20. Miss E says that the Practice referred Mr E to Hospital A on 8 September 2023, she told us that the referral was rejected as the Hospital did not feel that his case was urgent enough to be seen there.
21. Miss E says that she does not feel that the Practice highlighted the urgency of Mr E’s case in the referral.
22. In its complaint response on 18 July 2025 the Practice say that the referral it sent to Hospital A on 8 September 2023 was an urgent referral, and that the Hospital rejected it on the grounds that Mr E’s case was not urgent enough to be seen there. They go on to say that the Hospital advised that it should refer Mr E to a local general cardiology clinic. It was after this that the Practice made the decision to refer Mr E to Hospital B on 13 October 2023.
23. Mr E’s medical records show that he was experiencing heart failure and had attended the Practice on 25 August 2023 for a heart failure review. Mr E told the Practice at this appointment that he had previously been experiencing headaches and dizziness, however these symptoms had now subsided. He also told it that his shortness of breath had not worsened.
24. On 8 September 2023 Mr E had a telephone consultation with the Practice. The records show that he had told it that he had been recently experiencing a ‘stabbing sensation’ on the left side of his chest that was coming and going. The Practice made the decision to refer him to Hospital A on the basis of this.
25. The records show that this referral was sent on 12 September 2023 and it was marked as ‘urgent’. The records also show that the Practice included with this referral a clear record of Mr E’s clinical history, and the most recent problems he had presented to it with.
26. The GMC guidance explains that practitioners must ‘refer a patient to another practitioner when this serves the patients needs’ and ‘promptly provide or arrange suitable advice, investigations or treatment where necessary.’
27. We asked our adviser if the Practice should have done more to ensure that Mr E was seen at Hospital A. Our adviser explained that the referral sent on 12 September 2023 was clear and showed that the priority selected by the Practice was ‘urgent’. They told us that it included the correct information in the referral by explaining Mr E’s clinical history and the most recent problems he was presenting with. They said that it was appropriate to refer Mr E to another practitioner to ensure that it was serving Mr E’s needs.
28. Although we cannot say why Hospital A rejected Mr E’s referral, we can say that in line with the GMC guidance the Practice made an appropriate referral and followed the correct process in how it made the referral on 12 September 2023, by marking it as ‘urgent’ due to the symptoms Mr E was presenting with at the time.
29. We understand that it will be difficult for Miss E to feel that her dad should have been seen at Hospital as early as September 2023. However, we have seen no indication that the Practice made the referral incorrectly. As explained above the Practice correctly marked the referral as ‘urgent’ and included the correct information about Mr E’s recent consultations and health problems with it. We have therefore not seen any indications of failings in the way that the Practice made Mr E’s 12 September 2023 referral.
30. Miss E also told us that when Mr E’s referral to Hospital A was rejected the Practice then referred Mr E to Hospital B on 17 October 2023. Miss E explained that when Mr E went to Hospital B for his initial appointment, it told him that it did not turn pacemakers back on at that Hospital. Mr E was under the impression that this referral was for him to have his pacemaker turned back on.
31. In its complaint response on 18 July 2025 the Practice explained that the referral to Hospital B was sent on 17 October 2023 and was also marked as ‘urgent’. It explained that after this referral was accepted, Mr E was under the care of Hospital B’s cardiology team, and the team made the decision to change his medication before discharging him to the community heart failure team.
32. Mr E’s medical records show that he was referred to Hospital B on 17 October 2023 and the referral was marked as ‘urgent’. The records also show that the Practice included a clear record of Mr E’s clinical history, and the most recent problems he had presented to it with.
33. Our adviser explained that it was appropriate for the Practice to refer Mr E to another cardiology service when his initial referral to Hospital A was rejected. This is in line with the GMC guidance that says that practitioners must ‘refer a patient to another practitioner when this serves the patients needs’.
34. The records show that Mr E was referred to Hospital B’s cardiology department. Our adviser explained that this was the correct department for Mr E to be referred to for support with his condition.
35. Although we cannot comment on the treatment that was provided to Mr E at Hospital B, we can conclude that there is no evidence that the Practice were incorrect to refer Mr E to Hospital B for management of his heart problems. The referral was in line with the GMC guidance and included the correct required information to ensure that Mr E was treated appropriately.
36. We understand that it will be distressing for Miss E to feel that the Practice did not refer Mr E to the correct Hospital for the treatment that he needed. We have seen no indication that Hospital B was not suited to Mr E’s needs as a patient.
37. Miss E explained that the Practice told Mr E that it would refer him to Hospital C on 1 May 2024 to have his pacemaker turned on, however, this referral was never sent.
38. In its complaint response on 18 July 2025 the Practice explained that Mr E was discharged from the community heart failure team who sent a letter to it on 23 May 2024 to inform it of this. The Practice said that the letter explained that the heart failure team had sent a referral to Hospital C for Mr E to receive further treatment.
39. The records show that on 23 May 2024 a letter was sent from the community heart failure team to the Practice. The letter explained that Mr E had now been discharged from the community heart failure team, it then says that ‘as the referral for Hospital C has been sent already, he will hear from there directly’.
40. Our adviser explained that as the letter said that the referral had already been sent, there was no necessity for the Practice to send a further referral, as the referral had been dealt with by the community heart failure team. We have therefore not seen any indications that the Practice needed to make a referral to Hospital C.
41. Miss E told us that following a consultation on 28 June 2024, the Practice explained that it would refer Mr E for a cardiology appointment. Miss E says that this referral was put through as routine rather than urgent as it should have been.
42. In its complaint response on 18 July 2025 the Practice explained that it referred Mr E to Hospital D following his 28 June 2024 appointment. It said that it could see that Mr E was seen there on 10 July 2024 and a follow up appointment was arranged for him on 16 September 2024. It then said that as Mr E was no longer a patient at the Practice by September 2024 it had no record of that appointment.
43. The records show that Mr E had an appointment at the Practice on 28 June 2024. During this appointment he explained that he had two weeks of worsening breathlessness. We can see that the Practice examined Mr E, and took his blood pressure and pulse, tested his oxygen saturation and listened to his chest. The records also say that Mr E was not breathless at the appointment.
44. The Practice then sent a routine referral for Mr E to cardiology on 1 July 2024, increased his medication dose, and arranged for him to have a blood test.
45. The heart failure guidance says that clinicians should monitor patients with heart failure by providing a clinical assessment of their functional capacity and should provide a more detailed monitoring if the patient has a significant comorbidity, or if a patient has deteriorated since the last review.
46. Our adviser explained that the results of the testing done at Mr E’s appointment were ‘normal’ and therefore, although Mr E had reported being breathless, there was no indication from the clinical testing that Mr E’s condition had deteriorated and required an urgent onward referral.
47. As Mr E’s test results were normal, and he had not deteriorated since the last review, the Practice sent a routine referral to cardiology for Mr E on 1 July 2024.
48. In line with the heart failure guidance, there were no indicators from the tests done in Mr E’s 28 June 2024 appointment that the Practice should have referred him as an urgent patient. We have therefore not seen any indications of failings in the way that the Practice categorised its referral for Mr E on 1 July 2024.
49. We are sorry that Miss E feels that if her dad had been referred earlier or to different cardiology departments, he could have received care that may have saved his life. I hope that our findings reassure her that he was appropriately treated by the Practice during this period.