A practice in the Wokingham area

4. Mr L complains about the care and treatment his father, Mr M, received from the Practice between September 2024 and January 2025. Mr M resides in a Care Home which is a short distance from the Practice. Specifically, Mr L complains:

• Mr M is not offered face-to-face appointments or home visits when he needs to be physically examined, only telephone consultations although he is hard of hearing • There is a lack of communication from the Practice regarding appointments, specifically in relation to a blood test that his father was called to the Practice for on 6 January 2025

5. Mr L says that his father experiences distress, and he experiences stress having to consistently chase up the Practice.

6. As outcomes to his complaint, Mr L is seeking an investigation into why the Practice does not use the additional funding they receive to manage Care Home patients care in an appropriate manner. He is also seeking service improvements by way of a permanent policy of face-to-face appointments, in preference to telephone or photograph emails for example, where the ailment needs visual inspection and/or the patient is hard of hearing or frail.

7. Lastly, Mr L would like the Practice to stop using alternative sites for the Care Home patients in all cases as this causes patients discomfort and removes a carer from their responsibility for extended periods of time.

8. Mr M has lived in a Care Home since June 2023. Mr L tells us the incidents began in Spring 2024 when there were multiple needs for a GP appointment. Mr L says that there has been a number of occasions when a face-to-face appointments or home visits have been required by Mr M and the Practice have given telephone consultations instead.

9. Mr L feels this is not appropriate when his father needs to be seen in person, as he is 99 years old and hard of hearing. Mr L says that the Care Home is very near the Practice, and that the Practice is paid additional funds to offer the residents of the Care Home appointments at the surgery or home visits.

10. Mr L also complains about the communication from the Practice regarding face-to-face appointments. Mr L says that there have been occasions where his father has attended the site closest to the Care Home and on arrival, has been advised that the appointment is at the alternative site, implying that the Care Home carers were not aware of the location or involved in the location choice.

11. Mr L feels this is not appropriate for elderly patients such as his father as it involves a taxi ride which can be stressful for him and taking up to two hours of a carers time as they must accompany them.

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 something has gone wrong.

Issue 1 - Mr M not being given face-to-face appointments or home visits

15. Mr L says that M is not given face-to-face appointments or home visits at the Care Home when a physical examination is needed. He says he is only offered telephone consultations, despite being hard of hearing.

16. We understand that this has caused Mr M distress, and he does not feel he receives the appropriate treatment.

17. In response to the complaint, the Practice explained there is an arrangement in place for the Care Home to send the Practice a list of residents that need a review and an explanation of why they need a review. The list is then reviewed by clinicians and the Practice manager, and there is a discussion between the Practice manager and the Care Home manager and residents that require a face-to-face appointment and are able to attend the Practice are booked in, and those that are unable to attend are reviewed by telephone, video, or in person when the paramedic or GP goes out to see them.

18. The Practice also explained that the triage system allows the booking of appointments as clinically appropriate to maximise the best use of the clinician’s time. If a telephone or video consultation was considered as inadequate to allow a full assessment, then the clinician involved would visit.

19. The Practice also states that if a consultation by telephone is indicated, the patient will normally have a carer present in case there are any issues such as poor hearing.

20. The Practice explains its usual process is for reviews, routine and planned visits to be conducted on a regular basis (e.g. weekly), to review residents ongoing health needs. It says the Care Home staff will send a list of residents requiring a review least 24-48 hours in advance.

21. The Practice also explains it will arrange any acute or urgent visits when a resident’s condition deteriorates unexpectedly. When this happens, the Care Home will use the surgery bypass telephone, providing relevant clinical details and urgency, and the duty clinician will triage and decide if a home visit is required the same day. The duty clinician will also consider if a telephone or video consultation is appropriate or if a referral to another service is needed.

22. We consider the Practice’s explanation to Mr L is in line with the policy as it explains the process that it follows for Care Home visits for residents, how the requests are triaged, and how the clinicians make decisions if a telephone consultation is appropriate or if a home visit is required. The response assures Mr L that a carer is always on hand if the patient is hard of hearing.

23. GMS contract Regulations say where a patient is required to be seen and where it would be inappropriate for them to attend the Practice’s premises, the patient must be seen in a location deemed to be the most appropriate location based on the clinician’s judgement.

24. In line with this the Practice says that the Care Home sends out a patient list each week which is then reviewed by clinicians and the Practice manager, and there is a discussion between the Practice manager and the Care Home manager and residents that require a face-to-face appointment and are able to attend the Practice are booked in, and those that are unable to attend are reviewed by telephone, video, or in person when the paramedic or GP goes out to see them. We have considered their usual practice and consider this in line with the guidance.

25. Further to this, we have reviewed Mr M’s medical records, and we can see that he is offered face-to-face visits when it is clinically indicated, and that he is seen in a timely manner when requested.

26. In conclusion, we have not seen any indications of failings regarding the provision of face-to-face appointments and home visits, and we do not feel any further investigation is needed in relation to this aspect of the complaint.

27. We hope our consideration of this part of the complaint reassures Mr L that Mr M is given the most appropriate appointments based on his level of clinical need.

Issue 2 – Communication around appointments, specifically, a blood test on 6 January 2025

28. Mr L says that there is a lack of communication from the Practice regarding appointments, specifically regarding a blood test on 6 January 2025.

29. Mr L says that the Practice makes appointments for patients and moves them to its alternative Practice location without notification, which can cause distress to Mr M having to travel, and causes stress to himself as he has to consistently chase the Practice for information.

30. Mr L says that on 6 January 2025, his father was called for a blood test, however neither he nor the Care Home were informed what the blood test was for. Mr L also says when one of the carers emailed the Practice to enquire about this, there was no response.

31. We understand that not being informed about appointments can be stressful as Mr L wishes to be involved in his father’s care.

32. In response to the complaint, the Practice explained that it works across two sites, and all patients are cared for at both sites. It also explained that if there are no appointments available, it will direct patients to its other surgery if there are available appointments there. This ensures all patients have timely access to appointments with medical practitioners.

33. The Practice says that a doctor contacted the Care Home on 19 December 2024 and spoke with the deputy manager to arrange a face-to-face appointment for a medication review for Mr L’s father which included a blood test.

34. We have reviewed Mr M’s medical records, and we can see an entry from the 19 December 2024 which supports the Practice’s explanation around the communication of the blood test on 6 January 2025.

35. The GMC’s Good Medical Practice guidance says continuity of care is particularly important when care is shared between teams, between different members of the same team, or when patients are transferred between care providers (Point 65 - Contributing to continuity of care).

36. We can see throughout the medical records that the Practice communicates with the Care Home on a regular basis regarding Mr M’s care needs, and on this occasion communicated the need for the medication review and blood test.

37. We therefore do not see indications to suggest further investigation is needed in relation to this concern.

38. We recognise that this may not be the outcome Mr L was hoping for, and the stress these events have caused. We do not wish for our decision to detract from the experience Mr L and Mr M have had. We hope our explanations above offer Mr L some reassurance that there is sufficient communication between the Practice and the Care Home regarding his father’s treatment.

1. We have carefully considered Mr L’s complaint about the GP Practice in Reading (the Practice) on behalf of his father, Mr M, in relation to the treatment he receives and communication of appointments.

2. We want to reassure Mr L that we have fully considered the circumstances and the impact it has had on both him and Mr M. We hope this statement offers some reassurance that their experience matters.

3. Having reviewed all the evidence, we have seen no indication that anything went seriously wrong. We therefore do not see any indications to suggest further investigation is needed. We will explain the reasons for our decision in this statement.