18. Before we decide if we should investigate a complaint, we look at whether there are signs the organisation concerned has got something wrong. We do this by comparing what should have happened with what did happen.
The Practice’s consultation with Miss G in July
19. The Practice contacted Miss G to arrange a face-to-face consultation. The purpose of the consultation was to discuss the GP’s concerns about her mental wellbeing. The GP discussed the possibility of referring Miss G back to the CMHT, which she did not consent to. After a discussion with their colleague, the GP referred Miss G back to the CMHT without her consent.
20. Miss G complains the GP should not have made the referral back to the CMHT without her consent, and this has brought on PTSD symptoms. We took clinical advice from a suitably experienced GP to inform our thinking on this part of the complaint.
21. Our adviser directed us to the General Medical Council’s ‘The professional standards’ which sets out the professional standards for doctors across 11 categories, and provides a framework for ethical decision making in a wide range of situations.
22. The ‘Confidentiality: good practice in handling patient information’ (2018) section is the first part of the GMC’s guidance we are looking at. Paragraph 44 of this guidance says ‘you may disclose personal information if it is of overall benefit to a patient who lacks capacity to consent. When making the decision about whether to disclose information about a patient who lacks capacity to consent, you must:
• make the care of the patient your first concern
• respect the patient’s dignity and privacy
• support and encourage the patient to be involved, as far as they want and are able, in decisions about disclosure of their personal information.’
23. When we look at this guidance, we can understand why the GP made the decision to refer Miss G back to the CMHT. The GP had clear concerns about Miss G’s capacity to consent to them contacting CMHT at the time of the consultation. The GP recorded they suspected she was experiencing hypomania, which is a symptom caused by bipolar disorder and causes extreme changes in mood. We cannot comment on whether Miss G did have capacity to consent to the GP contacting CMHT at the time of the consultation. But based on the information recorded, and the GP’s concerns of hypomania, we can see why they made this decision.
24. We think the GP clearly had Miss G’s care as their first concern. They recorded their view of a significant concern for her welfare and there being a risk. The GP decided it was in her best interests to contact the CMHT for further advice as they were specialists in her condition and knew her well.
25. We think this is also an example of the GP respecting Miss G’s dignity and privacy. The GP contacted the CMHT, knowing it had previously treated her and was clear she could be referred back if she needed to be. The CMHT already knew Miss G. It was not necessary for the GP to share her personal information with a new team who did not already have much of it already recorded.
26. The GP clearly had concerns about sharing this information with CMHT without Miss G’s consent. We can see this was not a decision the GP made lightly, and without very detailed consideration. We have looked at GMC’s ‘Good medical practice’. Paragraph 7 says ‘In providing clinical care you must:
• consult colleagues or seek advice from your supervising clinician, where appropriate.’
27. We think the GP did this. They sought advice from another GP colleague at the Practice. We have also noted the GP did not refer Miss G to CMHT necessarily to restart treatment, but to seek advice on what the best next steps would be. CMHT then decided it would be best to attempt to contact Miss G directly.
28. We understand why Miss G brought this complaint to us. She was in an extremely vulnerable time of her life when she had this consultation with her GP. We know this from the information Miss G provided us. When we have considered all the information available to us, we cannot see the GP did something wrong here. We think it acted with Miss G’s care as its first concern, in line with GMC’s guidance.
The medication the Practice prescribed
29. Miss G was treated with three different medications: lamotrigine, aripiprazole and propranolol. She has complained these treatments were not appropriate, as they were for treating a mental health condition she did not have.
30. We can see Miss G was treating the symptoms of bipolar affective disorder for a long time. She was diagnosed with this condition approximately 13 years before her consultation with the GP. We understand her condition was mostly stable and well controlled with this medication.
31. In March 2023, Miss G reported to CMHT she had not been taking her medication, and stopped in early February. CMHT reviewed Miss G again in April. It agreed she would continue to not take her medication, but it would write to the Practice to advise it to restart lamotrigine and aripiprazole treatment should she see any signs of relapse.
32. We cannot see the Practice did prescribe any further lamotrigine or aripiprazole after Miss G stopped her treatment in February 2023. The CMHT had advised the Practice to restart it only if needed. We cannot see Miss G ever requested for a prescription of these medications. We cannot say the Practice has done anything wrong here.
33. We did seek some advice from our GP adviser about this part of the complaint to gain some more information about GPs prescribing medication based on recommendations by secondary services, such as the CMHT. Our adviser directed us to GMC’s ‘Good practice in proposing, prescribing, providing and managing medicines and devices’ (2021).
34. Paragraph 75 of this guidance says, ‘if you prescribe based on the proposal or recommendation of another healthcare professional, you must be satisfied the prescription is needed, appropriate for the patient, within the limits of your competence and that you have enough information to safely proceed.’
35. We hope this reassures Miss G the GP can prescribe medications based on the recommendations of other professionals. As her GP did not prescribe any medication during the period of time we have looked at, we are not going to comment on whether the prescription was appropriate. We want to reassure Miss G that it is a common practice for GPs to prescribe medications based on recommendations from secondary services.
36. We have carefully considered all the information available to us and looked at the appropriate standards and guidance. We have found the Practice acted in line with the relevant guidance in how it cared for Miss G.