SPSO Individual Decisions

Mr C complained about the care and treatment provided by the practice for his skin issues, sinus issues and headaches. We took independent advice from a GP. We found that there was no evidence of any delay in Mr C being referred to the Plastic Surgery Unit at the board for his skin issues and that the care and prescriptions Mr C received for his sinus symptoms were reasonable. Mr C's symptoms were consistent with a working diagnosis of allergic rhinitis. There is no evidence of any delay in the treatment Mr C received or the management of his sinus symptoms. We found the assessment and management of Mr C's headache symptoms was reasonable. We did not uphold the complaint. Related reading View Decision Report 201806303 as a PDF (23.64 KB) Updated: May 22, 2019

Mr C complained on behalf of his wife (Mrs A) about the care Mrs A received at the practice. Mrs A had previously been diagnosed and treated for breast cancer. Six months after her treatment concluded she began attending the practice complaining of recurrent urinary tract infections and back pain. Six months following that it was found that the cancer had returned and spread to her bones. We took independent advice from a GP. We found that the practice had carried out reasonable investigations when Mrs A first reported her symptoms. They had appropriately sought to investigate and exclude other possible causes of the symptoms Mrs A was presenting with. However, when Mrs A's symptoms did not resolve and investigations did not reveal a definite cause, the practice should have been alert to the possibility of a more serious underlying condition. We noted that referral guidelines for patients who have previously suffered from breast cancer note that unresolved back pain is a 'red flag' sign, indicating further serious investigation is required. Therefore, we upheld Mr C's complaint.

Mrs C complained that the practice failed to provide her late aunt (Ms A) with appropriate care and treatment. Ms A visited the practice on three occasions and was later admitted to hospital where she was diagnosed with septicaemia (blood poisoning), multi-organ failure and metastatic gastric (stomach) cancer. Mrs C complained that the practice failed to reasonably investigate Ms A's symptoms. Mrs C also complained that the practice failed to respond to her complaint in a reasonable way. The practice acknowledged that there were shortcomings in record-keeping and checking observations. The practice apologised and took action to address these issues. We took independent advice from an adviser in general practice medicine. We found that the investigation and treatment decisions provided to Ms A at each of the three consultations were of a reasonable standard and that an emergency admission to hospital by ambulance was not required given the circumstances. We considered that the standard of medical care and treatment provided to Ms A was reasonable. We also found that the practice responded to Mrs C's complaint in a reasonable way. Therefore, we did not uphold Mrs C's complaints. Related reading View Decision Report 201800868 as a PDF (23.89 KB) Updated: March 20, 2019

Ms C complained about the care and treatment she received from the practice regarding a flu vaccination and that the practice did not provide her with an appointment when she called them. Ms C was subsequently diagnosed with Idiopathic Thrombocytopenic Purpura (ITP, a disorder that can lead to easy or excessive bruising and bleeding. The bleeding results from unusually low levels of platelets (the cells that help blood clot)) which she considered was linked to the flu vaccination she received. We took independent advice from a GP. We found that the care and treatment Ms C received was reasonable and that she was not informed about the risk of ITP because it is not a recognised side effect of the flu vaccination. We also found that there was no record of Ms C's call to the practice to book an appointment. We considered that it was reasonable that there was no record of this call in Ms C's medical record. In the circumstances we did not have sufficient evidence to determine whether Ms C should have been offered an appointment or that the care provided by the GP Practice was unreasonable. We did not uphold Ms C's complaints. Related reading View Decision Report 201803602 as a PDF (23.9 KB) Updated: March 20, 2019

Having been diagnosed with lung cancer, Mrs C complained that she had been attending the practice for years with breathlessness and she considered that she should have been referred for specialist investigation sooner. The practice noted that Mrs C was fully investigated for intermittent complaints of breathlessness, and that she was diagnosed with chronic obstructive pulmonary disease (COPD - a disease of the lungs in which the airways become narrowed). The practice said that when Mrs C presented with new symptoms (a nocturnal cough along with worsening breathlessness) she was promptly investigated and the diagnosis of lung cancer was made. They did not consider there were previously any suggestive symptoms that might have prompted an earlier referral for suspicion of cancer. They noted that the grading of the cancer indicated it had been detected relatively early, and they considered that her COPD was the more likely source of her breathlessness. We took independent advice from a GP. We found that it was reasonable for the practice to have made a presumptive diagnosis of COPD and that they sought to manage this within the primary care setting. The adviser said that the practice could have considered requesting a chest x-ray and respiratory referral around ten months earlier than they did, as Mrs C had reported worsening breathlessness (not just on exertion but also at rest). However, the adviser did not consider it unreasonable for them not to have taken that approach. They noted Mrs C was referred for breathing tests at that time, which confirmed the COPD diagnosis. On balance, we did not uphold the complaint. Related reading View Decision Report 201704511 as a PDF (24.14 KB) Updated: March 20, 2019

Mr C complained that the practice failed to contact him to arrange a blood test. Mr C's GP had referred him to the plastic surgery department who wrote back to the practice to request blood tests. The practice failed to contact Mr C to arrange the blood tests and he complained that this caused a delay in him receiving further treatment. Mr C also complained that the practice's handling of his complaint was unreasonable. We took independent advice from a GP. We found that the practice failed to contact Mr C to arrange the blood tests and upheld this aspect of his complaint. However, we noted that this failing was likely an administrative oversight and was not due to a lack of clinical skill. The practice acknowledged this failing and apologised. In relation to complaint handling, we found that the practice referred Mr C to our office appropriately and responded within the required timescales. Therefore, we did not uphold this aspect of Mr C's complaint. Related reading View Decision Report 201806211 as a PDF (23.75 KB) Updated: March 20, 2019

Ms C complained that the practice provided unreasonable treatment to her late mother (Mrs A). A GP from the practice attended Mrs A at home and prescribed an antibiotic. Mrs A was also on Warafin (a drug used to prevent blood clots) and other medication. She later became unwell and was admitted to hospital with bleeding from a peptic (stomach) ulcer and considered at risk of internal bleeding. Mrs A died a few weeks later. Mrs C complained that the prescription of the antibiotic was unreasonable and that Mrs A should have been advised to have her INR (a blood test which allows monitoring of Warafin levels) checked after she was started on the antibiotic. We took independent advice from a GP. We found that the practice reasonably prescribed the antibiotic. However, the practice should have advised Mrs A that she should have her INR checked four to seven days after starting the antibiotic. Therefore, we upheld Ms C's complaint.

Ms C complained about the care and treatment provided to her late mother (Mrs  A) by the practice. Mrs A reported hip and back pain to her GP, and was later found to have breast cancer which had spread to her stomach and bones. Ms C complained that the practice failed to identify that Mrs A's back and hip pain was due to cancer in her bones. We took independent advice from a GP adviser. We found that, when Mrs A presented with back pain she was directed to physiotherapy, which was reasonable, and that there were no signs or symptoms of cancer at this point. We found that the practice provided reasonable care and treatment to Mrs A for her back and hip pain, and we did not uphold the complaint. Ms C also complained about the way the practice handled her complaint. We found that the practice had not handled her complaint in line with the model complaints handling procedure and, therefore, we upheld this part of Ms C's complaint.

Miss C complained to us that the practice had failed to provide appropriate care and treatment to her mother (Mrs A). She said that her mother had reported symptoms of severe pain in her back and shoulders to GPs over a two month period, and they increased her painkilling medication and made a referral to the Elderly Care Clinic. Mrs A was subsequently diagnosed with bone and lung cancer. Miss C felt the GPs should have taken additional action to investigate the cause of her mother's pain. We took independent advice from a GP adviser. We found that the practice had provided a reasonable level of care. The GPs had taken a thorough medical history from Mrs A and examined her appropriately, including taking blood samples and making a referral for a hospital opinion. Mrs A's back pain had been present for two months and the shoulder pain for three weeks which was not a long presentation. It was appropriate for the GPs to have altered Mrs A's painkilling medication while waiting for the hospital referral and to chase up the referral when Mrs A had not heard from the hospital. The blood test results did not show significant abnormalities or signs suggestive of cancer. We did not uphold the complaint. Related reading View Decision Report 201800398 as a PDF (11.22 KB) Updated: December 2, 2018

Mrs C complained that the practice failed to carry out appropriate checks for allergies before prescribing penicillin. Mrs C was visited by a GP at home and prescribed an antibiotic containing penicillin which she is allergic to. Mrs C did not suffer any ill-effects as she read the information on the packet and therefore did not take the medication. The practice said that the GP asked Mrs C if she was allergic to penicillin before prescribing, which Mrs C denies. They also noted that doctors do not have sight of patients' medical records when on house calls but that the GP looked at the patient's medical summary before the appointment. We took independent advice from a GP. They considered that it was reasonable for the surgery to check a patient's records before leaving the practice and to ask the patient if they were allergic to any medications. We found that Mrs C's penicillin allergy was noted on the medical summary the GP said that they had referred to. We considered that if the GP had checked this first they ought to have been alert to prescribing penicillin in a patient with allergies. Although the practice acted reasonably in checking the medical records before the home visit, we considered the allergy should have been picked up then. Therefore, we upheld Mrs C's complaint.

Ms C complained that the practice failed to provide a reasonable standard of medical care and treatment to her late father (Mr A). Mr A attended appointments at the practice over a period of two months. Mr A was initially referred to hospital by the practice to be assessed for deep-vein thrombosis (DVT, a blood clot that develops within a deep vein in the body) and was prescribed medication. The results of the ultrasound scan taken at the hospital did not indicate DVT and the medication was stopped, however, Mr A's condition deteriorated. He attended two more appointments at the practice but died of a pulmonary embolism (a blocked blood vessel in the lungs) a few days after his final appointment. Ms C said that the practice had failed to see that Mr A's symptoms indicated DVT and believed that his death could have been prevented. Ms C also complained that the practice failed to respond to her complaint in a reasonable way. We took independent advice from a GP. We found that the medical care and treatment was of a reasonable standard based on the evidence provided and the information available to the practice at the time in question. We also noted that the practice fully addressed the issues raised and took account of the clinical evidence available when responding to Ms C's complaint. Therefore, we did not uphold Ms C's complaints. Related reading View Decision Report 201701714 as a PDF (11.25 KB) Updated: December 2, 2018

Ms C complained to us that the practice had failed to provide appropriate care and treatment to her when she reported symptoms of altered bowel habit. When she was referred to hospital cancer specialists after a period of some months it was established that she had bowel cancer. Ms C belived that the practice should have referred her to the hospital cancer specialists earlier and that the diagnosis would have been reached sooner. We took independent advice from a GP adviser and concluded that there were no delays in the practice making a referral for a specialist hospital opinion. Ms C had attended the practice on a number of occasions with a number of physical and psychological symptoms and initially it was felt that a referral to a respiratory clinician was appropriate. However, when Ms C continued to report different symptoms it was then appropriate for a referral to be made to the hospital cancer specialists. We found this to be reasonable and we did not uphold the complaint. Related reading View Decision Report 201705356 as a PDF (11.06 KB) Updated: December 2, 2018

Ms C visited her GP practice a number of times as she had concerns about a loss of appetite and unexplained weight loss. The practice carried out blood tests, and referred Ms C for an x-ray and an ultrasound. When these tests reported as normal, the practice referred Ms C to a gastroenterologist (a doctor specialising in the treatment of conditions affecting the liver, intestine and pancreas). Ms C complained that the practice unreasonably delayed in investigating her weight loss. We took independent advice from a GP. We found that the practice carried out the relevant tests and referred Ms C to gastroenterology at the appropriate time. The practice acted appropriately and did not delay in investigating Ms C's weight loss. Therefore, we did not uphold this complaint. Related reading View Decision Report 201703852 as a PDF (10.97 KB) Updated: December 2, 2018

Ms C complained that the medical practice wrongly provided her with the flu vaccination a number of years ago and that, as a result, she suffered from numerous medical conditions. These included brain damage, multiple sclerosis, uveitis (inflammation in the eye), reactive arthritis and facial disfigurement. Ms C was concerned that she had not been advised of the risks or potential side effects of the vaccination. We took independent advice from a GP and found that it was appropriate for the practice to have offered Ms C the vaccination as she suffered from asthma. There was nothing in Ms C's medical records that showed she was suffering from any medical conditions which would have prevented her from receiving the flu vaccination. We also noted that Ms C had signed the consent form for the vaccination at the time. In addition, Ms C's later health issues were not recognised as being attributed side effects from the vaccination. Therefore, we did not uphold the complaint. Related reading View Decision Report 201705195 as a PDF (11.09 KB) Updated: December 2, 2018

Mr C, who works for an advice and support agency, complained to us on behalf of his client (Mrs A) that her GP practice failed to provide her with appropriate medical treatment for a painful shoulder. Mrs A asked the practice to give her a steroid injection as her frozen shoulder was causing her pain and distress but was referred to physiotherapy who would decide whether or not to provide the injection. Mrs A was unhappy as she had been given the steroid injection by the practice the year before. We took independent advice from a GP and found that the practice had provided a reasonable level of care. Although some practices can administer steroid injections to patients if they have additional training, there is no requirement for them to do so. We found that the practice had acted reasonably by asking Mrs A to attend physiotherapy and that they would determine if it was appropriate to administer a steroid injection. We also found that the practice had acted reasonably by prescribing painkilling medication to Mrs A in order to address her symptoms. Therefore, we did not uphold Mr C's complaint. Related reading View Decision Report 201704777 as a PDF (11.13 KB) Updated: December 2, 2018

Mr C, who was diagnosed with gastric lymphoma (a cancer originating in the stomach), complained that there had been an unreasonable delay by the practice in referring him for a specialist opinion. We took independent advice from a general practitioner. We found that there was no undue delay in referring Mr C for a specialist opinion given the information the practice had on which to base their decision. We also found that the practice had been diligent in their review of Mr C's case and that the action taken by the practice was reasonable. We did not uphold Mr C's complaint. Related reading View Decision Report 201608263 as a PDF (10.85 KB) Updated: March 13, 2018

Mrs C complained that the practice unreasonably removed her from the patient list. Mrs C had been expecting to receive a call from the receptionist about whether her adult son could have an appointment with a GP to discuss blood test results. Mrs C had earlier tried to speak to a GP by phone to see about an appointment for her son but was told that the GP would not speak to her. Mrs C left her contact details and asked that the practice return her call with details of an appointment time. Mrs C then received a phone call from the practice manager who said that the decision had been taken to remove her from the patient list. Mrs C could think of no reason why she had been removed from the patient list. We took into account the contractual regulations and relevant guidance regarding the removal of patients from the practice list. This sets out that, other than in cases involving violence or aggression, a patient whose behaviour is giving cause for concern should be given a written warning informing them that they will be removed from the practice list if they do not alter their behaviour. The warning should last for 12 months. While the practice did provide us with two examples of why they had concerns about Mrs C's actions, staff did not formally bring them to Mrs C's attention in line with the regulations and guidance and therefore she was unaware of the practice's concerns. We upheld the complaint.

Mrs C complained to us about the care and treatment she received at her GP practice. She considered that the practice delayed in diagnosing the severity of circulation problems in her leg and she questioned the treatment she had received. Mrs C felt that she should have been referred to the hospital's vascular department sooner. She believed that if she had been provided with appropriate clinical treatment and referred to vascular surgeons earlier then she may not have had to have her lower leg amputated. We took independent advice from a GP adviser. We found that the assessment and treatment provided to Mrs C by the practice doctors was reasonable and appropriate and was in accordance with national guidelines. We found that there was no unreasonable delay by the practice in making the referral to the vascular department and that the referral did not require to be urgent because, at the time Mrs C was assessed, there was nothing to suggest critical ischaemia (an advanced state of peripheral artery disease and a threat to a limb). In addition, the referral had appropriately requested further investigation and clearly stated that Mrs C's doctor suspected vascular disease and asked that a doppler scan (a non-invasive test that can be used to estimate the patient's blood flow through blood vessels by bouncing high-frequency sound waves off of circulating red blood cells) be arranged. We also considered that there was no evidence to support the view that an earlier referral by the practice could have avoided the loss of Mrs C's lower leg. Taking account of the evidence available, and the advice we received, we did not uphold Mrs C's complaints. Related reading View Decision Report 201608353 as a PDF (11.42 KB) Updated: March 13, 2018

Mr C, who is an advocacy and support worker, complained on behalf of his client (Ms B) about the clinical treatment provided to Ms B's son (Mr A). Mr A had been attending the practice over a number of months with recurrent symptoms, and Ms B felt that further investigations should have been carried out to determine the cause of Mr A's symptoms. We took independent advice from a general practitioner. We found that Mr A had been appropriately assessed, examined and investigated by the practice. We also found that appropriate referrals were made for further investigations in light of Ms B's concerns. We found that the care and treatment provided was in line with the General Medical Council Good Medical Practice guidance. We did not uphold this aspect of Mr C's complaint. Mr C also complained that the practice had unreasonably refused to provide Mr A with a medical appointment. We found that there had been no indication for an urgent appointment when Ms B had contacted the practice and that appropriate and adequate advice had been provided by the practice to Ms B based on Mr A's past clinical record, past attendances and persistently normal investigations. We did not uphold this aspect of Mr C's complaint. Related reading View Decision Report 201608897 as a PDF (11.16 KB) Updated: March 13, 2018

Mrs C complained that the medical practice failed to provide appropriate care and treatment to her late husband (Mr A), who died in hospital of double pneumonia a few days after last seeing a GP. She said that her husband had seen a GP on two occasions before the hospital admission and that the GP had not carried out appropriate assessments to diagnose the pneumonia or to have referred her husband to hospital for a specialist opinion. We took independent advice from an adviser in general practice medicine and concluded that the practice had provided a reasonable level of care. The records showed that the GP had carried out appropriate assessments and that, based on the symptoms which Mr A had reported, it was reasonable for the GP to have diagnosed a viral illness. The GP had advised Mr A to rest, take fluids and paracetamol. It was clear that, following the last GP appointment, Mr A's symptoms had changed and that he had deteriorated and at that time a hospital referral was appropriate. We did not uphold the complaint. Related reading View Decision Report 201703479 as a PDF (11.1 KB) Updated: March 13, 2018

Ms C complained on behalf of her late brother (Mr A) about the treatment he received from the practice in the four months prior to his diagnosis of lung cancer. She complained that the standard of care and treatment provided to her brother was unreasonable. We took independent advice from a GP adviser who said that the initial symptoms Mr A presented with had led doctors to believe that he had a problem with his hormones, and that doctors had referred him appropriately at that time. When Mr A complained of different symptoms, which could have indicated cancer, his GP then asked him to complete a form to arrange an x-ray. The practice were unable to reach Mr A by phone and Mr A either did not receive the letter sent to him, or did not respond to it. When Mr A re-attended the practice it was noted that the x-ray request had not been returned and he was referred urgently to hospital that day. The adviser said that this was reasonable. We accepted the advice we received and we did not uphold the complaint. Related reading View Decision Report 201700923 as a PDF (11.11 KB) Updated: March 13, 2018

Mrs C complained to us that the medical practice had failed to provide appropriate care and treatment to her son (Mr A) who had attended an appointment with one of the GPs with symptoms of sore lungs and a cough. Ms C said that the GP had failed to listen to Mr A's lungs or chest and did not prescribe an antibiotic for him to take. Mr A was still unwell the following week and was taken to hospital, where he was diagnosed with pneumonia. We took independent advice from an adviser in general practice medicine and concluded that the GP had provided a reasonable level of care. We found that the GP had examined Mr A's lungs and had found no signs of an infection. We also found that an adequate medical history was recorded and that it was not unreasonable for the GP to have diagnosed a viral infection. As such, it was not unreasonable that the GP did not prescribe antibiotics. We did not uphold the complaint. Related reading View Decision Report 201702838 as a PDF (11.04 KB) Updated: March 13, 2018

Ms C, who is an advocacy and support worker, complained on behalf of her client (Mr A) regarding the care and treatment he received at the medical practice. In particular, she complained that the practice did not do more to assist Mr A in obtaining a clear diagnosis and appropriate treatment for his mental health difficulties. This included concerns that Mr A's repeated requests for cognitive behavioural therapy (CBT) were not actioned. We took independent medical advice from a GP, who considered that the practice arranged appropriate referrals for Mr A to mental health services. They noted that the specialists involved in these clinics had shown reluctance to give a specific diagnosis. They observed from one of the clinic letters that a psychiatrist had suggested a CBT approach and, while this did not appear to have progressed, they said it was not the role of a GP to follow up treatment plans arranged by a separate specialty. The adviser concluded that the care provided to Mr A by the practice was reasonable. We accepted this advice and did not uphold this aspect of complaint. As Mr A had moved to a new GP practice, the practice were only able to access his electronic records and not any older paper records. Ms C also raised concerns that the complaint was not fully investigated as all medical records were not accessed. The practice considered that they had enough information to respond to the complaint and the adviser agreed that sufficient records were accessible to enable a response to the concerns and queries raised. We concluded that the practice's investigation was reasonable and proportionate to the issues raised and we did not uphold this aspect of the complaint. We noted that the practice had failed to provide details of our office in their complaint response, but they acknowledged this and we were satisfied that this had since been appropriately addressed through the revision of their complaints handling procedure. Related reading View Decision

Mr C complained that, following his discharge from hospital, his medical practice unreasonably failed to contact him for more than 48 hours, and unreasonably failed to carry out a home visit despite his request for one. The practice responded to his complaint by apologising for any lack of care which Mr C felt he had received, but explained that the discharging unit at the hospital usually take responsibility for co-ordinating with community care and district nursing teams. They also noted that where there was a medical need for immediate post-discharge medical input, hospital clinicians would usually communicate this directly to the practice. We noted that Mr C requested a home visit when on the way home from hospital by visiting the practice and dropping off a letter. We took independent advice from a GP adviser. The adviser reviewed Mr C's medical records and said there was no indication that a house visit was necessary, as it appeared that Mr C was able to attend the practice for an appointment. The adviser also noted that the decision whether or not to offer a home visit lies with the clinician, and should be based on clinical need. The adviser confirmed that it is not routine practice for GPs to contact patients who have been discharged from hospital once they have returned home, although they may do so following a review of the patient's discharge medication and history. The adviser noted that in this case the practice had reviewed Mr C's medication and history and contacted him by phone within 48 hours of his request and considered this reasonable. The adviser also commented that if there was a clinical need for contact from the GP, this would have been detailed on the discharge letter from the hospital. There was no request for contact in Mr C's discharge letter. It was unfortunate that reception staff at the practice did not make clear to Mr C that home visits would only be carried out on the basis of clinical need, and by phone request on the day

Miss C complained to us that that the medical practice had failed to provide her with appropriate care and treatment when she phoned to report that she was suffering from vaginal bleeding and cramps and was in the early stages of pregnancy. Miss C believed that the GP who she spoke to had inferred that she had suffered a miscarriage. However, later testing revealed that Miss C had not suffered a miscarriage. The GP had apologised for the miscommunication and said that they had not meant for their comments to be interpreted that Miss C had suffered a miscarriage, but had meant that it was a possibility. We took independent advice from a GP adviser and concluded that the GP had not put themselves in a position to arrive at a potential diagnosis for Miss C's symptoms and that they should have offered Miss C a face-to-face consultation so that they could carry out an examination. This would also have given Miss C some reassurance about her condition. We upheld the complaint.