15. 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.
Blood pressure readings
16. Mr F said the Practice failed to communicate the results of seven-day blood pressure tests to him in January 2024.
17. The Practice said on each occasion Mr F submitted a blood pressure report, it sent a notification with instructions and advice informing him that his readings were in an acceptable range. Mr F disputes that he received these notifications.
18. Mr F’s GP records show the Practice asked him in early January to monitor his blood pressure at home and submit one week’s worth of readings. Mr F submitted the readings, and the seven-day average was 138/89 mmHg.
19. National guidelines on hypertension (high blood pressure) say that organisations should:
‘Advise people with hypertension who choose to self-monitor their blood pressure to use HBPM (home blood pressure monitoring.
When using HBPM to monitor the response to treatment in adults with hypertension, use the average blood pressure level taken during the person’s usual waking hours. Reduce blood pressure and ensure that it is maintained below 135/85 mmHg for adults aged under 80. Use clinical judgement for people with frailty or multimorbidity.’
20. Mr F’s readings were slightly above the target specified in the guidelines. We cannot see any evidence from the records that the Practice communicated with Mr F immediately after he submitted these readings. Mr F then contacted the Practice just over two weeks after submitting the readings to express concern that he had not heard anything.
21. GMC Good medical practice guidance that was in place at the time says doctors:
• ‘must listen to patients, take account of their views, and respond honestly to their questions • must give patients the information they want or need to know in a way they can understand.’
22. Our adviser said in line with good medical practice, the Practice should have communicated with Mr F after receiving his first week’s blood pressure monitoring. We recognised Mr F was concerned and anxious about his readings being high and the impact this could have on his health.
23. Our adviser added that although the readings were slightly above target, the decision on whether to make any changes to Mr F’s treatment plan was a matter of clinical judgement, as increasing medication also increases the risk of the patient suffering side effects.
24. We consider it would have been good practice for staff to contact Mr F to discuss his readings earlier. This may have avoided some anxiety that Mr F experienced while he was awaiting communication from the Practice.
25. After Mr F had contacted the Practice to express his concerns about the lack of contact, staff arranged a telephone appointment to discuss the readings, among other concerns he had. The GP explained that Mr F’s blood pressure was within what it considered to be an acceptable range. It agreed to another week of home monitoring and reassured Mr F that it was unlikely to be significantly different after less than a month.
26. Mr F then submitted the second set of readings in mid-February. The results of these readings were an average of 132/85 mmHg. The Practice arranged a further appointment which took place in late February. In this appointment the GP told Mr F that his readings were now below target and he could continue with his medication.
27. We appreciate the two weeks it took for Mr F to find out about his blood pressure readings caused him some anxiety and concern. We have carefully considered this, and we recognise that under the Practice’s usual process Mr F should have received earlier communication which may have eased this anxiety.
28. We have considered the extent that the delay affected Mr F. This was over a relatively short period of time and did not have a lasting significant impact on him. We have considered the level of injustice Mr F may have suffered as a level one on our severity of injustice scale.
29. This is defined as injustices 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 individual is of short duration, and where there are no other adverse effects or ongoing wider impact.
30. When we look at complaints, we must focus on the most serious complaints we see. This is because as a publicly funded organisation we must work in a proportionate way and focus our attention on the matters that have had the most significant impact. The severity of Mr F’s injustice does not meet the threshold for us to consider this complaint any further.
31. We were also pleased to hear that Mr F’s second set of readings were within an acceptable range and there were no further concerns regarding his blood pressure.
Delays arranging appointments
32. Mr F also said the Practice did not arrange a GP consultation after he received the results of a LHC that stated he had coronary disease. Mr F said he had to contact the Practice directly after he did not hear anything following receipt of the LHC letter.
33. The Practice said it arranged an appointment in late February to discuss in detail the results of the LHC. It said during this appointment it explained that no further action was required from the results of the scan, as Mr F had existing heart disease. It explained that the LHC was a national targeted health programme that did not have access to Mr F’s more specific medical information.
34. We have reviewed the letter from the LHC, which it addressed to Mr F and sent a copy to the Practice. The letter states that Mr F’s CT scan confirmed evidence of coronary disease, and ‘if this is not known already, it confirms an increased risk of cardiovascular disease’. The letter instructs Mr F to consider other lifestyle changes that may help to reduce this risk such as a balanced diet, maintaining a healthy weight and regular physical activity.
35. There are no specific instructions to the Practice. The letter states the LHC would inform Mr F’s GP of these findings to consider whether any additional treatment would be helpful. Our adviser confirmed the responsibility for informing Mr F of the results of CT scan lay with the LHC and there were no expected actions from the Practice on receipt of this letter.
36. The records show Mr F had existing coronary disease and the Practice had been managing and treating this prior to the LHC letter.
37. NICE guidelines on reducing the risk of cardiovascular disease recommend lipid modification treatment and blood pressure monitoring as one of a selection of treatment choices. Simvastatin, which Mr F had been already taking, is one of the recommended low intensity statins in the guidelines for lipid reduction.
38. Our adviser confirmed that as the Practice was already prescribing Mr F with Simvastatin and treating his blood pressure, there were no additional actions from the letter that staff would be expected to carry out.
39. We recognise Mr F’s concern upon seeing the results of the LHC, and his wish to discuss this in more detail with the Practice. Once Mr F contacted the Practice to express his concern about the LHC results among other things, the Practice arranged an appointment to review the letter and reassured him that no changes to his treatment were required.
40. Mr F also said the Practice failed to act on the instructions of a cardiology letter from July 2024.
41. The Practice said the letter stated that the cardiologist had started Mr F on aspirin and had not specifically instructed the Practice to prescribe this.
42. The Practice said the cardiologist had ultimately concluded no further action was required regarding Mr F’s existing heart disease except continuing with the aspirin and statins that Mr F was already receiving. The Practice said it added aspirin to Mr F’s repeat medication at this stage.
43. The Practice had referred Mr F to the local cardiology clinic after Mr F had reported symptoms of chest tightness during physical activity in March 2024. Mr F had an appointment in May 2024 and the consultant cardiologist wrote to the Practice. The consultant said he had arranged a further appointment to look for functional ischaemia and would let the Practice know of any further management plan based on these results. The consultant also said he had prescribed Mr F with 75mg of aspirin.
44. The cardiology consultant again wrote to the Practice in July 2024 to confirm the results had shown no functional ischaemia and there were no further investigations necessary at this stage. The letter advised the Practice it could continue with the aspirin and statins. The Practice then added aspirin to repeat prescription.
45. GMC Good medical practice says doctors should work within the limits of their competence. The Practice had referred Mr F to a cardiology specialist and responded to their instructions.
46. Our adviser said the Practice responded appropriately to the cardiology letters. There were no instructions for the Practice to continue to prescribe aspirin to Mr F in the first letter. Once the Practice received these instructions it acted quickly to respond to them. Our adviser said it was not necessary to arrange an appointment to discuss the letter, as there were no further actions required from the Practice.
47. We recognise Mr F was concerned about both the results of the LHC and the cardiology referral and wanted to ensure the Practice was taking these seriously. From the evidence we have seen, the Practice acted correctly in dealing with these letters.