Echocardiograms
23. 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.
24. Mr J says in 2010, the Trust cardiology department told him a repeat echocardiogram should take place in two to three years.
25. Mr J said he had been having two yearly ECGs between 2010 and 2019/2020. He further explained the Practice and Trust cardiology team arranged the appointments between them. Mr J says it was the joint responsibility of both the Practice and the Trust to arrange the appointments.
26. Mr J explained the last time an echocardiogram had taken place was had during 2019 or 2020. He says it is understandable the appointments lapsed during the COVID-19 pandemic; however, the Practice did not request them to continue.
27. The Practice response dated 16 August 2024 says it reviewed Mr J’s records and could see he was under the cardiothoracic department at the Trust, and they were arranging the echocardiograms every two to three years.
28. We can see from Mr J’s Practice and Trust records Mr J had echocardiograms in October 2008, May 2009, September 2010 and December 2013.
29. It is unclear when in 2016 a transthoracic echocardiogram took place. There is nothing in Mr J’s Practice or Trust records in 2016 stating it took place. However, it is referenced in a letter sent to the Practice by the Trust in July 2024 that an echocardiogram took place in 2016, but it does not give any results.
30. In June 2017 Mr J was placed on the waiting list for atrial fibrillation ablation using the cyrobaloon method under sedation. Due to his difficult personal circumstances at the time it had been agreed to postpone the procedure.
31. The Trust wrote to the Practice on 3 July 2024. The Trust said due to the impact of the Covid-19 pandemic on elective procedures Mr J had dropped off the NHS waiting list, but it is now in a position to put his atrial fibrillation back on track.
32. Covid-19 is a highly infection respiratory (breathing) disease. In January 2020, the disease spread worldwide, resulting in the COVID-19 pandemic. During the pandemic NHS services were paused to enable resources to be diverted to manage the pandemic.
33. We sought advice from a consultant cardiologist (our adviser) who has over 5 years experience and is suitably qualified to advise on this case.
34. Our adviser told us echocardiograms would not be routine for the monitoring of atrial fibrillation. The ESC guidance says serial echocardiography is generally not necessary in the monitoring of left ventricular dysfunction, it would usually be a one off unless the condition deteriorates.
35. Our adviser also told us due to Mr J being under the care of cardiology all tests would be requested by cardiology rather than primary care (the Practice).
36. There are no specific policies relating to tests being requested by primary or secondary care. However, in July 2017 NHS England produced a document relating to the good organisation of care across the interface between general practice and secondary care providers. The guidance says a secondary care provider must itself arrange and carry out all the necessary steps in a patients care and treatment.
37. We cannot see any evidence in the Trust or Practice records the Trust requested Mr J’s GP to arrange thoracic echocardiograms. The Trust acted in line with NHS England guidance which says secondary care providers must arrange and carry out the necessary steps in the patients care and treatment.
38. Due to secondary care being responsible for the care it provided Mr J, it was not the Practice’s responsibility to arrange his thoracic echocardiograms. We do not see any indications of service failings in this part of Mr J’s complaint.
Referral for echocardiogram
39. Mr J says he requested the Practice complete a veteran’s war pension form, there was a considerable delay in the Practice completing this form. Whilst discussing this with the Practice during a telephone appointment it was also discussed he was considerably overdue for an echocardiogram and the GP said they would request this.
40. The Trust response dated 16 August 2024 says after checking its notes from January 2024 onwards they cannot see any request for an echocardiogram documented.
41. We have looked closely at Mr J’s Practice records from January 2023 onwards.
42. We can see in August 2023 the Practice received a request from Veterans UK for a GP report. The Practice sought MR J’s consent for this report.
43. On 18 September 2023 Mr J contacted the Practice due to the form not being completed. The Practice apologised for this and said it would be completed the following week.
44. On 21 September 2023 it is documented in Mr J’s records ‘phone call to discuss form. Information shared and form completed’.
45. On 23 September 2023, the Practice spoke to Mr J advising the form had been completed and asked if he wanted a copy. Mr J didn’t want a copy, and the form was sent out that day.
46. There is nothing documented in Mr J’s records regarding a request for an echocardiogram.
47. We cannot see any written evidence Mr J requested an echocardiogram during a telephone consultation with a GP at the Practice.
48. Mr J says this discussion took place whilst discussing his report for Veterans UK which means this conversation would have taken place during September 2023.
49. It is unlikely the Practice would remember the details of a consultation taking place due to the length of time since the consultation.
50. We are unable to say with certainty whether Mr J requested an echocardiogram or not. For this reason, we are unable to reach a conclusion in this part of Mr J’s complaint. This is not to say we disbelieve Mr J or the Practice, but a lack of corroborating evidence means we cannot reach a robust decision.
Complaint handling
51. Mr J complains the Practice did not investigate his case thoroughly because they only looked at his records from January 2024 onwards when the discussion with the Practice took place in 2023.
52. Mr J’s complaint dated 17 July 2024 says ‘Last year I requested that you complete a veteran’s war pension form for me. There was a considerable delay in doing that. I subsequently had a telephone consultation with a GP where we discussed that I had been lost to follow up for paroxysmal atrial fibrillation and was considerably overdue for an echocardiogram. These were supposed to be done every 2 years. The GP stated that she would request an echocardiogram. However, I never received an appointment.’
53. The Practice response dated 16 August 2024 says ‘I have looked through your digital notes and have gone as far back as January 2024 to see which doctor you are referring to that said they would refer you for an echocardiogram.’
54. Although Mr J did not give a specific date within his complaint, he did state it was ‘last year’, which we can take to mean 2023, and he referenced the Veterans UK form the Practice received in August 2023.
55. The Practice complaints policy says it ‘will investigate all complaints effectively and in conjunction with extant legislation and guidance.’
56. We consider, to investigate Mr J’s complaint effectively, the Practice should have looked into Mr J’s 2023 records. We do acknowledge this would have not changed the outcome of his complaint.
57. An error was made in the investigation of Mr J’s complaint by the Practice, and we consider this a service failing.
58. We have discussed this with the Practice and the Practice are willing to write to Mr J to acknowledge the error made and apologise.
59. The Parliamentary and Health Service Ombudsman’s (PHSO) Principles of Good Complaint Handling says ‘Providing fair and proportionate remedies is an integral part of good complaint handling. Where a public body has failed to get it right and this has led to injustice or hardship, it should take steps to put things right.’
60. Mr J was frustrated by the complaint investigation and the error made in not looking at his records prior to January 2024.
61. To assist us in considering an appropriate level of remedy we use our severity of injustice scale (our scale).
62. Our scale allows us to ensure the recommendations we make are consistent and transparent for everyone who uses our service. The figures included in the scale represent the Ombudsman’s judgement about the sort of sums that are both appropriate and proportionate for us to recommend. The scale contains six different levels of injustice that a complaint could fall into, which increase in severity. Each level is then linked to a range of the financial amounts we would usually recommend in those circumstances.
63. Level one on our scale says ‘A case will generally be level one if we consider the person affected has experienced a low impact injustice such as annoyance, frustration, worry or inconvenience, typically arising from a single (one-off) incidence of maladministration or service failure, where the effect on the person complaining is of short duration, and where there are no other adverse effects or ongoing wider impact. We will usually consider an apology to be an appropriate remedy for these cases.’
64. We consider the Practice have made an error and the frustration felt by Mr J is at level one of the Severity of Injustice scale.
65. We consider an acknowledgement of the error made and an apology is an appropriate response, and this part of Mr J’s complaint can be closed as a resolution has been agreed.
66. We can see Mr J has had a troubling experience and would like to thank him for giving us the opportunity to look into his concerns. Complaints give us valuable insight into the organisations we investigate, and we recognise this has been an emotionally challenging process for Mr J. We would like to thank him for sharing his experience with us.