14. 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 something went wrong.
15. Mr D complains the Practice did not take appropriate action when his father reported chest pain and shortness of breath during a GP telephone appointment on 14 December 2021. He says a GP should have visited him at home, arranged for him to go to hospital or informed a family member of his condition.
16. In response to Mr D’s complaint, the Practice said Mr F reported symptoms that had been present for several months and were gradually worsening. This being feeling tired and short of breath on exertion. The Practice said he had been seen by a GP two weeks earlier during a home visit.
17. The Practice said, as the symptoms were longstanding and he had recently been seen face-to-face, there was no indication he needed an emergency review. It said recent blood tests had shown he had mild anaemia and the most common symptom of this is shortness of breath.
18. The Practice said the GP arranged for further blood tests to try and identify the cause of the anaemia. It said the plan was to arrange another GP home visit once the results of these further blood tests were back.
19. The Practice said Mr F had a diagnosis of heart failure but the symptoms he described during the call on 14 December 2021 did not indicate he had severe worsening of heart failure. This being rapidly worsening shortness of breath and shortness of breath at rest.
20. The Practice said heart attacks normally occur suddenly and without any warning symptoms. It said people occasionally experience angina (a type of chest pain caused by reduced blood flow to the heart), but this occurs at rest. It also said Mr F was not experiencing any chest pain at the time of the appointment.
21. Looking at Mr F’s GP records, we can see he first reported breathlessness on 13 March 2020. He said he had been experiencing this for several months and it was slowly getting worse. This prompted the GP at the time to request blood tests and a chest X-ray.
22. The GP also increased Mr F’s furosemide medication (used to treat conditions that have fluid retention and high blood pressure) and prescribed a salbutamol inhaler (used to treat and prevent conditions associated with airways obstruction).
23. Mr F was then seen on 17 March 2020, and he said his symptoms had improved so the GP cancelled the chest X-ray. He was seen on 26 March 2020 and his symptoms were noted to still be settled.
24. Mr F reported shortness of breath on exertion again on 29 April 2020. The GP increased the furosemide prescription further, and his symptoms were noted to be settled when he was seen on 20 May 2021.
25. During the telephone appointment on 14 December 2021, Mr F reported feeling tired and breathless doing activities and said this had been ongoing for several months but was gradually getting worse. The notes say he had no chest pain, indicating the GP specifically asked about this and he denied having such pain.
26. Mr F had recently had a GP home visit on 1 December 2021 as his family had raised some concerns about his memory. The GP had carried out a memory test and arranged for some blood tests. Our GP adviser confirmed the results of these blood tests showed a marked reduction in haemoglobin (red blood cells) indicating Mr F was anaemic.
27. Anaemia is where you do not have enough red blood cells for your body’s needs. The common symptoms include looking pale, feeling tired and weak, not feeling able to do as much exercise as normal, dizziness, feeling faint, feeling short of breath while exercising and heart palpitations.
28. The GP’s notes on 14 December 2021 say these blood test results had been reviewed by another GP who had suggested follow-up blood tests and a review. The GP who spoke with Mr F on 14 December 2021 requested these blood tests and asked Mr F to contact the Practice to book a review with his usual GP once the results were back.
29. Our GP adviser confirmed Mr F’s records show breathlessness was not a new concern and had been an issue for around 18 months prior to the GP telephone appointment on 14 December 2021. They also confirmed Mr F did not raise any new or urgent issues during the appointment.
30. Our GP adviser said the appointment was carried out in line with section 15 of the GMC Good Medical Practice. This says GPs must adequately assess the patient’s conditions, promptly provide or arrange suitable advice, investigations or treatment and refer a patient to another practitioner when this serves their needs.
31. Our GP adviser said there is nothing in the notes of the appointment to indicate Mr F needed to be seen by a GP face-to-face or referred to hospital. They said there is nothing in the notes to indicate Mr F would very sadly suffer a heart attack only a week later.
32. Our GP adviser also said it was appropriate for the appointment to have taken place by telephone. They said this was in line with the GMC guidance on remote consultations which says they can be appropriate when the patient’s clinical need or treatment is straightforward, they have access to the patient’s records, they can give them all the information they need, and they do not need to examine them.
33. Overall, Mr F’s records show he did not report chest pain during the telephone appointment. They also show breathlessness was not a new issue and it had been successfully managed with medication for around 18 months. We also note feeling tired and breathless are symptoms of anaemia which recent blood tests had shown Mr F had.
34. This means we have not seen any indications something went wrong with the appointment on 14 December 2021. We will therefore not be considering Mr D’s complaint any further. We sincerely hope our consideration brings him and his family some comfort and reassurance about the Practice’s care and treatment.