Dismissal of symptoms and concerns
14. 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 anything has gone wrong.
15. Mr R says the Surgery dismissed his symptoms and health concerns during a telephone consultation on 6 December 2024. Specifically, he says the GP ignored previous issues, including fainting spells and bleeding which he raised during an in-person appointment in November 2024.
16. The recording of the call confirms the purpose of the call was so the GP could discuss Mr R’s blood tests with him, in particular around the worrying information he had seen on his blood test results on the NHS app. He had seen references to cancer and reduced life expectancy, which understandably alarmed him. The GP explained this wording was part of the clinical reference guide and not related to his specific results.
17. The GP went through the test results in detail with him, reassuring him that his kidney function test, full blood count and prostate results were normal. They explained the results showed elevated ‘bad fats’ (triglycerides) and prediabetes.
18. GMC good medical practice says GPs must provide a good standard of practice and care when assessing, diagnosing, or treating patients and base this on assessing the needs and priorities of their patients.
19. The telephone consultation was specifically arranged to address Mr R’s concerns about his recent blood test results, which he had viewed on the NHS app and found distressing. The main purpose of the call was for the GP to reassure him and explain what the results said.
20. During the call Mr R did not inform the GP of concerns about fainting spells and bleeding. If he had raised this, we would have expected the GP to address these issues.
21. We could see no evidence in the medical records or the call recording to suggest the GP was dismissive. They responded to each one of Mr R’s queries and worries. Throughout the call, Mr R appeared receptive and acknowledged the GP’s explanations.
22. We can see no indications the Surgery dismissed Mr R’s symptoms or concerns. We will take no further action on this part of the complaint.
Did not provide appropriate support and focused on weight without looking at medical history
23. Mr R states that the GP focused solely on his weight without considering his IBS, dietary restrictions, or past medical history. He believes the GP should have proactively referred to his medical records during the consultation.
24. The consultation call recording confirms the GP acknowledged Mr R’s IBS and was careful not to suggest dietary changes that would aggravate his condition. They advised about portion control and calorie reduction, offering practical suggestions based on the foods Mr R described eating, along with reducing the quantity of food he was eating and keeping a food diary to monitor his diet.
25. GMC good medical practice says doctors “must work in partnership” with the patient.
26. The call recording indicates this happened. The GP took Mr R’s needs into consideration as they referenced his IBS and medical history and provided advice on each issue raised. The GP also encouraged Mr R to keep a food diary and return in three months for a more tailored discussion, with the option of a dietitian referral if needed. This showed they were willing to work in partnership with Mr R and adapt their advice based on his individual needs.
27. As we have seen no indications anything went wrong, we will take no further action on this part of the complaint.
Weight loss injections and their availability on the NHS
28. Mr R complains the doctor did not provide any information on how to receive weight loss injections and incorrectly said Mounjaro is unavailable on the NHS. He is unhappy the GP gave advice about general weight-management methods like restricting his calories and exercise.
29. During the consultation, the GP explained that Mounjaro is not currently available on the NHS for prediabetes and is expected to become locally accessible for such issues within 12 years. Given the unavailability of the requested treatment, the GP advised that the most appropriate approach at this stage is a focus on diet and exercise.
30. As outlined in NICE guidance on weight loss injections, the NHS uses a tiered model for weight management. GPs provide tier one and tier two support, focusing on lifestyle advice around diet, exercise, and behaviour change. Tier three and tier four care is delivered by specialist services, which may include access to weight loss medications.
31. NICE guidance on weight loss injections states that medication must be prescribed and monitored within specialist services. While it is approved for NHS use under strict criteria, Mounjaro is currently only licensed for type two diabetes and not approved for weight management. Future availability will depend on further NICE guidance and local commissioning.
32. Based on the guidance available, GPs cannot prescribe weight loss injections directly, as they are limited to providing support within their designated tier. During Mr R’s consultation, the GP provided tier one and tier two support, which is appropriate for his current stage and within the GP’s remit. The GP also correctly explained that weight loss injection treatments are not available through primary care for conditions like prediabetes.
33. While this may have caused some confusion, the GP’s advice was accurate, that these medications are only accessible via referral to specialist services. The GP must work within the tiered approach, first focusing on diet and exercise before making a specialist referral.
34. The GP did not provide information on tier three and tier four care, as Mr R did not enquire further about how to access such support. The GP provided adequate care by advising the use of a three-month food diary to be reviewed collaboratively.
35. We consider the GP appropriate advice about weight loss injections in line with NICE guidance.
Complaint closed without providing adequate advice
36. Mr R sent the details of his complaint to the Surgery on 11 December 2024.The Surgery responded on 16 December, setting out what had happened in the phone call and concluding the GP did not do anything wrong.
37. Mr R emailed the same day, disputing the outcome of the investigation. He set out safety concerns about the Surgery’s suggestion of a 1200 calorie diet particularly for a patient with IBS and dietary restrictions. He also complained the GP only considered his weight, dismissing any exploration of alternative causes for his symptoms. Mr R asked for the GP to be removed from any future involvement in his care.
38. The Surgery responded on 17 December, explaining the call was an emergency appointment for the on-call doctor to allay Mr R’s fears about his test results. The Surgery said it was not a specific consultation about his prediabetes and the GP provided general weight loss advice as he asked about Mounjaro. The Surgery said a pre-bookable appointment would be suitable to support him with treatment and management of his prediabetes and discussion about if any further investigations were necessary.
39. Mr R replied the same day. He complained the Surgery had not addressed his concerns about the safety of the advice around a 1200 calorie diet nor his concern about the lack of exploration into alternative causes of his symptoms. Mr R asked the Surgery it would remove this GP from managing his care.
40. The Surgery responded on 3 January 2025. This response explained again about the purpose of the emergency telephone appointment and that a pre-bookable appointment would be appropriate to discuss his prediabetes in more detail. The Surgery included comments from a dietician which confirmed the GP gave appropriate dietary advice which took account of Mr R’s IBS. The Surgery offered Mr R a dietician referral and encouraged him to attend a prediabetic course for comprehensive advice and support. The Surgery confirmed it could remove the GP from his care, but this may reduce his access to emergency appointments.
41. The Surgery closed Mr R’s complaint at this time and signposted him to PHSO.
42. Both the Surgery’s complaints policy and the NHS Complaint Standards state the Surgery should: • acknowledge and respond to complaints promptly • investigate concerns thoroughly and proportionately • provide clear, evidence-based explanations • offer appropriate remedies or next steps • communicate respectfully and transparently throughout.
43. We consider the Surgery handled Mr R’s complaint in line with relevant standards by investigating thoroughly and providing clear and evidence-based explanations. It was appropriate for the Surgery to close Mr R’s complaint when it had responded three times about the same issues and had nothing further to add. We can see no indications of failings in how the Surgery managed Mr R’s complaint.
44. We understand the reasons for Mr R’s concerns and that he wanted personalised advice about how best to manage his prediabetes. We consider the GP acted appropriately by addressing the immediate concern which was Mr R’s worries about his blood test results. The GP also gave general advice about weight loss which also took account of Mr R’s history of IBS. The Surgery’s response is correct that Mr R should book an appointment if he wants more detailed advice and support.