SPSO Individual Decisions

Mrs C complained about the care and treatment of her late mother (Mrs A). Mrs A became unwell and was seen initially by an out-of-hours doctor, who diagnosed infection and prescribed antibiotics. Mrs C called the practice and spoke to a GP the following day as Mrs A was still unwell, and a home visit was arranged for the following day. When a GP reviewed Mrs A at home the next day, arrangements were made to admit her to the GP unit in a local care home. From there, she was transferred to hospital in the early hours of the following morning, where she deteriorated and died five days later. Mrs C complained that, when she called the practice, they did not arrange for Mrs A to be reviewed that day. We took independent advice from a GP adviser, who considered that the GP carried out an appropriate assessment and, based on the information gathered, took steps to arrange for Mrs A to be reviewed within a reasonable timescale. We accepted the advice and did not uphold the complaint. Mrs C also complained that the GP who reviewed Mrs A at home should have arranged to admit her directly to hospital. She also raised concerns that the GP retrospectively altered Mrs A's recorded oxygen saturation level. The practice indicated that this was to rectify a typing error. We were advised that the originally recorded level should have led to a direct hospital admission, whereas the amended level was in keeping with the actions taken. We were unable to establish the true picture and, therefore, could not conclude that there was an unreasonable failure to admit Mrs A to hospital. As such, we did not uphold the complaint however we made a recommendation in relation to record-keeping.

Mrs C complained about the care and treatment provided to her late mother (Mrs A) by the practice. In particular, she complained that Mrs A had not been seen by a medical professional before antibiotics were prescribed to her, and, futher, that she had not been seen when the antibiotics were subsequently changed. We took independent advice from an advanced nurse practitioner. We found that a home visit should have been carried out before the antibiotics were prescribed to Mrs A and that, as such a visit did not take place, it was even more important that a review should have been undertaken of Mrs A before her antibiotics were changed. The advice we received was that there was a lack of detail in the clinical records and that it was not clear from the records what symptoms Mrs A had when the decision to change antibiotics was made. We were concerned that the practice had failed to follow guidelines that all older patients suspected of having a urinary tract infection, like Mrs A was, should be seen and fully examined. In light of these failings, we upheld this aspect of Mrs C's complaint. Mrs C also complained that the practice had inappropriately decided not to undertake a home visit after she had contacted them a number of times. We found that, when the visit was requested, Mrs A had deteriorated and she needed to be seen or arrangements needed to be made for admission to hospital. We also found that, whilst reasonable advice had been given to Mrs C to contact the ambulance service if Mrs A's condition deteriorated, there was a delay in this advice being given to Mrs C. The practice accepted that a home visit should have been carried out. We upheld this aspect of Mrs C's complaint. Finally, Mrs C complained that the member of staff she was complaining about had responded to her complaint. We found that neither the Scottish Government guidance on complaints handing which was in place at the time of the complaint, or the new NHS Scotland model complaints h

Mr C complained to us that the practice had failed to manage his medication in an appropriate manner. He had been on pramipexole medication (used as treatment for Parkinson's disease and restless legs syndrome) for four years and he said that during that period the practice had not reviewed the medication. Mr C said that the practice had also increased the medication dosage without telling him and that he had experienced severe side effects. Mr C felt that the practice should have kept the medication under review and informed him of the change in dosage. We took independent advice from a GP adviser. We found that, during the period in question, Mr C had not reported to the practice that he was having side effects from the medication. The practice had invited Mr C to attend for a review of his medication on five occasions, but he had not responded. Mr C was also reviewed on two occasions when he attended the practice to discuss other clinical matters. We also found that it was appropriate for a pharmacist to advise Mr C of the increase in the dosage of the medication, rather than have him make an appointment with a GP. We did not uphold Mr C's complaint. Related reading View Decision Report 201701810 as a PDF (11.14 KB) Updated: March 13, 2018

Miss C complained that the medical practice had failed to carry out an appropriate assessment or refer her late father (Mr A) to hospital when he attended a consultation. Mr A was very breathless and suffered from pulmonary fibrosis (scarring of the lungs). The GP did not take Mr A's temperature or provide medication, as they felt that no further treatment was required at that time. Mr A was told to wait until his next scheduled respiratory clinic at the hospital, which was in nine days time. When Mr A attended the clinic, a clinician arranged an immediate hospital admission. Mr A deteriorated and died a few days later. Miss C felt that the GP should have referred Mr A to hospital sooner. We took independent advice from an adviser in general practice medicine. We concluded that, although the GP had arranged for an ECG (electrocardiogram - test to check the rhythm of the heart), the GP failed to record Mr A's oxygen saturation, temperature and blood pressure. We found that the GP had failed to carry out an examination of the heart, which would have been appropriate for a patient who had presented with increased breathlessness and chest pains. We also concluded that, while it was possible that the GP's decision for Mr A to wait until his clinic appointment may have been reasonable, we were unable to establish this as the standard of record-keeping for the consultation was inadequate. We upheld Miss C's complaint that the GP failed to provide Mr A with appropriate treatment in view of his reported symptoms. However, in view of the inadequate record-keeping, we could make no finding on the complaint that the GP should have referred Mr A for a hospital assessment.

Ms C, an advocacy and support worker, raised a complaint on behalf of her client (Mr A) about the care and treatment he received for a bunion from Golden Jubilee National Hospital. Specifically, she complained that appropriate surgery was not carried out, that the cause of infection following surgery was not properly investigated and that Mr A had not been advised of the problems which could occur with the surgery. We took independent advice from a consultant orthopaedic trauma surgeon and found that there was evidence to support that discussion had taken place with Mr A about the recognised complications associated with the bunion surgery. Some of these included the possible risk of non-healing and a need for further surgery. We considered that the surgery was appropriate and that, whilst there was no clear evidence of infection post-surgery, it was appropriate to consider the possibility of infection when Mr A experienced problems following his surgery. We noted that the board had apologised to Mr A regarding the lack of communication about this. We concluded that there was no evidence of unreasonable treatment and that delayed healing had been the likely reason for Mr A's protracted recovery. We did not uphold the complaint. Related reading View Decision Report 201605577 as a PDF (11.21 KB) Updated: March 13, 2018

Mrs C complained about the cardiology care and treatment given to her late husband (Mr A) when he was a patient at Aberdeen Royal Infirmary. Mr A was admitted to hospital and reported having chest pains and shortage of breath. During his admission, Mr A was also seen by the diabetic team and urology advice was taken. The next month, he attended the cardiology clinic and he was noted to have continuing and increasing breathing difficulties. It was recommended that he be admitted for tests. However, in order to first rule out an infection, he was referred to the Acute Medical Initial Assessment Unit (AMIA). A few months later, Mr A was admitted to the AMIA for the second time as he was reporting chest pains and breathlessness. The cardiology team were contacted and it was decided only to manage his medical conditions, and not for him to have a clinical review at that time. He was later discharged. Mr A died the following month and Mrs C believed that this was as a result of the pills he had been taking and she said that she felt he had not been treated properly. She also said that communication had been poor and that Mr A's unexpected death came as an enormous shock. She complained to the board and they considered that Mr A had been treated appropriately. Mrs C then brought her complaints to us. We took independent advice from a consultant cardiologist and we found that Mr A's cardiology care had not been of a reasonable standard. We found that Mr A and Mrs C had not been given the opportunity of cardiac rehabilitation education. We found that a diuretic (a drug that enables the body to get rid of excess fluids) was recommended to Mr A during his treatment, but that he declined this. The adviser was concerned that this was not discussed further with Mr A during subsequent admissions to hospital. We found that after his second admission to the AMIA, it may have been preferable for Mr A to have been reviewed by the cardiology team. We also found that duri

Mr C complained to us that he, his wife and daughter were removed from the practice's list. National Services Scotland (NSS) wrote to Mr C to say that his GP practice had asked NSS to remove him, his wife and their daughter from their patient list because of a breakdown in the doctor/patient relationship. Mr C said it was not clear why they had all been removed and that he had not been given a warning. Mr C believed it was because of a complaint he had made previously to us about the practice. As a result of the decision, Mr C and his family were distressed and left without the care of a GP practice while they found a new practice. We took independent advice from a GP adviser. The advice we accepted was that there was no evidence that the practice had complied with their contractual regulations and General Medical Council guidance. We found that there had been an appointment between Mr C and practice nurses that was difficult for all concerned and that aspects of the appointment were challenging for staff. However, having reviewed in detail the witness statements and the entries in Mr C's medical records, we were not satisfied that it was reasonable for the practice to remove Mr C without first warning him that his behaviour was causing staff concern and giving him an opportunity to help restore the professional relationships. We found that the practice had failed to give him an open and transparent response on their reasons for having him removed and that, as a result, he was concerned that he was removed because he had made a complaint. It is also of concern that the practice failed to take all reasonable steps to restore the professional relationship. We were not satisfied that the professional relationship with the practice had broken down to such an extent following the appointment with practice nurses that it affected the standard of clinical care provided, and so we found it to be unreasonable that Mr C was removed from the list. Similarly, there wa

Ms C complained that GPs at her medical practice had misdiagnosed her after she attended several appointments complaining of earache. Ms C was later found to have chronic tonsillitis. She complained that the GPs had not diagnosed this when she presented with her symptoms. She also complained that she was not prescribed anything for her pain during this period. We took independent medical advice and found that the GPs assessed and treated Ms C appropriately and in line with her symptoms. An appropriate referral had been made to the ear, nose and throat department. In relation to the matter of pain relief, the practice pointed out that Ms C was already on a number of strong painkillers for other conditions. Ms C complained that the practice's handling of her complaint was unreasonable. We found that their response to her complaint was not professional and lacked objectivity. We upheld this aspect of the complaint.

Mr C complained about the care and treatment provided by the practice to his late wife (Mrs A). Mr C complained that the practice had missed red flag symptoms prior to her diagnosis of carcinoma of the epiglottis (cancer in the tissue that covers the windpipe). He also complained that the next year, the practice missed red flag symptoms for cancer of the floor of the mouth. We took independent advice from a GP. We found that Mrs A had suffered from throat discomfort for around three months before the practice referred her to a specialist. National guidelines state that persistent throat discomfort for three weeks should have led to an urgent referral, particularly as Mrs A was a smoker. We therefore upheld this aspect of Mr C's complaint, although we found that as the carcinoma of the epiglottis was cured, the delay in referral did not result in any significant injustice. We further found that when Mrs A first presented with oral symptoms, the practice acted in an appropriate and timely manner, therefore, we did not uphold this aspect of Mr C's complaint.

Mr C has suffered from diabetes for some years. He recently changed GP practice and said his life and health had improved dramatically since moving to a new practice. He complained that his old practice failed to manage his diabetes care and treatment appropriately and that this may have contributed to him suffering liver damage. We reviewed the care and treatment provided to Mr C for the management of both his diabetes and his liver. We considered the medical records and took independent advice from a GP and from a nursing adviser qualified in specialist diabetes care. Both advisers were satisfied that the practice had taken appropriate steps to monitor Mr C's condition and to attempt to manage his care. Therefore, we did not uphold the complaint. Related reading View Decision Report 201601978 as a PDF (10.95 KB) Updated: March 13, 2018

Mrs C raised a number of concerns about the care that her mother (Mrs A) received from her medical practice. Mrs A had been diagnosed with terminal pancreatic cancer and was receiving care in her home from a multi-disciplinary team including her GP, district nurses and a Macmillan nurse. Once Mrs A's care needs increased, her GP referred her to a specialist palliative care facility, where she died. We found that in response to Mrs C's complaint, the practice had reflected on the care they had provided to Mrs A and had identified a number of learning points to take forward and act on. We took independent advice on the case from a GP adviser who noted Mrs C's concerns about communication, but did not find evidence that the practice had communicated unreasonably with Mrs C or Mrs A. The adviser was satisfied that the practice had provided appropriate care and treatment for Mrs A's symptoms, and that the GP's role in an investigation into potential diabetes was reasonable. The adviser did not consider that the GP unreasonably delayed visiting Mrs A after she suffered a fall, and considered that the assessment performed at the subsequent home visit and referral to a specialist palliative care facility were reasonable. We did not uphold this complaint. Mrs C also expressed concern about the level of support and information the practice provided to her in her role as a carer. We found that the practice did not send Mrs C the range of leaflets and resources that they usually send to individuals who have been identified as carers in terms of the practice's protocol. The adviser did not consider that this was unreasonable as it was the responsibility of Mrs C's GP, rather than Mrs A's GP, to provide this information. The adviser noted that the practice had provided some information at a late stage to Mrs C and considered the practice might want to consider taking steps to ensure that any information that is provided in these circumstances is provided at an earlier st

Ms C complained on behalf of her late mother (Mrs A) about the care and treatment she received from her GP practice. Ms C considered that Mrs A's medication was changed inappropriately, that Mrs A was not given appropriate treatment for her symptoms and there was a failure to communicate reasonably with Mrs A and her family about her condition. Ms C also complained about the handling of her complaint. During our investigation we took independent GP advice. We found that Mrs A's practice gave appropriate treatment for her symptoms, but delayed in making an urgent referral to a consultant geriatrician and a routine referral to a dietician. They also delayed in issuing Mrs A with a prescription. In light of these delays, we upheld this aspect of Ms C's complaint and made recommendations to address this. We found that it was reasonable that Mrs A's medication was changed, and did not consider that there were failings in communication by the practice. We considered the handling of Ms C's complaint to be reasonable and, therefore, we did not uphold these aspects of her complaint.

Mrs C complained about the care and treatment provided to her late husband (Mr A). Over the course of a number of years Mr A attended the practice with anxiety and depression. During this time, the practice treated Mr A in primary care, and did not refer him to mental health services. Subsequently, Mr A did not attend the practice with these problems for approximately 18 months. Mr A then contacted the practice and reported persistent thoughts about suicide to the GP who saw him. The GP developed a plan of management, including referring Mr A to psychiatric services. However, the referral was not processed. Mr A committed suicide approximately ten days after his attendance at the practice. Mrs C complained that the practice failed to appropriately refer Mr A to mental health services in view of his presenting symptoms. The practice said they provided appropriate treatment based on Mr A's symptoms during his earlier attendances. They did not consider a referral was appropriate at that stage. When Mr A returned and described persistent thoughts about suicide, they said a referral was appropriate. The practice acknowledged there was an error in processing the referral, although they noted that it was unlikely Mr A would have received an appointment before his death. After receiving independent advice from a GP, we upheld Mrs C's complaint. We found there was an administrative failing in not making the referral (as the practice acknowledged). We also found the practice should have scheduled an earlier review when Mr A re-attended the practice. However, we did not consider the practice should have made a referral at any of Mr A's earlier attendances, and we found that the care and treatment provided during this time had been reasonable.

Ms C complained about care and treatment her mother (Mrs A) received from her medical practice. Ms C was concerned that the practice missed opportunities to enable an earlier diagnosis of lung cancer. She felt that an earlier diagnosis could have helped prevent Mrs A's death. Ms C also raised concern about the way in which a GP handled a conversation about possible future resuscitation. We took independent medical advice from a GP. We found that the practice had provided a reasonable standard of care in response to the various symptoms Mrs A had presented with in the year leading up to her cancer diagnosis. We did not identify any clear evidence to show that the conversation about resuscitation was handled inappropriately, and considered that it was reasonable to have this conversation with Ms C and Mrs A. The practice reflected on Ms C's concerns in any case and took steps to improve the way in which their staff deal with such conversations with patients and their families. We did not uphold Ms C's complaints. Related reading View Decision Report 201603001 as a PDF (11.09 KB) Updated: March 13, 2018

Ms C, who works for an advocacy and support service, complained on behalf of Ms A about the practice's monitoring of her infant daughter (Miss A). Miss A was diagnosed with hydrocephalus (an abnormal build-up of fluid in the brain) at around four months old. Ms C complained that this should have been picked up sooner. We took independent medical advice. It was noted that, prior to her six to eight week assessment, the health visitor had measured Miss A's head circumference and the measurement had crossed over the top centile. This should have been a cause for concern and should have prompted a referral for further investigation. However, the health visitor had not taken action to alert the practice. The adviser considered, however, that the GP carrying out Miss A's six to eight week assessment should reasonably have looked at the growth charts and sought to satisfy themselves that Miss A was developing normally. They did not do so. We upheld the complaint. However, the GP had already apologised for not personally examining the growth charts and arranging further action. The practice had reflected on the case and confirmed that they were now checking measurements and centile charts at the six to eight week assessment. We considered this action to have appropriately addressed the identified failings and we had no further recommendations to make. Related reading View Decision Report 201508590 as a PDF (11.28 KB) Updated: March 13, 2018

Mr C complained to us that the medical practice had failed to provide appropriate care and treatment to his late teenage daughter (Miss A). He said that Miss A had a lump on the side of her head which, over a couple of years, the doctors had said was a cyst. This turned out to be cancer. Mr C felt that there had been a delay in reaching the diagnosis and that it was inappropriate that the practice had sent letters directly to his daughter about possibly removing the cyst at an earlier time. He said that he and his wife were not aware of the letters. The practice responded that the presumption was that Miss A had a cyst, and that the option of removal under local anaesthetic was discussed. Miss A was given the opportunity to consider the excision along with the offer of a second opinion. When the cyst was noted to be increasing in size, Miss A was referred to hospital and cancer was diagnosed. The practice explained that the diagnosis was unusual for a child of Miss A's age but that their investigation had identified a number of learning points. We took independent GP advice. We found that based on the recorded evidence, there were no concerns about the way the GPs managed the situation. Initially there were no signs that the lump was sinister and the offer to have it removed was made. Miss A was competent to make the decision whether to have the lump removed at an earlier stage for cosmetic reasons rather than for clinical reasons and she decided not to have it removed. That was a reasonable decision for her and her parents to consider as her parents were involved in Miss A attending the practice at times. It was also reasonable for the practice to write directly to Miss A directly. We did not uphold Mr C's complaint. Related reading View Decision Report 201605999 as a PDF (11.46 KB) Updated: March 13, 2018

Mr C complained about the treatment he received from his GP practice after a fall in which he sustained a head and neck injury. He thought the practice should have referred him to A&E. We found the treatment Mr C received was reasonable. He attended the practice without an appointment and was seen by a triage nurse who assessed his injury. He was advised to take pain relief. Mr C later called the out-of-hours service and was given a pain-relieving injection and on-going pain relief. When the medication ran out he went back to the practice, was assessed, and was given more medication. Mr C returned to the practice and told them he wanted to go to A&E. He attended A&E the same day and had an x-ray, which was clear. He was given advice about lying flat and exercise. We found the treatment the practice provided was reasonable in the circumstances, given Mr C's presenting symptoms. Mr C's injury was assessed in the normal way by a triage nurse. No serious injury was evident. Mr C was, appropriately, advised to seek further advice should his condition deteriorate. When Mr C was assessed in A&E, no significant injury was found. We therefore did not uphold Mr C's complaint. Related reading View Decision Report 201601173 as a PDF (11.15 KB) Updated: March 13, 2018

Mrs C complained that when she phoned the medical practice for an appointment, she was given neither an appointment nor a phone consultation. We looked at the practice's records and took independent advice from a GP adviser. As there was no audio recording of the phone calls, we could not determine what was said. There was no evidence that Mrs C was not taken seriously when she was unwell, and we found that she saw a GP the day after she phoned the practice. We did not find that practice staff failed to respond to Mrs C's request for a medical consultation in a reasonable manner and therefore we did not uphold Mrs C's complaint. Related reading View Decision Report 201603468 as a PDF (10.91 KB) Updated: March 13, 2018

Mrs C complained to us about the treatment her mother (Mrs A) received from her medical practice. In particular, she was unhappy with the treatment Mrs A received for pain in her left arm and in relation to choking episodes. She also made a number of complaints about the medication prescribed to Mrs A. We took independent advice from a GP adviser. We found that, in general, the treatment provided to Mrs A by the practice had been of a reasonable standard. However, although Mrs A had angina, she had been prescribed an anti-inflammatory medication by a GP that is contraindicated in (should not be given to) patients with angina. In addition, Mrs A had incorrectly been prescribed a double prescription of heart medication and iron tablets. Although there was no evidence that Mrs A suffered harm as a result of these prescribing errors, in view of these failings we upheld the complaint. The practice had already apologised for this. Mrs C also complained that a GP had told Mrs A that she had cancer when she attended a consultation at the practice on her own. We found that the specialist clinician who had previously arranged tests for Mrs A should have previously informed her of the diagnosis. It was reasonable for the GP to assume that Mrs A had already been informed of her diagnosis. We did not uphold this aspect of Mrs C's complaint. Finally, Mrs C complained about the practice's handling of her complaint. We upheld this, as we found that the practice had delayed in responding and had not advised Mrs C that she could contact SPSO.

Mr C complained about the medical practice after they removed his family from the practice list for being outwith the practice boundary. Following a home visit to Mr C's father-in-law, the practice had advised that they felt the distance they had to travel presented a potential safety risk. This had led them to audit the practice list and they had decided to remove all patients outwith their boundary. Mr C advised that, although his family was outwith the practice boundary, they had been registered there for many years following a complaint against their previous practice. He considered that this meant they should be allowed to remain on the practice list. We found that the practice had clearly explained the reasons for their decision and given reasonable notice of the removal of services. We sought independent advice from a GP adviser, who was satisfied that the practice had complied with the provisions set out in the General Medical Services Contract for the removal of patients from the practice list, and that it was within their discretion to remove patients who were outwith their practice boundary. We accepted this advice and did not uphold Mr C's complaint. Related reading View Decision Report 201600712 as a PDF (11.13 KB) Updated: March 13, 2018

Mr C attended his medical practice with a recurrence of back pain and sciatica (back and leg pain caused by irritation or compression of the sciatic nerve) and it was agreed he would be referred to neurosurgery. Mr C complained about a subsequent delay in the referral being sent and about the practice's response to his complaint to them. We took independent advice from a GP, who confirmed that routine referrals should normally be sent within one week. Mr C's referral was not sent for almost six weeks. We were critical of the practice for not having clearly explained the reason for the delay to Mr C. In their response to Mr C they had blamed general delays across the NHS system and had not accepted any specific fault on their part. However, the practice told us that the delay was caused by a delay in dictating and typing the referral letter. They informed us of the process they have in place to avoid a similar future occurrence. The adviser also noted that Mr C attended the practice on a further three occasions in the interim period. They considered that his reported symptoms should have prompted the upgrading of the referral to urgent. They noted that urgent referrals should be sent within 24 hours. The adviser saw no evidence of Mr C having been asked questions to rule out further warning signs that may have necessitated an emergency hospital admission. We therefore found that there was an unreasonable delay in sending the routine referral and an unreasonable failure to upgrade this to urgent. We upheld this aspect of Mr C's complaint. With regard to the practice's handling of Mr C's complaint, we noted in particular that Mr C did not receive a response to his initial complaint letter and that he was not referred to the SPSO at the end of the process. We were also critical of the practice for including details of Mr C's medical history in their correspondence to us that was not relevant to his complaint. We upheld this aspect of Mr C's complaint.

Ms C complained about the communication between her grandfather (Mr A), who had prostate cancer, and the medical practice. Mr A was cared for by the practice at home, on a GP-led ward and while he was in a nursing home. Mr A died ten days after his admission to the nursing home. Ms C complained that the practice had failed to communicate appropriately with Mr A in relation to his cancer diagnosis and treatment options, despite the practice having access to this information. We took independent advice from a GP adviser. They noted that Mr A was being seen by a consultant urologist (a clinician who treats disorders of the urinary tract) and that it was the urologist's responsibility to discuss Mr A's cancer diagnosis and treatment options with him, not the GP's. We therefore did not uphold Ms C's complaint. The adviser noted that there was a delay in referring Mr A for an ultrasound scan and that the national referral guidelines for suspected cancer had not been followed. We therefore made a recommendation in relation to this.

Mr C said that his late father (Mr A) attended the GP practice on a number of occasions with symptoms indicating a serious condition. He said that the practice unreasonably failed to consider the possibility of bowel cancer and carry out appropriate tests, investigations and referrals. Mr A died a few months after several admissions to hospital where he was diagnosed with bowel cancer. We took independent advice from a GP adviser. We found that the care and treatment provided by the practice was reasonable including that referrals and investigations were arranged within a reasonable time before Mr A's first admission to hospital. We also found no evidence suggesting that the practice failed to monitor Mr A appropriately when he was discharged from hospital. Related reading View Decision Report 201507752 as a PDF (10.97 KB) Updated: March 13, 2018

About six weeks after the birth of her child, Mrs C attended her GP practice with bleeding and abdominal pain. She was treated with antibiotics. She was reviewed several times over the next few months, and a urine test and vaginal swab were carried out, with further antibiotics prescribed. Mrs C was then referred to gynaecology as a private patient, and subsequent investigations showed there were retained products of conception (pieces of placenta) left after the birth. Mrs C complained about the delay in referring her, and said she was only referred after telling the GPs she had private medical insurance. The practice explained that the cause of Mrs C's bleeding had been unclear. Mrs C had had a CT scan (a scan which uses x-rays and a computer to create detailed images of the inside of the body) after the birth which had returned a normal result (suggesting there were no retained products of conception). In relation to the delay, the practice noted that on one occasion the GP asked Mrs C to come back in one to two weeks, but Mrs C did not return until six weeks later. Mrs C said this was the first available appointment, but the practice said there were a number of earlier appointments available with the same or different GPs. The practice gave us a copy of their audit records, which showed the appointment was booked only a few days before the date of the appointment. After taking independent medical advice from a GP, we upheld Mrs C's complaint. The adviser said that the GPs should have arranged an ultrasound in view of Mrs C's symptoms of unexplained bleeding for six weeks after birth, and they should have referred Mrs C to gynaecology earlier. However, we agreed that part of the delay was caused by Mrs C returning in six weeks, rather than two (which may have been due to a misunderstanding or miscommunication).

Mrs C complained to us that after having had surgery on her wrist she attended the medical practice to have four stitches removed by the practice nurse. The practice nurse removed the stitches but Mrs C continued to have problems with the wound site and developed infections. She was referred back to the clinic where the surgery was performed and it was discovered that one of the stitches had not been removed and was the cause of the infections. Mrs C believed that the practice had failed to appropriately remove all of the stitches following the surgery. We took independent advice from an adviser in general practice medicine and a nursing adviser. The clinical adviser said that the practice had provided Mrs C with appropriate treatment when she reported concerns following the surgery. The doctors prescribed antibiotic medication and made an appropriate referral for an orthopaedic opinion. The nursing adviser explained that a recognised complication when removing stitches is that a small piece can remain under the skin but would, over time, make its way to the surface. This could cause infection but would not necessarily indicate that a failing in care had occurred. In light of the advice we received, we did not uphold Mrs C's complaint. Related reading View Decision Report 201508665 as a PDF (11.19 KB) Updated: March 13, 2018