13. Miss X said the Practice failed to recognise how unwell her three-year-old daughter, was in November 2024 and did not diagnose pneumonia before she was later admitted to hospital. She said she was reassured that her daughter was fine despite having a cough, fever, poor intake, and tiredness.
14. Miss X said her daughters’ condition worsened later the same day she was seen by the GP and that she was admitted to hospital, where she was diagnosed with pneumonia and fluid on her left lung. Her daughter remained in hospital for five days receiving intravenous antibiotics, fluids, and oxygen, followed by oral antibiotics at home.
15. The GMC guidance says in providing clinical care doctors must adequately assess a patient’s condition, taking account of their symptoms and carry out a physical examination where necessary. It also says doctors should promptly provide (or arrange) suitable advice, investigation or treatment where necessary.
16. The NICE guidance says an upper respiratory tract infection should be considered where a child has a cough and symptoms of infection but a clear chest examination. The guidance explains that no combination of symptoms or signs gives absolute diagnostic certainty, particularly in the early stages of illness.
17. The NICE guidance explains that pneumonia should be suspected when specific clinical features are present. These include persistently high fever, raised respiratory rate above age-related thresholds, signs of increased work of breathing, focal crackles on chest examination, reduced oxygen saturation, or absent breath sounds suggesting an effusion.
18. The records show her daughter was seen on 11 November 2024 with a cough. She was seen alongside a younger sibling with similar symptoms. In line with the GMC guidance, the GP conducted an examination. There was no fever recorded, she was not unwell, and her chest examination was normal.
19. Our adviser confirmed that the examinations provided were appropriate and it was appropriate to diagnose an upper respiratory tract infection and provide reassurance.
20. There were no signs of pneumonia, as set out in the NICE guidance above, such as persistent fever, focal crackles, or signs of increased work of breathing, during this consultation. Therefore, we consider the care provided during this consultation was in line with the GMC and NICE guidance, and there are no indications that a diagnosis of pneumonia was missed, or any further investigations or treatment was necessary.
21. Her daughter was seen again on 25 November 2024. She had an ongoing cough, fever over the previous five days, lethargy, and poor appetite. In line with the GMC guidance, the GP carried out an examination and recorded observations that were within normal limits for her age, including oxygen saturation, heart rate, pulse, and capillary refill time.
22. The records show that there were no signs of respiratory distress, such as laboured breathing, nasal flaring, or chest indrawing, and her chest examination was normal, with no crackles or reduced air entry.
23. Our adviser confirmed that the clinical features set out in the NICE guidance that would indicate suspected pneumonia or the need for urgent hospital admission were not present at the time of the GP assessment.
24. Our adviser also explained that it would be very difficult to detect a small amount of fluid on the lung during a routine clinical examination. They confirmed that the GP appropriately requested a urine sample in response to reported lower abdominal pain and provided safety-netting advice, to seek medical help if her symptoms worsened or if there were further concerns.
25. Miss X was concerned that the GP should have taken greater account of how long her daughter had been unwell and the fact she had recently been given Calpol. Our adviser confirmed these factors were considered. They explained that a cough persisting from an earlier illness is common in children and that a temperature responding to Calpol is generally a reassuring sign.
26. Our adviser confirmed that it is possible for a child’s condition to worsen significantly between a GP consultation and later hospital admission. Hospital records show her daughter’s condition had deteriorated by the time she was admitted, with a markedly raised heart rate, high temperature, pallor, and increased work of breathing.
27. Again, we consider the care provided during this consultation was in line with the GMC and NICE guidance, and there are no indications that a diagnosis of pneumonia was missed, or any further investigations or treatment was necessary.
28. We recognise how distressing it would have been for Miss X watching her daughter’s condition deteriorate and having to take her to hospital. It is understandable the distress this caused Miss X and her family, and we understand why she would question whether something could have been done earlier.
29. We have not seen any indications that the care provided to Miss X’s daughter during these consultations was inappropriate or the Practice missed an opportunity to diagnose pneumonia earlier. Therefore, we will not consider this complaint any further.