Penicillin allergy test 16. Mr B says the Practice refused to arrange a penicillin sensitivity test after his dentist advised him to request one. He says this delayed his access to the right antibiotics and caused stress.
17. The NICE drug allergy guidance says people with a suspected allergy to beta-lactam antibiotics (a group of antibiotics that includes penicillin and related medicines) should be referred to a specialist drug allergy service if they need treatment for a condition that can only be treated by a beta-lactam antibiotic, or if they are likely to need beta-lactam antibiotics frequently in the future.
18. The clinical records show that on 17 February 2025 Mr B had a telephone consultation with a GP. The records from the consultation state that Mr B had attended the dentist and had been advised to discuss a penicillin allergy test with his GP because of limited antibiotic options for dental treatment.
19. The GP recorded that Mr B had a penicillin allergy documented in his medical record and that he reported developing a rash after taking penicillin when he was around 10–13 years old. The record notes there was no history of lip or tongue swelling, breathing difficulty, wheeze, or hospital attendance following the reaction.
20. The records state the GP explained that the Practice does not normally refer patients to an allergy clinic for an allergy that is already documented and can be avoided. The records also note that other antibiotics can be used as alternatives to penicillin. The GP recorded that a referral to an allergy clinic for penicillin sensitivity testing was not required.
21. Our adviser explained that penicillin allergy testing is not carried out in general Practice. They said that if referral is considered appropriate, this would be to a specialist allergy service and would usually only be appropriate where the NICE criteria set out above are met.
22. The records show Mr B already had a penicillin allergy recorded in his medical notes in 2001 and again in 2017. Therefore, it was already established that Mr B had an allergy to penicillin.
23. Our adviser said dental infections can usually be managed with non-beta-lactam antibiotics (antibiotics that are not related to penicillin). Because of this, they said Mr B did not meet the NICE criteria for referral for penicillin allergy testing.
24. Therefore, we consider it was appropriate and in line with the NICE guidance for the GP not to arrange a penicillin allergy test and not to refer Mr B to an allergy clinic.
25. As such we have not identified any indications of failings in the Practice’s response to Mr B’s request for penicillin allergy testing and we will not be investigating this issue further.
Chest X-ray results – 13 January 2025 26. Mr B says the Practice did not give him the result of his chest X-ray taken on 13 January 2025. He says he asked about the result during a Health Check appointment on 15 February 2025, but the healthcare assistant could not find the result on the system. Mr B says he was told he would need to book another GP appointment to discuss it. He says this caused stress and worry about his health.
27. The Practice says the chest X-ray result was received and filed in Mr B’s medical record on 13 January 2025 and that the radiology report recorded the findings as normal.
28. In its complaint response, the Practice explained that its usual process is to contact patients proactively only when results are abnormal or require follow-up. The Practice acknowledged that the healthcare assistant was unable to locate the result during the Health Check appointment on 15 February 2025. It apologised for this and said it would ensure nursing staff are aware of where results can be found and how patients can obtain them.
29. The GMC guidance says doctors should give patients the information they want or need about their care in a way they can understand and take steps, where possible, to meet patients’ communication needs.
30. The records show that on 13 January 2025 the result of Mr B’s chest X-ray was received and automatically added to his medical record. The radiology report said the heart looked normal and the lungs were clear, meaning the X-ray did not show any abnormal findings.
31. Our adviser explained that in primary care it is common practice for normal test results not to be proactively communicated because of the volume of results practices receive.
32. However, our adviser said that when a patient asks about a test result, the Practice should provide that information so, once Mr B asked about the result, he should have been told that the chest X-ray was normal.
33. As such, we consider that in line with the GMC guidance, the Practice should have given Mr B the information he wanted to know when he asked for this on 15 February. The Practice did not do this, and we consider this is an indication of a failing.
34. As the X-ray result was normal, our adviser said there is no evidence this caused a delay in treatment or clinical harm. Therefore, the impact caused from this was avoidable worry and inconvenience in that he had to wait until his next appointment to ask about the results.
35. Our NHS Complaint Standards say organisations should openly identify instances when things have gone wrong, take responsibility for these, and give meaningful and sincere apologies. It also says staff should also look at what action can be taken to learn from the experience to continuously improve services and help support staff.
36. The Practice has apologised and identified this as a learning point for staff. We consider this is in line with Our NHS Complaint Standards and the apology appropriately recognises the distress and worry caused to Mr B. For this reason, we consider the Practice has already remedied the injustice caused and as such we will not be taking this issue further.
Sick notes 37. Mr B says the Practice often took up to four weeks to issue his sick notes and that this was longer than NHS guidance allows.
38. The Practice informed us its internal standard is that sick notes are not treated as urgent because they can be backdated, and that it usually aims to complete them within two weeks.
39. The records show that on one occasion Mr B requested an extension to a sick note on 3 January 2025 and this was issued on 18 January 2025, two weeks and one day later. The other sick note extensions were completed within the usual two-week timeframe.
40. Our adviser explained that there is no national guidance specifying a fixed timeframe for issuing sick notes and Practices are allowed to set their own internal standards.
41. Our adviser said these were extensions of existing sick notes and that they were backdated, so there is no evidence of harm arising from any delay.
42. Our Principles of Good Administration say that public bodies should behave helpfully, dealing with people promptly, within reasonable timescales and within any published time limits.
43. We can see that there was one minor delay of one day in the Practice issuing Mr B’s sick note when he requested this on 3 January 2025. All other sick notes were issued within the Practice’s internal time limit, in line with Our Principles.
44. As this was a delay of only one day, we do not consider it shows that the Practice did not deal with Mr B promptly or within a reasonable timescale. As such, we do not consider it falls so far below Our Principles that it would amount to service failure.
45. We recognise this would have been frustrating for Mr B, particularly when he was unwell and relying on the documentation. We do not consider this shows indications of a significant service failing, as such we will not investigate it further.
Handling multiple issues in one appointment
46. Mr B says the GP did not allow him to discuss all his concerns in one appointment and instead told him to book another appointment. He says this led to delays and poor continuity of care.
47. Mr B referred to an appointment in February 2025 where he wanted to discuss more than one concern, including his request for a penicillin allergy test and the result of his chest X-ray.
48. The Practice said it serves more than 42,000 patients and has a finite number of appointments available to ensure services can be delivered safely. It said that once it reaches capacity, patients may be advised to seek support through other services such as community pharmacies or NHS 111, which can book patients directly into same-day GP appointment slots where appropriate.
49. The Practice also said it has trained reception staff to gather information so that patients can be directed to the most appropriate clinician, for example a practice pharmacist for medication queries. It said it is introducing a new appointment model aimed at improving access and continuity of care and increasing the number of face-to-face GP appointments available.
50. Our adviser explained that there is no national requirement specifying the length of GP appointments or how many concerns must be dealt with during a single consultation.
51. Our adviser said typical GP appointments are around 10 to 15 minutes, and clinicians have responsibilities to other patients booked after that appointment. They said it would not be safe or realistic to fully assess several different problems during one short consultation.
52. Our adviser said it is therefore reasonable and standard practice for a GP to prioritise the most important issue and ask the patient to book another appointment to discuss additional concerns.
53. The clinical records do not clearly document that multiple issues were raised during the consultation in February or that Mr B was advised to rebook.
54. The GMC guidance says you must provide a good standard of practice and care and be honest and trustworthy when communicating with patients.
55. As the GP only had time during the appointment to discuss one issue it was appropriate and in line with the GMC guidance to explain this to Mr B and ask him to book a separate appointment. If the GP did not have time to discuss more than one issue, then they could not have provided a good standard of care, which would not have been in Mr B’s best interests.
56. Our adviser said that asking a patient to arrange another appointment when several concerns are raised during a short consultation is clinically reasonable and consistent with safe GP practice, and there is no national standard the Practice has breached.
57. We recognise Mr B found this situation frustrating. Based on the information available, we consider the Practice acted in line with the GMC guidance, and we have not identified any indications of failings in how the Practice managed this issue. For this reason, we will not take this issue further.
Repeat prescription 58. Mr B says the Practice repeatedly failed to issue his repeat prescriptions on time. He says this meant he ran out of medication and had to contact the Practice several times.
59. Mr B raised this concern in an email to the Practice on 14 May 2025. In that email he said he had tried to arrange a repeat prescription in December 2024 for medication he had been receiving for several years. He also said that his most recent prescription should have been available on 13 May 2025, but it had not been issued.
60. A note of a later telephone call between Mr B and the Prescribing Lead indicates that Mr B’s concern was mainly that repeat dispensing had not been set up earlier. The note states that the Prescribing Lead apologised for this.
61. The Practice responded on 15 May 2025. It apologised that its repeat prescription process had not been clearly explained earlier and explained that repeat prescriptions must be requested by the patient and are not issued automatically. The Practice said patients are asked to allow five working days for prescriptions to be processed and sent to their nominated pharmacy. It also confirmed that Mr B had submitted a request on 14 May 2025, which had been forwarded to the GP for approval.
62. Our adviser explained that there is no national standard specifying an exact timeframe for issuing repeat prescriptions, and GP practices set their own internal processing times.
63. Our adviser said patients are responsible for requesting repeat prescriptions in good time. They also explained it is important to distinguish between the Practice issuing the prescription and the pharmacy dispensing the medication, as pharmacies may take additional time to prepare medication after a prescription has been issued.
64. Our Principles of Good Administration say that public bodies should behave helpfully, dealing with people promptly, within reasonable timescales and within any published time limits.
65. The Practice’s internal standard is to process prescriptions within five working days, and the Practice says it met this standard for Mr B’s requests. The records suggest that the Practice did meet this standard.
66. Based on the information available, we have not seen any evidence that the Practice delayed issuing repeat prescriptions beyond its internal standard. Our adviser said any longer waits Mr B experienced may have been related to pharmacy dispensing times or requests being made close to the date the medication ran out.
67. Therefore, we consider the Practice acted in line with Our Principles, and we have not seen any indications of a failing by the Practice that caused Mr B to go without his prescribed medication.
68. We are sorry to learn of Mr B’s complaint about the Practice and the impact this has had. We hope we have explained the thorough consideration we have given to our decision and clearly outlined the reasons for them.