A practice in the Sandwell area

3. Mr S complains about the lack of action taken by the Practice when his father called it on 27 February 2023 after falling at home.

4. Mr S says the Practice failed in its duty of care because a receptionist asked his father if the reason for his call was an emergency. Mr S complains his father should not have been asked this and the receptionist did not offer any advice, do a referral or arrange a follow up call.

5. Mr S says his father had a brain haemorrhage in March 2023 and hospital staff told him this could have been caused by the fall. Mr S feels that because his father was not seen by the Practice, any potential problems were not found.

6. Mr S explains his father:

• is much less independent and relies on family to look after him and help him eat • is unable to do daily tasks he used to enjoy like gardening • spends much more time upstairs where he is closer to the bathroom • experiences short term memory loss and sometimes forgets the names of his grandchildren.

7. Mr S would like financial compensation to help pay for changes to the home to improve his father’s quality of life.

8. When Mr S’s father called the Practice to make an appointment, he explained he had fallen and had started to feel more out of breath and to lose control of his bowel and bladder. Mr S says the receptionist asked his father if it was an emergency and then booked a routine appointment for 31 March 2023.

9. On 4 March, an ambulance had to be called because Mr S’s father had soiled himself trying to get to the bathroom. Mr S says the paramedics thought his father had had a stroke as the right side of his face had dropped and his speech was slurred. He was taken to the hospital who confirmed Mr S’s father had a brain haemorrhage.

10. On 6 March, Mr S complained to the Practice on his father’s behalf.

11. On 13 March, the Practice said it may not be able to discuss the complaint with Mr S because of data protection.

12. On 21 March, the Practice sent an email to Mr S explaining it did not have the right proof of authority and it would be unable to release any personal information to him.

13. On 29 March, Mr S brought his complaint to us.

14. On 9 May, Mr S gave the Practice a signed form of authority.

15. On 19 May, the Practice sent its final complaint response to Mr S.

18. The Practice’s final response letter says that when Mr S’s father called, he told it about problems with his bowels, but not that he had fallen and was getting breathless.

19. The Practice confirmed it cannot record its calls. This means there is no evidence of what was discussed other than Mr S’s and the receptionist’s different accounts.

20. Our service model guidance says:

‘There will be occasions when we decide that there are other reasons why we should not investigate a complaint made to us. These include:

• That an investigation would not be practical, would not reach a satisfactory conclusion and there would be no value in providing that response through an investigation.’

21. In this case, we cannot investigate the complaint further as there is no other evidence for us to look at to help us reach a decision. It would not be fair or right for us to try and decide what is more likely to have happened.

22. We have considered Mr S’s concerns that his father was asked whether he needed an emergency appointment. The Practice’s response says, ‘All reception staff are trained to take initial details of any request for an appointment. All callers are asked if it is a routine or urgent, same day appointment’.

23. The Practice response also says, ‘As a learning point, we have discussed your concerns with the whole Practice Team. We have asked each individual receptionist questions about what actions they would take using several scenarios to ensure they are fully compliant with our standard procedures. In addition, all of them have undertaken online triage training which they have all passed successfully… We have reviewed our standard operating procedures and because of the concerns raised, we have developed a template which details the actions we have taken i.e., advised referral to A&E, Pharmacy, 111 or Extended hrs etc as this will enable us to have an audit of what actions the practice have taken’.

24. We hope this provides Mr S with some comfort that although we cannot reach a decision, the Practice has taken action and learned from his complaint.

1. The Parliamentary and Health Service Ombudsman has carefully considered Mr S’s complaint about a practice in the Sandwell area (the Practice). There is not enough evidence for us to be able to reach a decision on the complaint.

2. We are sorry to hear about Mr S’s concerns about his father’s experiences when contacting the Practice. We appreciate the events will have been, and continue to be, extremely distressing for both Mr S’s father and his family.