘may benefit from a blood pressure review’.
25. NHS guidance provides information on the NHS Community Pharmacy Blood Pressure Check Service. It says the service supports identifying and preventing cardiovascular disease by doing unplanned blood pressure tests when a GP asks them to. Therefore, pharmacies provide a suitable service to monitoring someone’s blood pressure on behalf of a GP.
26. The Practice’s response explained it was unsurprising Miss Q’s blood pressure was variable during her time in hospital because she was unwell. A GP had considered the blood pressure readings Miss Q had taken at home in April 2021. These readings showed the ‘true measure’ of her blood pressure. As her readings were perfect they took no further action.
27. Our adviser explained Miss Q’s blood pressure in April was 107/72, which was very different to her blood pressure whilst in hospital in October 2022. During her time in hospital her blood pressure was recorded as 196/88 and 178/91, which was very high. On 21 November the Practice advised her to go to the pharmacy and check her blood pressure.
28. The adviser explained the GP was aware Miss Q’s blood pressure in hospital was very different to normal. It was reasonable and appropriate to recommend Miss A visit a pharmacy and check her blood pressure.
29. The Practice directed Miss Q to a service recommended by the NHS for monitoring blood pressure. Therefore, we consider it gave her reasonable advice in response to the hospital’s letter advising the GP they might wish to review Miss Q’s blood pressure.
Acquired dyslexia referral 30. Miss Q complains the Practice did not refer Miss Q for support with her acquired dyslexia. When dyslexia develops later in life tied to brain illness or injury, it is called acquired dyslexia. The Practice explained there is no NHS service to help with acquired dyslexia.
31. GMC guidance sets out doctors should ‘adequately assess the patient’s conditions, taking account of their history’. They are also expected to refer patients to another practitioner if this best serves the patient’s needs.
32. Miss Q contacted the Practice on 20 July 2022 and asked for a specialist referral for an assessment of possible dyslexia following a transient ischemic attack (TIA). A TIA is commonly known as a ‘mini-stroke’, and is when blood supply to the brain is disrupted. TIAs can cause long-term effects on how someone’s brain works.
33. Miss Q attended the Practice on 16 September and the GP referred her to the neurologist for help with her dyslexia. A neurologist specialises in conditions affecting someone’s brain.
34. The adviser explained there is no specific NHS service for dyslexia. The best pathway for Miss Q to be assessed and diagnosed was with a neurologist. They would be best positioned to refer Miss Q to the appropriate neuropsychologist clinic. A neuropsychologist specialises in changes in thinking and behaviour associated with a brain condition.
35. We consider the GP referred Miss Q to the most appropriate service in line with guidance. Although nothing went wrong with the GP’s actions this does not take away from the fact Miss Q felt unheard, and we understand how upsetting this has been for her. We also acknowledge she continues to live with her acquired dyslexia.