13. 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 indication that something has gone wrong here.
14. Mr U said the Practice wrongly told him he needed to inform the DVLA that he had suspected OSAS. Mr U said he scored five on a sleep apnoea test and therefore the DVLA did not need to be informed. He said this was also confirmed to him in writing by a physiotherapist. Mr U said the Practice should have contacted the sleep clinic for advice as they would have confirmed that due to his sleep scores the DVLA did not need to be informed.
15. The Practice said Mr U reported one occasion of feeling sleepy at the wheel of his HGV truck and he was concerned that he may fall asleep. The Practice said it followed NICE guidance on OSAS and on examination it identified Mr U as being high risk for OSAS. The Practice said based on this it suspected Mr U’s drowsiness was due to OSAS and completed an urgent referral to the sleep clinic.
16. We will first consider whether it was in line with guidance for the Practice to suspect Mr U had OSAS.
17. NICE guidance on OSAS says the clinician should assess a patient for OSAS if they have two or more of the following features:
• snoring • witnessed apnoea’s (breathing temporarily stopping and starting) • unrefreshing sleep • waking headaches • unexplained excessive sleepiness, tiredness or fatigue • nocturia (waking from sleep to urinate) • choking during sleep • sleep fragmentation or insomnia • cognitive dysfunction or memory impairment.
18. It also says OSAS is more prevalent in patients who are overweight or obese and this should be considered when suspecting OSAS.
19. From the records we can see Mr U attended the Practice in January 2024 and reported one instance where he had felt sleepy at the wheel of his HGV truck. We can see Mr U reported he had felt more tired during the winter period, and he queried whether this could have been a side effect to medication he was taking.
20. On examination we can see the Practice documented Mr U had a neck circumference of 53cm, he snored, and he had a BMI of 49. The Practice noted Mr U was unsure whether his breathing stopped while he slept. The Practice noted it suspected Mr U had sleep apnoea which was causing his drowsiness.
21. We think it was in line with NICE guidance on OSAS that the Practice suspected Mr U had OSAS. We can see Mr U had two of the features listed in paragraph 17 - snoring and unexplained tiredness.
22. He was also noted to have a BMI of 49. BMI is when a person’s height and weight is used to determine their body mass index. A normal BMI is between 18.5 and 24.9. A BMI of 30 and above would indicate a person has obesity. Based on this it was in line with guidance for the Practice to suspect Mr U had OSAS.
23. NICE guidance on OSAS says to assess people for suspected OSAS using the Epworth sleepiness Scale (ESS) and to consider using the STOP-Bang questionnaire. It says not to use the ESS alone to determine if a referral is needed, as not all people with OSAS have excessive sleepiness.
24. The ESS consists of eight questions and assesses the daytime sleepiness of a patient during different activities. We can see the Practice completed the ESS and noted Mr U had a score of six. A score of between 6 and 10 indicates a higher-than-normal daytime sleepiness.
25. The STOP-Bang questionnaire also consists of eight questions and looks at the patient’s neck circumference, blood pressure, BMI, snoring, tiredness, age and gender.
26. The Practice also said it completed the STOP-Bang questionnaire which showed Mr U was at high risk of OSAS. We have not seen evidence from the Practice regarding Mr U’s results of the STOP-Bang questionnaire. Our adviser told us Mr U would likely have scored five during his appointment on the STOP-Bang Scale which would put him at high risk for OSAS.
27. It appears the Practice assessed Mr U for OSAS in line with the relevant guidance and identified he was high risk for OSAS. Following this assessment the Practice referred Mr U to the sleep clinic, and this appears to be in line with NICE guidance on OSAS.
28. We can see the Practice also advised Mr U to refrain from driving and to inform the DVLA of his suspected OSAS.
29. DVLA guidance for medical professionals says if a patient has suspected OSAS of any severity they must not drive. It says healthcare professionals should advise the patient of their legal requirement to notify DVLA if they have suffered with ‘sleepiness’ for three months.
30. The Practice advised Mr U to contact the DVLA about his suspected diagnosis which he did. It is important to note the Practice did not make any decisions regarding Mr U’s license or the decision to revoke this. Any decisions made regarding Mr U’s license has been made by the DVLA and not the Practice.
31. We have not seen any indication the Practice failed to act in line with the relevant guidance when advising Mr U not to drive or to contact the DVLA. We can see the DVLA guidance says patients with suspected OSAS should not drive and we can see the Practice advised Mr U of this.
32. It is unclear how long Mr U had been suffering with ‘sleepiness’ for. We can see he reported unexplained tiredness throughout the winter period with a recent instance of falling asleep at the wheel. This would indicate Mr U had been experiencing his symptoms for an extended period which appeared to be worsening.
33. We can see he reported experiencing symptoms throughout winter, which would be approximately three months from the appointment date. Due to his prolonged and worsening symptoms, the Practice’s advice to Mr U to contact the DVLA regarding his suspected diagnosis appears to be in line with DVLA guidance for medical professionals.
34. We recognise this is not the decision Mr U was hoping for, and our decision will be disappointing for him. We understand this was an extremely stressful and worrying time for Mr U as he was unable to work and this caused him a great deal of anxiety. We appreciate this was an extremely challenging period for Mr U and the uncertainty caused him a lot of distress.
35. We have not seen any indication of a failing in the Practice advising Mr U not to drive and to contact the DVLA. We will be taking no further action on this complaint.