SPSO Individual Decisions

Ms C complained about the care and treatment provided to her late mother (Mrs A) by the medical practice. In particular, she complained that the practice delayed taking action which diagnosed Mrs A was suffering from pancreatic cancer. We took independent GP advice and found that the practice had acted promptly in referring Mrs A for specialist intervention and that there were no delays in sending the referrals. The medical records detailed that Mrs A was referred to hospital twice under the two-week cancer pathway. We did not uphold the complaint. Ms C also raised concerns that the practice had failed to investigate Mrs A's abnormal liver function results taken in 2014. The advice we received was that the test results had not shown any deterioration until September 2015 and at that time the practice had acted reasonably in making an urgent referral to hospital. In view of the advice that the practice's response was reasonable, we did not uphold the complaint. Ms C was also concerned that the practice had failed to take appropriate action on Mrs A's reported weight loss. The clinical records demonstrated that Mrs A had been referred for dietary advice and attended a dietician clinic, and the advice we received was that the referral had been made at an early stage. We were satisfied, based on the medical records and independent advice we received, that the practice responded appropriately to Mrs A's reported weight loss and we did not uphold the complaint. Finally, Ms C complained that the practice failed to ensure appropriate palliative care was put in place for Mrs A at home. The advice we received was that, based on the medical records, the practice had not delayed in referring Mrs A to palliative care services and that the practice offered reasonable care. We did not uphold the complaint. Related reading View Decision Report 201601387 as a PDF (11.35 KB) Updated: March 13, 2018

Mrs C complained to us that the medical practice had failed to prescribe her with medication that had been recommended by a private clinician. Mrs C withdrew her complaint to us and we therefore did not continue our investigation. Related reading View Decision Report 201608067 as a PDF (10.68 KB) Updated: March 13, 2018

Mrs C complained that she was unreasonably asked by her medical practice to pay for a travel assessment before she could access typhoid vaccinations for her family. Mrs C said her family travelled regularly and that she kept an accurate record of her family's vaccination history. Mrs C said the practice's assessment had merely confirmed that typhoid vaccinations were required. The practice said they had been advised by the British Medical Association that such a travel assessment was acceptable. They believed they were acting in line with the charging structure set out in their contract with the board and that this allowed them to charge for the assessment carried out before the vaccinations were given. The practice said it was appropriate to insist that a clinician determine which travel vaccinations the patient required and that whilst different practices had different approaches to charging, theirs remained appropriate. We took independent advice from a GP adviser. They noted that the provision of travel vaccines fell under the 'additional services' section of the General Medical Services (GMS) contract. We found that the practice had acted inappropriately in charging a fee. As the service was funded, the practice could not charge for access. We therefore upheld Mrs C's complaint. The board said that they were unaware of the practice's charging structure. They considered the practice's interpretation of what they could charge for to be inaccurate and said they had contacted the practice and asked them to review their charging procedures. They said that the practice had agreed to make necessary arrangements to comply with the statement of financial entitlement (SFE) relating to travel vaccination under the GP contract.

Mrs C complained that the practice failed to provide appropriate medical care to her husband (Mr A). Mr A suffered from ischaemia (inadequate blood supply), which had previously resulted in the amputation of his right leg below the knee. He was admitted to hospital with ischaemia of his left foot and an ulcer. There was no surgical option available to address this issue and the plan was to delay amputation as long as possible. Mr A was being seen twice a week by district nurses following discharge from hospital. Some months after discharge, the practice was contacted by the board's district nurse who had identified deterioration in Mr A's foot. A GP at the practice did not consider a visit was necessary at that time, and instead prescribed antibiotics for Mr A. On the fourth day after the visit, Mrs C further contacted the practice when she received no subsequent visit from the board's district nurses. A second GP from the practice attended Mr A at home. The GP did not examine the wound, but prescribed further antibiotics. Two days later, the practice was further contacted as a district nurse had attended and discovered a maggot infestation in Mr A's wound. A GP attended and Mr A was taken to hospital. Mr A subsequently received an above-knee amputation of his left leg. Mrs C complained about the actions of the two GPs. She also complained about the practice's communication with the board. The practice acknowledged communication failings had occurred, and apologised to Mrs C. After receiving independent advice from a GP, we upheld Mrs C's complaint. While we found the first GP acted appropriately in prescribing antibiotics, we found the second GP should have examined the wound given Mr A had previously received antibiotics and his symptoms were worsening. We also found that the practice's communication with the board fell below a reasonable standard.

Mrs C complained about the practice's handling of her cervical screening (commonly known as a smear test), and also about their response to her complaint. Mrs C received a positive result from her smear test, and over the following year underwent investigations for suspected cancer. No cancer was detected and in looking into the matter, the board decided to look again at the original smear test result. The board convened a Problem Assessment Group (PAG) with input from a public health specialist and investigated the circumstances. As part of the investigation they tested the DNA on the original smear test and identified two sets of DNA, Mrs C's and another, unidentified sample. The PAG was unable to say definitively how or when the test was contaminated with another DNA sample. The laboratory that tested the sample was confident contamination could not have occurred there. The PAG concluded that the correct procedure in handling and processing smear tests had not been followed. All tests should be sent to the laboratory on the day taken or the next working day if done in the afternoon. The practice instead was sending batches of tests over a number of days or weeks. Women who had had smears around the same time as Mrs C were re-tested and none were found to have cancer. We were not able to establish for certain how the DNA and that of another person ended up in the same sample. Clearly, an error had occurred, and the independent advice we took from a nursing adviser confirmed that the nurse who took the smear test had not followed best practice guidance. The adviser also noted that Mrs C's appointment was not recorded in her medical records; only the date the test was sent was noted, which had led to confusion about the date of Mrs C's test. We made a recommendation to address this. We confirmed with the board that the nurse in question had discussed the incident at the time with senior staff at the practice and was now processing smear tests in the correc

Mr C attended both his medical practice and A&E on several occasions with back, leg, neck and arm pain. After a visit to A&E, a scan was arranged and Mr C was referred to neurosurgery. He underwent surgery to improve his pain, although Mr C was advised that he will never be pain-free. Mr C complained that the practice failed to take his condition seriously and contributed to a delay in his treatment. He also complained that the practice did not arrange a new prescription for painkillers in time for his discharge from hospital after surgery, despite him giving them notice of this. Mr C raised concerns that although he has been sober for several years, the practice was treating him differently due to his history of alcohol addiction. We took independent advice from a GP. We found the practice made several referrals to neurosurgery and that Mr C did not attend the first appointment, although it is unclear whether Mr C received the letters. The hospital declined further referrals as a scan showed surgery was not appropriate for Mr C at that time. The adviser said there was no indication that Mr C's condition had changed until he attended A&E, when an urgent scan was arranged. The practice then made a further urgent referral to neurosurgery, which was accepted. We also found it was reasonable for the practice not to have issued a repeat prescription for Mr C's medications until they had received the hospital discharge letter and Mr C had been reviewed by a GP. The adviser explained that this would be the same for all patients in this situation and that there was no evidence the practice had treated Mr C differently in view of his past history of alcohol addiction. We did not uphold Mr C's complaints. Related reading View Decision Report 201507865 as a PDF (11.41 KB) Updated: March 13, 2018

Ms C complained about the care and treatment she had received from her former GP practice. Ms C felt that doctors there had not managed an ongoing medical condition effectively and that there had been a delay in treating her acne. Ms C was also concerned by the practice's approach to her mental health. After taking independent advice on this case from a GP, we did not uphold Ms C's complaint. The advice we received was that there were no failings in the care or treatment of Ms C's physical or mental health. The adviser reviewed Ms C's medical records and commented that her acne had been appropriately treated on the first occasion it was mentioned in her notes. They advised that responsibility for managing her ongoing condition lay with the local NHS board, rather than the practice, and that appropriate action had been taken in relation to Ms C's mental health. Related reading View Decision Report 201508845 as a PDF (11 KB) Updated: March 13, 2018

Mr C attended the practice on three occasions between 2010 and 2013 for blood glucose tests (a standard test for blood sugar levels, used in diagnosing diabetes). Mr C was not diagnosed with diabetes until a fourth blood test later in 2013. He has complained that, based on these test results, the practice could have diagnosed his diabetes earlier than they did. We took independent advice from a GP adviser. They noted national guidance and the protocols in place in the practice for diagnosing diabetes. They also reviewed the test results from Mr C's blood glucose tests. They identified that it was not clear whether the first test, in 2010, had been a 'fasted' blood sample (ie whether Mr C had been told to fast prior to the blood test). They noted that this would have had an impact on what further action was appropriate. Given that the GP involved at that point had since retired, and that the actions could have been reasonable, they were not critical. However, the second blood test results showed concerns and should have been immediately responded to. Instead, Mr C was advised to return for another test in six months. When he had another blood test 18 months later, the test results were conclusive of diabetes, and the adviser noted that the error in identifying this had already been picked up by the practice in their response to the complaint. We concluded that the GP had not taken reasonable steps in their response to Mr C's second blood test, as further tests should have been taken at that time. We agreed with the practice's assessment of their response to Mr C's third blood test. We were also concerned that the local protocols in place for the assessment of blood glucose results did not fully reflect the national guidance.

Mr C complained on behalf of his mother (Mrs A). He said Mrs A's GP practice had not diagnosed quickly enough that the symptoms she was suffering from were side effects of the medication she had been prescribed. Mr C said these side effects were well known. He did not believe the practice had been as aware as they should have been of these side effects, which had caused Mrs A unnecessary and prolonged suffering. We took independent advice from a GP adviser on the care and treatment provided. The adviser said that the practice had reasonably considered Mrs A's ill health to be the result of a possible reoccurrence of breast cancer and had sought to rule this out. However, under national guidance for prescribing this medication, the practice should have been monitoring Mrs A's lung and liver function and they had failed to do so. The adviser noted the practice had subsequently taken all reasonable steps to address the failings in this case. We found that the practice had not provided reasonable care and treatment, but they had taken the appropriate action to address this. We made no further recommendations. Related reading View Decision Report 201500073 as a PDF (11.13 KB) Updated: March 13, 2018

Mr C complained about the treatment his late wife (Mrs C) received from the practice. Mrs C suffered from chronic obstructive pulmonary disease (a collection of lung diseases) and died three days after she had attended the practice. It was also the day after Mr C had phoned the practice as he had concerns that the medication which Mrs C had been given was ineffective. He said that he had wanted to speak to a GP but was offered a phone consultation which was scheduled for later in the day that his wife died. We took independent advice from one of our GP advisers, who said that she had concerns about the consultation Mrs C had attended. Our adviser was critical that the GP who saw Mrs C did not check Mrs C's oxygen saturation levels (pulse oximetry); did not ensure that Mrs C was able to use her inhaler appropriately; and failed to prescribe steroid medication. We found that the treatment which was provided to Mrs C was not of a reasonable standard. We also considered whether Mr C's phone call to the practice was actioned appropriately. Mr C believed that he was contacting the practice to explain that Mrs C's medication was not working and that her condition was deteriorating. The receptionist at the practice had recorded the phone call as 'medication and issues' and had not contacted a GP for advice and had made arrangements for Mr C to have a phone consultation with a GP. We found that Mr C should have been given the opportunity to speak to a GP on the day of his phone call and that had they done so then the GP would have had the opportunity to make a clinical judgement as to whether a further consultation was required. The practice have accepted that the system which was in use for phone calls required updating. The system has now been updated and our adviser believes that the service has now been improved.

Ms C complained about the care and treatment she received from her GP practice. She had an operation to fit a catheter, during which she sustained an injury to her bowel. This injury was not identified at the time and she subsequently experienced a lot of pain. She consulted the practice and a number of tests were carried out but the damage to her bowel was not diagnosed. It was not detected until she was admitted to hospital two months after her initial surgery. Further surgery was carried out to correct the damage. Ms C complained about the practice's failure to diagnose the bowel injury. She also complained that the practice refused to prescribe two drugs that had been recommended by hospital specialists; that they failed to appropriately treat her urine infections and that they failed to provide the hospital with details of her medical condition prior to an emergency attendance. We took independent advice from one of our GP advisers. Our adviser considered that the tests the practice carried out were reasonable and that the damage to Ms C's bowel would have been difficult to diagnose. However, as Ms C's pain was not resolving and no cause for this pain was identified, the adviser considered that further assessment should have been arranged. She stressed the importance of keeping a wide differential diagnosis in mind when investigating unexplained symptoms in patients (a systematic method of diagnosing a disorder that lacks unique symptoms or signs). We accepted the advice we received and upheld this complaint. We recommended that this should be fed back to the doctor concerned. We did not uphold Ms C's other complaints. Our adviser noted that the practice had not prescribed the two drugs recommended by specialists as they were concerned about potential interactions with other drugs Ms C was taking. Our adviser considered that this was reasonable and in line with safe clinical practice. She also noted that the urine tests in question had produced n

Mrs C's late husband (Mr C) was receiving treatment for prostate cancer. His condition deteriorated and Mrs C complained that GPs at the practice failed to take into account concerns that the medication to treat the cancer was the cause of the problems and that Mr C had a history of severe allergic reactions. Mrs C said that the GPs did not listen to her concerns and that Mr C rapidly deteriorated and died following a heart attack caused by an allergic reaction to the medication. She said that she and her husband were not warned about the possible side effects of the medication, and that staff failed to take reasonable action to resolve matters. We took independent advice from one of our medical advisers. We found that the care and treatment provided to Mr C was reasonable, and that the practice took Mr C's symptoms into account and acted appropriately in addressing his concerns about his medication. We also found that Mr C had suffered an acute heart attack and there was no indication to suggest that this was imminent. As such, his condition could not have been anticipated. Related reading View Decision Report 201403171 as a PDF (11.1 KB) Updated: March 13, 2018

Mrs C had been receiving medication prescribed by her medical practice for around ten years. However, the practice reviewed her medication and decided to stop it. Mrs C complained to us about the decision to stop her medication and the practice’s response to her complaint. We looked at the practice’s complaints file and Mrs C’s medical records, as well as taking independent advice from one of our GP advisers. Relevant guidance stated that medical practices should review medication periodically. We found that the practice had done so, while also taking advice from appropriate specialists. In addition, the practice had offered Mrs C an alternative, which was to receive her medication on a private prescription. Although the practice’s response to Mrs C’s complaint could have provided some additional information, it dealt with the key point of why they would no longer prescribe the medication to her, which we decided was reasonable in the circumstances. We did not uphold Mrs C’s complaints. Related reading View Decision Report 201407722 as a PDF (11.07 KB) Updated: March 13, 2018

Miss C complained to the medical practice because she said the doctor had inappropriately told her mother (Mrs A) at a consultation that she had been diagnosed with dementia. Miss C said the doctor repeated the diagnosis of dementia to both herself and her father in further phone calls. However, it was confirmed that Mrs A did not have dementia. The doctor denied telling Mrs A and her family that she had been diagnosed with dementia. Instead, the doctor said she advised that there was a possible diagnosis. Having reviewed the related medical information, the evidence available suggested dementia was being explored as a possible diagnosis and at no point was it confirmed as having been diagnosed. We did not see any evidence to suggest that the doctor, or any of the other clinicians involved in Mrs A's case, had confirmed a diagnosis of dementia. Therefore, we did not uphold the complaint. Related reading View Decision Report 201500437 as a PDF (10.99 KB) Updated: March 13, 2018

Mr C complained that, when his wife (Mrs C) phoned the GP practice for a home visit, the GP should have phoned for an ambulance instead. He also complained that the GP did not arrive at their home for just over an hour. We took independent advice from one of our GP advisers. They considered that it was clear from the medical records, and from a discussion the GP had with the district nurse who had made a routine visit to Mrs C earlier that day, that there was no reason for an ambulance to have been called on the basis of Mrs C's phone call. We noted that the medical records recorded the call as taking place about half an hour later than Mr C had indicated. However, regardless of the exact time, the adviser considered that the GP had arrived very promptly. When the GP saw and examined Mrs C, the GP felt that Mrs C had a significant infection. In line with relevant medical guidelines, she arranged hospital admission at that time. However, that decision was based on a physical examination, not the phone call. We did not uphold Mr C's complaint. Related reading View Decision Report 201500076 as a PDF (11.13 KB) Updated: March 13, 2018

Mrs C complained about the standard of medical care she received when she reported a cough to the medical practice. She said that she reported a persistent cough on two occasions but was not referred for a chest x-ray. At a third consultation, seven months after Mrs C first reported her cough, a locum GP referred her for a chest x-ray and, after further tests, Mrs C was diagnosed with lung cancer. We took independent medical advice from one of our GP advisers. We found that the practice missed two opportunities to arrange for Mrs C to have a chest x-ray as part of their routine investigations into a persistent cough. We found that the practice failed to reasonably follow the national referral guidance for suspected cancer which all GPs should be aware of and which clarify the significance of a cough in the diagnosis of lung cancer and state that a time-frame of three weeks should be considered a persistent cough. When Mrs C first reported the cough it had been present for eight weeks, and when she next mentioned the cough it had been present for 13 weeks. The criteria for referral for suspected cancer had been met on both occasions. We found that Mrs C should have been sent for a chest x-ray earlier than she was, so we upheld her complaint, and made a number of recommendations.

Mrs C complained about the treatment that her late mother (Mrs A) received from her medical practice between September and November 2012. Mrs A was eventually diagnosed with lung cancer and Mrs C said that the family had made repeated requests for a chest x-ray but these were ignored. The family believed that an earlier x-ray might have allowed Mrs A's cancer to be diagnosed sooner. They were also concerned that the practice failed to follow up blood test results as they should have done and which again they thought would have led to an earlier diagnosis. We took independent advice on this case from one of our medical advisers. Our adviser said that the practice had not failed to follow up on blood tests arranged by the hospital. However, he considered that the practice did not take reasonable steps in light of the results of blood tests they themselves organised. The adviser said that there were repeated and high levels of inflammatory markers shown on blood tests in late October 2012. These should have created a higher degree of suspicion, and led to consideration of a referral rather than just arranging repeat tests. The test results should have been considered in the context of an unwell adult and consideration given to referral for other possible conditions, although he also said that it was unlikely this would have led to an earlier diagnosis. The adviser also thought that Mrs A should have been referred for an x-ray in early November, when swollen lymph glands were noted. We concluded that, whilst Mrs A's care was reasonable up to the end of October 2012, and that earlier diagnosis was unlikely in her case, on balance there were failings by the practice from early November 2012 onwards.

Mr C complained about the care and treatment his late brother (Mr A) received from the medical practice. Mr A had been suffering from a cough, shortness of breath and chest pain and died of a pulmonary thromboembolism (a blood clot which forms at one point in the circulation, becomes detached and lodges at another point) in April 2014. Mr C said that he believed the practice had contributed to the death of his brother. Mr C complained that Mr A's GP did not treat his condition as worsening on his last visit to the practice. He also said that the day before Mr A's death, a receptionist had not allowed Mr A to speak to, or see, a GP when he called the practice to get the results of tests. Mr C complained to the practice but was unhappy with the response he received. He said that there were several things which he felt were inaccurate or incorrect in their response. Mr C questioned why the GP had not considered or recognised that Mr A's condition was worsening and disputed the practice's version of what was said during the phone call with the receptionist. We took independent advice from one of our medical advisers, who is a GP. We found that the medical records depicted a series of events consistent with a chest infection with some additional signs which needed further investigation and that the appropriate tests had been arranged, so we did not uphold Mr C's complaint about his brother's treatment. However, our adviser also said that the role of reception staff is to facilitate communication between a patient and a GP, and, therefore, they should not be making a decision that a patient who has specifically asked to speak to a GP should not have this option. Our adviser said the information should be passed to the GP who has clinical knowledge and responsibility for patient care to make the decision as to how to proceed. On this basis, we upheld the complaint about the care given to Mr A by the practice.

Mrs A registered with the medical practice when she moved into a care home. She had several ongoing medical conditions and was seen by GPs from the practice on a number of occasions. A number of months after moving into the care home, Mrs A became quiet and was not drinking enough fluids. Staff contacted the practice and were advised to keep her under close observation. A call back was arranged for a short time later at which time the care home staff reported that Mrs A was much better and was drinking fluids. As they also advised the practice that Mrs A had very strong, foul smelling urine, an antibiotic was prescribed to treat any underlying infection. Later that night, however, Mrs A's condition deteriorated and she was admitted to hospital later that night. She died some days later. Mrs A's daughter (Mrs C) complained that the GPs had not provided Mrs A with appropriate medical care while she was resident at the care home. In considering this complaint, we took independent advice from one of our medical advisers, who is a GP. Having reviewed Mrs A's medical records, our adviser said that she had received reasonable care and treatment from the practice. The GPs had reviewed and amended her medication, referred her to specialists in old age psychiatry and speech and language therapy, and responded to requests for advice from the care home staff as well as monitoring her general health. We did not uphold this complaint. However, Mrs C also complained that the practice took too long to respond to her complaint. We reviewed their complaints handling procedure and agreed that the complaint had not been dealt with within their published timescales. We also noted that their complaints handling procedure had not been updated to reflect the introduction of new legislation, so we upheld this complaint and made recommendations.

Mrs C had a hip replacement a few years ago which initially seemed to be successful. In early 2013, Mrs C attended her medical practice with pain in her thigh that was preventing her from bending to put her shoes on or driving. She was prescribed painkillers for a possible muscle or ligament injury and advised to rest. Mrs C's pain continued and she was sent for an x-ray which was reported as normal by a radiologist (a specialist in x-rays). The pain got no better and Mrs C was referred to a specialist. Some months after initially attending the practice, Mrs C contacted them to ask for a referral to a private hospital. Later that month, the practice arranged crutches for Mrs C as she was struggling to walk, and she was seen by the private consultant a few days later. He considered that the x-ray showed a possible issue and made suggestions for further investigations at an NHS hospital. These were carried out the following month and showed that Mrs C's replacement hip had become loose, causing the thigh bone to fracture. Mrs C complained that the practice failed to diagnose the cause of the pain in her thigh. We took independent advice from one of our medical advisers, who is a GP. The adviser reviewed Mrs C's medical records and said that although the x-ray was normal, the fact that she continued to suffer from pain and visited the practice on several occasions should have prompted them to carry out further x-rays, particularly when she had to be given crutches to walk. We, therefore, upheld her complaint.

Mr C complained about a number of aspects of the care and treatment the practice provided for his late mother (Mrs A). This included that there was a delay of six weeks in the practice referring Mrs A to a specialist, after a doctor at the practice told Mr C at a home visit that this would be done. Mr C also complained that when another doctor at the practice saw Mrs A at home on a later date, he failed to arrange for her to be admitted to hospital and made an inappropriate reference to her condition. Mr C said the practice failed to take his mother's deteriorating condition seriously and provide her with appropriate care and treatment. After obtaining independent advice on this case from one of our medical advisers, who is a GP, we upheld Mr C's complaints. Our adviser said that he would have expected the first GP to have set a time to see Mrs A to go over blood test results and to review her condition. This did not happen. The referral, which was eventually made more than six weeks after the home visit, appeared to have been prompted by Mr C and was made to a psychiatrist for the elderly, rather than a consultant geriatrician. It appeared that the practice might have taken some reassurance from tests that had suggested there was no sinister cause for Mrs A's long-term problems. The adviser said, however, that as Mrs A had red flag (warning) symptoms that could suggest underlying cancer and as some time had passed since the tests were carried out, a referral to a consultant geriatrician should have been made. The second doctor accepted that, at the later home visit, he had referred to Mrs A inappropriately. In our view, the term he used was insensitive and would likely have added to the distress Mr C was experiencing at that time. Having correctly decided not to admit Mrs A to hospital, it then appeared that this doctor failed to assess Mrs A's social situation at the visit, although we accepted that, overall, the practice acted reasonably in trying to get social w

Mrs C went to her GP twice after noticing a lump in her abdomen. She complained to us that he did not perform appropriate examinations to establish the cause of her symptoms and did not offer her a NHS referral. Mrs C said that the doctor was dismissive of her concerns about the lump, and she asked him to give her a private referral for specialist opinion. This resulted in a diagnosis of ovarian cancer. She said that there had been a delay in diagnosis and that, had she not insisted on a private referral, there would have been further delay. The GP said that he had carried out appropriate examinations and that it was his intention to make a NHS referral but Mrs C had insisted on a private referral. We took independent advice on the complaints from one of our medical advisers, who is a GP. As our investigation found that the GP had carried out appropriate clinical assessments and made an appropriate referral, we did not uphold the complaint. We did not make any recommendations, although we did point out to the GP that if a similar situation arises in future he should record why a private referral has been requested and agreed. Related reading View Decision Report 201400455 as a PDF (11.13 KB) Updated: March 13, 2018

Ms C attended the medical practice a number of times with various symptoms including constipation, low abdominal pain, recurrent urinary symptoms and diarrhoea. She was also treated in hospital for kidney inflammation. Ms C was eventually diagnosed with pelvic inflammatory disease (PID) and said she was told that she was infertile as a result of the delay in diagnosing and treating this. She complained that the practice did not provide her with adequate care and treatment by failing to investigate her repeated symptoms and diagnose PID. We took independent advice on this case from one of our medical advisers. The advice, which we accepted, was that the care and treatment Ms C received was not unreasonable. The adviser said that PID is a difficult condition to diagnose, with symptoms that may also be indicative of other more common diseases, or that may not appear at all. There was nothing typical or suggestive of a diagnosis of PID in Ms C's consultation records, and the adviser agreed with the practice that Ms C did not present with a clear cut case of PID. While we did not uphold this aspect of Ms C's complaint we recommended that the practice reflect on issues raised by the adviser in relation to their record-keeping and symptom review in relation to PID. Ms C also complained that the practice delayed in responding to her complaint. We found there was delay in their investigation of Ms C's complaint and a failure to keep her updated about the investigation.

Mrs C complained that when her medical practice increased the dosage of her medication, it had side effects on both her heart rate and blood pressure. The practice said that they had acted in line with the appropriate guidelines when doing so. Mrs C remained unhappy and brought her complaint to us. As part of our investigation we took independent advice from one of our medical advisers, who is a GP. He considered Mrs C's medical records and confirmed that the practice had decided to increase the dosage because of blood test results, and that the increased dosage was in keeping with standard practice in most GP surgeries. He also said that the internal systems the practice had in place to review Mrs C's medication in future were in line with good practice. As such, although we recognised that the change in dosage had affected Mrs C, we found no evidence to suggest that the practice acted unreasonably in prescribing this. Related reading View Decision Report 201304471 as a PDF (11.04 KB) Updated: March 13, 2018

When Mrs C's young daughter (Miss A) became ill, she was taken to her medical practice, where she was treated for an upper respiratory tract infection. The next day Miss A attended an emergency appointment there, as her condition had deteriorated. As she was clearly unwell, the practice referred her urgently to hospital. She was treated for a viral infection and discharged home without follow-up. A few days later, she was again taken to a further emergency appointment at the practice, where, in view of the hospital's recent diagnosis, doctors advised Mrs C to continue with the treatment previously recommended. However, Miss A's condition continued to decline and she was admitted to hospital. She later spent a number of weeks in intensive care after being diagnosed with pneumonia. Mrs C complained that the practice showed little concern or empathy for her daughter's declining condition. She said that they had failed to take appropriate action on her symptoms as a consequence of which Miss A suffered distress and unnecessary suffering. We took independent advice on this case from one of our medical advisers, and took all the relevant information (including the complaints correspondence and Miss A's clinical notes) into account. We did not uphold the complaint, as our adviser said that the records indicated that the treatment given to Miss A was reasonable and that doctors made a reasonable working diagnosis. The adviser also said that Miss A went on to develop a rare and unusual medical condition, and there was nothing in her notes to suggest that this was developing. Related reading View Decision Report 201303187 as a PDF (11.4 KB) Updated: March 13, 2018