A practice in the Forest of Dean area

3. Mrs N complains that when Mr N attended the Practice with foot pain on 2 December 2024, the receptionist did not review his medical history or seek any clinical advice. She says the receptionist did not book an appointment with the GP and he was advised to ring NHS 111 instead.

4. Mr N was diagnosed with cellulitis and an ulcer on 4 December 2024, that required surgery to remove the affected areas. Mrs N says this might have been avoided if he was seen by the GP on 2 December 2024.

5. Mrs N says she wants the Practice to acknowledge the failings and apologise for the impact this had. She would also like financial redress.

6. Mr N is type 2 diabetic with a history of neuropathy (nerve damage), he had a previous kidney transplant and has a weakened immune system. He has also suffered with recurring gout.

7. On 2 December 2024, Mr N woke up with pain in his left foot. His foot was red and warm to the touch. He immediately attended a community hospital. The receptionist at the hospital told Mr N that the hospital was at capacity and advised him to see his GP.

8. Mr N immediately attended his GP practice. On arrival he spoke to the receptionist and told her about his medical history. The receptionist told him that there were no available appointments and recommended he ring NHS 111 if he needed urgent advice. Mrs N contacted the Practice later than day and gave the receptionist more information about Mr N’s medical history. The receptionist provided the same information to Mrs N and recommend she contact NHS 111.

9. Mrs N called NHS 111 and spoke with an adviser. NHS 111 sent the Practice the call report and recommended contact to be made within 6 hours. At 2.56pm the same day, the on-call doctor from the Practice called Mr N to discuss his condition. The GP increased his usual prescription of prednisolone (anti-inflammatory medication) and recommended Mr N return to the Practice if his condition did not improve.

10. On 4 December 2024, Mr N attended the hospital and was diagnosed with cellulitis and a subsequent ulcer which required surgical treatment.

The receptionist did not review his medical history or seek any clinical advice. Mr N was advised to ring NHS 111 and was not seen by a GP.

12. 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 seen any indications that something went wrong.

13. The Practice says its reception staff are not clinically trained and will not review medical notes for historical information to make a decision on treatment or the need to see a GP. We acknowledge that both Mr and Mrs N gave the Practice receptionist a full history of Mr N’s medical conditions to support their request for an urgent appointment. When booking appointments the Practice has its own protocol.

14. The Practice’s protocol for booking appointments says:

‘If a patient rings and we are at capacity, advise patients that if they feel they need to be seen urgently they can contact 111 to be triaged or attend A&E if appropriate. If they feel it is not urgent for the day and are happy to wait until the following morning to contact us again so they can be added to our On Call GP screen for that day.

Requests for “urgent” appointments on the day – triage using the triage tool (Ardens Template) – then add to list for the On Call GP if appropriate.

Patients can choose a telephone consultation or a face to face prior to reaching capacity. If capacity has been reached, it will be a telephone call from the On Call GP initially.’

15. In urgent cases, NHS 111 can book appointments into the GP system with an on-call GP even if no appointments are available.

16. When Mr N first attended the Practice it had already reached capacity for appointments for that day. For this reason, in line with its protocol the receptionist advised him to call NHS 111. When Mrs N called the Practice after her husband returned home it still had no appointments available for that day. For this reason, in line with its protocol the receptionist advised her to call NHS 111 if she felt he needed to be seen urgently.

17. We can see how distressing it was for Mr and Mrs N when they were trying to arrange to be seen by the GP when there were no appointments available. Based on the evidence we have seen the action taken and advice provided by the receptionist was in line with its protocol.

18. Mrs N followed the receptionist’s advice and contacted NHS 111. The GP records include the NHS 111 report of the discussion it held with Mrs N which was sent to the Practice. The report indicated NHS 111 believed Mr N’s condition was due to his gout and the report did not indicate he needed an urgent appointment. They recommended that the Practice contact Mr N within 6 hours and he was added to the on-call GP list for a telephone call.

19. Later the same day the on-call doctor from the Practice called Mr N and conducted a telephone consultation. The record of the consultation indicates the doctor discussed Mr N’s symptoms with him. Mr N said his symptoms felt exactly the same as a previous gout flare up. The doctor recommended Mr N contact the Practice again if he didn’t improve.

20. We carefully considered Mrs N’s complaint. Based on the information we have seen there is no evidence to indicate that the Practice failed to act in line with its protocol when Mr N attended on 2 December 2024 or when Mrs N called later that day. The Practice carried out a telephone consultation with Mr N after it received the NHS 111 report and provided appropriate safety netting advice in case his condition did not improve.

21. We acknowledge that Mr N’s condition did not improve and resulted in him having surgery. We recognise how upsetting this is and the huge impact this has had on both of their lives.

22. Based on the evidence we have seen we have not identified any failings by the Practice. We recognise it will be disappointing for Mr and Mrs N to find that we have decided not to start a detailed investigation of this complaint. We hope they can appreciate the reasons for our decision.

1. We have carefully considered Mrs N’s complaint about the Practice when her husband Mr N attended on 2 December 2024. We recognise that Mr and Mrs N have been through a challenging time. Based on the evidence we have seen, we have seen no indication that there was a failing.

2. We were sorry to read Mrs N’s complaint, that her husband Mr N had pain in his foot and was told by the Practice receptionist to ring NHS 111 as no appointments were available. We can see that this has caused them distress and they felt let down by the Practice. We recognise our decision is likely to be disappointing for Mrs N. We will now explain our reasons in more detail.