Accessible communication and same day appointments
21. 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.
22. Miss L has raised concerns she does not have the same opportunity as other patients at the Practice to make a same day appointment.
23. We recognise Miss L’s concern about this and understand how she feels let down and that her care and treatment is inferior and delayed due to this.
24. The Practice says if Miss L requires a same day appointment she can contact her care coordinators by text message from 8am and any request for an appointment will be deal with the same as requests from other patients.
25. The Practice says Miss L has four different email addresses for the Practice that she is able to contact it and she also has the direct email to the Practice’s reception manager. The Practice has a hearing loop available and has assisted Miss L in setting up relay so Miss L can contact the Practice by telephone. The Practice says it has a dedicated a care coordinator to Miss L to help her make appointments and says it can book a sign language interpreter for any appointments if Miss L feels this is appropriate.
26. The NHSE guidance says practices can help people with hearing loss by offering the following options:
• ‘email • SMS text • textphone • text relay • video relay.’
27. We consider the Practice has acted in line with this guidance and has offered Miss L a number of different ways for her to be able to contact it to make a same day appointment.
28. Within the Trust’s response it also said it was, ‘exploring digital solutions to support patients with additional requirements.’ We asked the Practice for further information about this and it confirmed it is developing its Patient Knows Best (PKB) Patient Portal, which gives the option for digitalised letters and leaflets to be added. The Practice says its primary digital solution at the moment for deaf patient is text and email. Miss L has been provided with email contact addresses for the Practice.
29. We understand Miss L’s concerns as she is not able to contact the Practice by telephone to seek a same day appointment. We consider Miss L has other ways to contact the Practice which is in line with the NHSE guidance. The Practice also confirmed any request for an appointment it receives from Miss L is triaged and allocated an appointment based on the same criteria as if she was to contact it by telephone.
30. We consider there is no indication of a failing here. The Practice has provided Miss L with alternative way for her to contact it. It is also working on further ways for patients including Miss L to be able to contact it for an appointment.
31. We understand reading this will be disappointing to Miss L but we hope our findings offer her some reassurances with regards to what the Practice has put in place and what is expected of it in guidance.
Consultation notes
32. Miss L has raised concerns she was not contacted by the Practice after it received her consultation notes.
33. We understand how worrying this would have been for Miss L to be expecting a phone call or communication from the Practice that did not come.
34. The Practice says it received a letter from the Trust which conducted Miss L’s procedure but it would be for the Trust to inform the patient of the findings and any further management needed.
35. Miss L’s medical records show she attended the Practice and was referred to the Trust on 29 June 2023 to the colorectal clinic as a fast track referral. Following a consultation, Miss L then underwent a sigmoidoscopy. The sigmoidoscopy took place on 17 July 2023 and a report was sent to the Practice which details the investigation and findings.
36. The BMA guidance says, ‘Traditionally a clinician who orders a test is responsible for receiving and acting upon the results once available.’
37. Therefore, we do not consider it is the Practice’s responsibility to inform Miss L of any findings or results of investigations ordered by the Trust. We consider this is the responsibility of the Trust to as it arranged and ordered the sigmoidoscopy. We will take no further action.
Referral for CT scan
38. Miss L has raised concerns the Trust did not make a referral for a CT scan (computerised tomography – a type of X-ray). We recognise the worry this caused Miss L at the time due to her concerning symptoms.
39. The Trust says in order for Miss L’s procedure to be carried out within the necessary timescales it needed to refer her to a private provider to carry out the procedure. It would therefore be the responsibility of the private provider to arrange any CT scans.
40. The GMC guidance says, ‘promptly provide (or arrange) suitable advice, investigation or treatment where necessary.’
41. Miss L was seen by the Trust on 11 July 2023 as she reported a one month history of passing blood, mucus and loose stools. Miss L’s medical records show she appeared well at the consultation, her abdominal examination was normal and her digital rectal examination was also normal. The Trust also completed blood tests which were returned as normal, an abnormal FIT test and normal calprotectin (a protein which indicates inflammation in the intestines).
42. Based on Miss L’s symptoms and observations the Trust believed the likely cause of her symptoms was the anus or rectum area (ano-rectal) rather than the colon. It therefore arranged a sigmoidoscopy rather than a CT scan.
43. Miss L’s medical records document Miss L has a hearing impairment however, the Trust was able to explain the findings to her which she understood.
44. We consider the consultation on 11 July 2023 was in line with the GMC guidance. The Trust took a thorough history from Miss L, performed appropriate examination, considered relevant investigations and communicated effectively despite Miss L’s hearing impairment. The Trust also arranged for further testing which is also in line with the GMC guidance.
45. The NICE NG12 guidance says CT scans are not routinely indicated in cases of suspected anorectal pathology (cause or origin), nor in patients with a background of ulcerative colitis who have previously normal colonoscopies and normal calprotectin. This was the case for Miss L. In line with the NICE NG12 guidance it was appropriate for the next step in investigating rectal bleeding and mucus to perform a flexible sigmoidoscopy which is what was done here.
46. We consider there is no indication of a failing here. Miss L was appropriately examined and based on her symptoms she was provided with the appropriate next steps. There is no evidence Miss L should have been referred for a CT scan at this point.
47. We hope this offers Miss L an explanation of the actions taken by the Trust and offered her some reassurance about the care and treatment she received.
Prescription to prepare for CT scan
48. Two months later, in September 2023, Miss L attended a consultation at the Trust. During this appointment the Trust agreed to refer Miss L for a CT scan due to her ongoing symptoms of abdominal pain, weight loss and intermittent rectal bleeding in her stool.
49. Miss L has raised concerns the Trust did not provide her with the appropriate medication for her CT scan to be carried out.
50. The Trust says a CT colonoscopy was requested and Miss L was provided with a prescription for the required medication.
51. It is documented within Miss L’s records that bowel preparation medication was provided.
52. Miss L’s medical records show the Practice contacted the Trust to ask about the medication needed. On 21 August 2023 it was confirmed Miss L had the prescription and would be picking up that day to start taking tomorrow.
53. The GMC guidance says, ‘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.’
54. We consider there is no indication of a failing here. We consider the prescription was made to Miss L and it was her responsibility to make sure the prescription was picked up and she took the medication as needed prior to her CT colonoscopy. We consider the Trust did everything it could to make sure the medication was available to Miss L.
55. We are sorry to hear Miss L’s CT colonoscopy could not take place due to her not having access to the medication.