Appointment at the Practice on 6 March 2025
20. Miss P said at an appointment with the Practice on 6 March 2025, the GP refused to conduct tests and observations which they had previously agreed via phone on 4 March for R’s, diagnosis of MD (a small pouch found in the wall of the small intestine, which can become inflamed or infected if it causes bleeding or a blockage).
21. Miss P said this caused her and her son distress and anxiety and left her in fear for R’s health.
22. The Practice said the GP followed the prescribed conservative management plan from the surgeons (specialists). It said the GP did not arrange for blood tests as this would not have been timely or clinically useful. It also said the GP told R and Miss P if he experienced worsening symptoms, the appropriate course of action for him would for him to visit an ED.
23. Our clinical adviser said MD is a specialised diagnosis, and specialists have more of a role as opposed to primary care (GPs) in treating it. The treatment is surgery or conservative treatment. A GP would not be able to treat MD.
24. R’s medical records show the GP called R and Miss P on 4 March. Our clinical adviser said the GP wrote a clear medical history for this appointment, noted that MD had been diagnosed and advised Miss P that surgery was recommended by the specialists. They recorded she did not agree with the specialist’s advice.
25. Our clinical adviser said this was in line with GMC Good Medical Practice. This says doctors must make sure patients’ medical records are clear, accurate, contemporaneous and legible.
26. The GP also noted R was feeling back to normal, his temperature was fine, and he did not report ongoing symptoms. The GP arranged a face-to-face appointment for 6 March to review R, which our clinical adviser said they would expect.
27. On 6 March, the GP noted R said he was feeling back to normal, walking normally, his bowels were normal, and he was passing stools daily and passing wind with no issues. The GP noted R was still on antibiotics and that they would refer him for potential elective surgery to reduce future risk. They also noted they advised R to attend the ED if his symptoms got worse.
28. Our clinical adviser said this suggests R had no urgent clinical concerns on that day, and it was appropriate for the GP not to conduct any tests or observations at this appointment based on the symptoms R presented with.
29. Our clinical adviser also said an ED discharge letter dated 1 March did not mention the GP should do blood tests or any investigations in the community. They also said a GP would not know what blood tests to do as it would be beyond their remit in primary care. They said the GP followed GMC Good Medical Practice sections 7a to 7h by safety netting R and advising he should attend the ED if his symptoms got worse.
30. We appreciate GMC Good Medical Practice says doctors should provide suitable advice, investigations or treatment having considered a patient’s symptoms. They should only provide treatment when they have adequate knowledge of the patient’s health, and they are satisfied the treatment meets their needs. They should refer patients to other clinicians when this serves their needs.
31. Our clinical adviser said it was appropriate for the GP to follow the specialist advice and not take any clinical action.
32. Therefore, we have seen no indications of failings when the Practice did not conduct observations or tests on 6 March. As the GP decided what to do in the way GMC Good Medical Practice recommends, we saw they acted in line with the relevant guidance.
Reporting to social services and historical safeguarding
33. Miss P said the Practice wrongly reported her to social services on 6 March 2025. This happened because she refused surgery for her son on 28 February 2025 for his diagnosed MD, and this was unjustified.
34. She said the GP used unfair reasons to justify the referral, like the fact her son had not seen a GP since 2018. Miss P said her son had no reason to visit a GP since 2018 as he was fully vaccinated and had no health issues.
35. She also complains the Practice asked questions about a previous referral to social services regarding her other child and included this in her and her children’s medical records. She said it was inappropriate for the GP to include details of this historic referral as it was not connected to R’s care and treatment.
36. She also said as she had been the victim in that case, she felt she was being punished by having this included as a history of involvement with social services.
37. Miss P said the referral was made because specialists at the hospital had said R needed ‘life saving’ surgery. Miss P said this was not true and R was feeling better after starting antibiotics.
38. Miss P said she was concerned the inclusion of the historic safeguarding concerns in her and her children’s medical records could have a negative impact on their reputation in the future. She said she had asked the GP to remove any mention of the historical safeguarding referral from the records. She said the GP said they could not remove it.
39. The Practice said it made the safeguarding referral on 6 March 2025 following a multi-disciplinary meeting on 3 March 2025. It said the decision was based on multiple factors. This included repeated recommendations by multiple surgical teams that urgent surgery was the appropriate course of action for R and the potential for significant harm if this was not undertaken.
40. Our clinical adviser said according to NHS safeguarding guidance, there were reasons for the Practice to decide to raise a safeguarding referral. There was a potential risk to R as his mother had not accepted the specialist recommendation for surgery.
41. Section 3 of the NHS safeguarding guidance says it is the responsibility of every NHS funded organisation and each individual healthcare professional working in the NHS to ensure the principles and duties of safeguarding children and adults are holistically, consistently and conscientiously applied.
42. Section 4.4 says all health providers, including provider collaboratives, are required under statute and regulation to have effective arrangements in place to safeguard and promote the welfare of children and adults at risk of harm and abuse in every service that they deliver.
43. Our clinical adviser said if the Practice’s GP saw or felt there was a suspected safeguarding concern, they should have made the referral. Recommendations from specialists for surgery following the MD diagnosis meant the GP had reason to suspect R could be at risk if Miss P refused to allow him to have the surgery.
44. Our clinical adviser said it was not for the GP to make a clinical decision on whether the specialist recommendation for surgery was correct. A GP takes the lead from specialists and their recommendations for surgery were clear and not optional.
45. Our clinical adviser said it is not up to a GP to decide the outcome of a safeguarding referral or if concerns are substantiated. That said, GPs must be diligent in reporting where they suspect concerns according to guidance.
46. They also said in this case, as there were historical safeguarding concerns that had been brought to the GP’s attention, there were reasons to support the GP being extra cautious and raising the safeguarding referral. This applied even if the historical safeguarding concerns were not regarding abuse or neglect by Miss P.
47. GMC Good Medical Practice says clinicians must make sure formal records, including patients’ records, should be clear, accurate, contemporaneous and legible. Therefore, the GP acted within the relevant guidance when they recorded details of the historical safeguarding concerns and the discussion about this on R’s medical records for the appointment on 6 March 2025.
48. The Practice confirmed in writing on 29 September 2025 there is no record of the safeguarding referral on 6 March 2025 or historical safeguarding concerns on Miss P’s medical records.
49. Therefore, we do not see indications of failings by the Practice when it raised a safeguarding referral. The GP should have reported concerns that R’s specialist recommendations for surgery had been declined by Miss P. This means the GP acted within relevant safeguarding guidance.
50. It was also within relevant guidelines for the GP to have recorded the referral was being made in R’s medical records on 6 March 2025, as well as discussions about historical safeguarding concerns that involved Miss P.
The Practice’s complaint response
51. Miss P said she felt the Practice was dishonest in its complaint response and did not answer her points.
52. In her complaint to the Practice, Miss P asked why its staff gave R no medical treatment on 6 March 2025. The Practice’s response explains the GP adhered to the prescribed conservative treatment plan by the specialists who have the appropriate clinical expertise to manage and treat MD.
53. The response details MD is within the domain of surgical specialists rather than general practice. It says when Miss P refused the recommended surgery and opted for non-surgical management, this was outside the standard medical guidance and carried a number of risks.
54. It also explains the safeguarding referral was made according to safeguarding standards and guidance and was done through due process following an MDT meeting. It also said the safeguarding referral was not a punitive action, but a necessary step to ensure R’s care and decision making were reviewed appropriately by safeguarding professionals.
55. Our NHS Complaint Standards say organisations should explain what happened in their responses to complaints based on evidence they gather during their investigations. They should also explain what should have happened. They should then compare the two, to consider whether there is a difference and anything went wrong.
56. In response to the concerns Miss P raised, as we set out above, we saw the Practice did this. Its complaint response is also in line with our clinical advice outlined above.
57. Therefore, we can see no indications of failings in the Practice’s complaint handling. In line with our NHS Complaint Standards, it provided a clear and detailed account what had happened and why during R’s care and treatment, and we see no indications it was dishonest in its response.
58. We were sorry to hear of Miss P and R’s experience and thank her for bringing her concerns to our attention. We hope the explanations we have provided in our decision help her in finding closure on her case.