Practice failed to reissue her medication
18. Before we decide if we should investigate 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 we have not found any indications that something has gone wrong.
19. Mrs G says in April 2024, the Practice did not reissue her morphine medication at the previously agreed prescribed dosage of 5mls, six times a day, despite contacting them on numerous occasions for several days to request this.
20. The Practice said it had no documented evidence to say a doctor had agreed an increase in her morphine. This was the reason she had been having difficulties in her prescription request.
21. GMC guidelines paragraph 7 c, d and g says, ‘doctors must promptly provide (or arrange) suitable advice, investigation or treatment where necessary, propose, provide or prescribe drugs or treatment (including repeat prescriptions) only when you have adequate knowledge of the patient’s health and are satisfied that the drugs or treatment will meet their needs, and consult colleagues or seek advice from your supervising clinician, where appropriate’.
22. A review of Mrs G’s medical records shows that at the end of February 2024, she attended the Practice regarding her medication. The GP noted Mrs G told them she was taking the prescribed 5mls of morphine four times a day with paracetamol but had been taking additional doses on ‘bad days’. The GP advised she discuss her pain management further with the specialist surgical team at her next appointment in March, (a week later), of which she agreed.
23. The records show Mrs G attended the Practice in March for a review of her hernia. A different GP noted that Mrs G asked they adjust her pain medication, as she said the surgical team had told her she could take 5mls of morphine up to six times per day when pain was severe, instead of the prescribed four times a day.
24. The GP explained they would consult with other GPs at the Practice regarding a review of her pain management and should the pain get worse to attend the Emergency Department (ED). The GP also sought advice from the specialist surgical team.
25. The medical notes show at the beginning of April, the surgical team and GPs at the Practice reviewed Mrs G’s pain management and noted as Mrs G was already on many pain medications, if pain was to occur, she should attend the ED. It stated no changes were to be made to her medications.
26. Over the following seven days, Mrs G contacted the Practice online on three occasions to request further morphine. The Practice rejected these as the already prescribed doses should have lasted four weeks as per the prescription instructions. Mrs G also made a request over the phone when it advised she would need a review with a GP, following which she booked an appointment to see a GP.
27. The evidence shows prior to Mrs G contacting the Practice to request further medication in April, the prescribed dosage of her morphine medication was 5mls, four times a day. This remained the same following a review of her pain management with other GPs and a specialist surgical team in March, when they decided no changes were to be made to her medication.
28. The evidence also shows Mrs G was aware in February and March of the prescribed dosage being 5mls four times a day and was also aware that extra doses she had taken were in addition to this. We also see Mrs G knew that any change would require a review with a GP.
29. We cannot see any evidence the Practice had agreed to an increase in the dosage of Mrs G’s medication prior to her request.
30. Our overall view is that the Practice did not prescribe repeat medication to Mrs G based on the information it had available about her medication at that time, until a further review of her circumstances could take place. It also promptly provided Mrs G advice about her medication when she attended the Practice and consulted with colleagues and specialist clinicians involved in her care prior to this time. These actions appear to be in line with the above GMC guidance.
31. We recognise Mrs G’s situation and appreciate how her symptoms and being in pain in April, caused her concern. We hope our explanation helps give Mrs G some reassurance the correct processes were followed in providing her the proper treatment she required.
The receptionist did not allow her to explain how she felt or escalate her call.
32. Mrs G says in April 2024, the Practice receptionist did not allow her to explain she felt suicidal and would not allow her to speak with the Practice manager on calling the Practice.
33. The Practice response explained it had reviewed the phone call recordings where Mrs G had said she needed a telephone appointment as she had pain, was out of her pain medication and was in withdrawal.
34. It said its receptionist had explained that medication requests are not deemed as urgent for the same day, and as Mrs G wanted a phone call from management about this, the receptionist explained she would get a manager to call her in the morning.
35. It explained a manager had called her back on the morning of the call to offer a same day appointment but could not reach her.
36. Our Principles explain, organisations should be prepared to listen to their customers, and communicate effectively, using clear language that people can understand and that is appropriate to them and their circumstances.
37. We have listened to the call of approximately eight minutes long. During the call we can hear the receptionist asked Mrs G for the reason of her call, to which she replied it was about pain and medication and that she understood she needed to speak to a GP.
38. The receptionist explained that she could see Mrs G already had an appointment booked in and asked if this was for something else or for the same reason, to which Mrs G replied it was about the same thing.
39. The receptionist clearly explained she could not offer a same day emergency appointment due to limited appointments but could bring the appointment she already had forward to a sooner date, of which Mrs G declined. Mrs G then asked to speak with the practice manager.
40. The receptionist explained they were not available because of leave from work but could ask for a return of call. Mrs G was unhappy with this and wanted to escalate the call. The receptionist offered a call back from the administration manager in the practice manager’s absence.
41. The receptionist asked Mrs G for the reason of the escalation to which Mrs G replied this was an issue about the competency of a practice GP and was not about her medication. The receptionist explained if the escalation was about a GP, this would need to be directed to the practice manager, of which she could arrange a call back the following week when they return.
42. Mrs G then asked to speak to the administration manager instead regarding her appointment and asked they do so the same morning. The receptionist said she would request a callback was made and explained she could not guarantee the time this would take place. The administration manager called Mrs G back the same morning.
43. We did not hear Mrs G indicate or explain she felt suicidal during the call. Mrs G also told the administration manager during her call back that this did not come out and that she only spoke about pain relief.
44. In line with our Principles, it appears the receptionist listened to Mrs G throughout the call, gave her time to speak, answered the questions asked, and clearly explained what they were able to do to assist with her request for an appointment for pain and medication.
45. It also appears the receptionist listened to Mrs G’s request to escalate her call to a manager and clearly explained that she would arrange for a callback to be made to Mrs G by the administration manager in the practice managers absence at the earliest opportunity.
46. We are sorry to hear that Mrs G found speaking with the receptionist difficult at what was obviously an already worrying time. We also recognise the impact her pain and medication issues have had on her.
47. While we appreciate Mrs G may not recall the conversation exactly as it happened, the call recording shows the receptionist gave her the opportunity to speak and offered to escalate her call. These actions are in line with our Principles so we will not take any further action.