SPSO Individual Decisions

Mr C complained about the care and treatment provided by the practice to his late child (Baby A). Baby A was taken to the practice with a blocked nose and congestion. The doctor considered that Baby A was suffering from a respiratory tract infection, but that there was no evidence of a more serious infection requiring any treatment or hospital admission at that time. The following day, Baby A suffered cardiac arrest at home and was taken by ambulance to hospital. They did not regain consciousness and died a number of weeks later. Mr C complained that the practice failed to carry out an adequate assessment and failed to make a hospital referral for further investigation, despite Baby A's history of bronchiolitis (a lower respiratory tract infection that affects babies). Prior to Baby A's death, they were found to have been positive for Respiratory Syncytial Virus (RSV - a virus which causes respiratory tract infections, and the most common cause of bronchiolitis). Mr C complained that the practice failed to detect RSV. We took independent advice from a GP adviser. We found that the doctor's assessment was reasonable and in line with relevant guidelines, which did not indicate that a hospital admission was required, based on the clinical findings. We found that hospital admission with bronchiolitis is normally only required when there are difficulties breathing or feeding, and the GP assessment did not identify any difficulties in Baby A in either regard. We found that the hospital consultant did not consider that RSV and bronchiolitis was the definitive cause of Baby A's death. We found no evidence that the practice overlooked any relevant factors in their assessment of Baby A and we did not uphold the complaint. Related reading View Decision Report 201709235 as a PDF (11.41 KB) Updated: December 2, 2018

Mrs C presented to the practice with weakness and pins & needles in her limbs and head. The practice reviewed her and arranged blood tests. She was informed that these came back normal and no further action was taken. Mrs C's symptoms began to improve over the following months and had resolved by the end of the year. However, her symptoms returned and she presented to the practice again, nearly two years after her initial appointment. She was referred to neurology and, following an MRI scan, was diagnosed with relapsing remitting multiple sclerosis (MS). Mrs C complained that this could have been diagnosed sooner, had she been referred for further tests following her first appointment at the practice. In responding to Mrs C's complaint, the practice said that the possibility of MS was considered but due to the fact that this was Mrs C's first presentation, that there was a lack of symptoms and that there was an absence of positive family history, they felt that the symptoms were unexplained. They said that the plan was to 'book bloods and review' and they apologised that they did not express clearly enough to Mrs C that she was expected to return for review. They observed that she was referred promptly at her second appointment as this was a second presentation of sensory symptoms, and that she was also exhibiting further symptoms. We took independent medical advice from a GP, who considered that an appropriate level of assessment and investigation took place for a first presentation of such symptoms. We found that it is generally accepted that MS is suspected if there are two or more episodes of suspicious symptoms. We noted that it would have been reasonable for the practice to have clearly explained to Mrs C that they wished to follow up her symptoms following the blood tests. The General Medical Council's Good Medical Practice (GMC GMP) guidance refers to this as 'safety netting'. However, the adviser did not consider this to be a serious oversight,

Miss C was referred for an endoscopy (a camera test into her stomach) by the practice to investigate stomach pain she was suffering from. She complained that this was not appropriately followed up and that further specialist investigation was not arranged. The practice said that all relevant investigations appropriate to Miss C's condition were undertaken by them. Miss C disputed this, noting that her psychiatrist had referred to anticipated follow-up investigation for her stomach issues, in a letter to the practice. Miss C said that this follow-up was not arranged by the practice. We took independent advice from a GP, who considered that the investigations arranged by the practice were appropriate. We found that the psychiatrist's letter was written in advance of the endoscopy appointment and that it referred to this investigation. It did not suggest that further investigation was expected. Therefore, we did not uphold this aspect of Miss C's complaint. Miss C also complained that some of her prescription requests were not appropriately responded to and that she had to go for long periods without her pain-killing and anti-anxiety/depression medication. The practice acknowledged that one monthly prescription for Miss C's anti-anxiety medication was missed and they apologised to her for this oversight. They also acknowledged some recording and communication issues, meaning some of Miss C's medication requests were not responded to appropriately. In particular, they recognised that an improved system was required for communicating with patients where medication requests have been declined. We upheld this aspect of Miss C's complaint, however, noted that the practice had appropriately reflected on the communication issues highlighted by this complaint and had instigated a reasonable plan to avoid similar future problems.

Mrs C complained that the practice failed to provide appropriate care and treatment to her late husband (Mr A). Mr A, who had type 2 diabetes, had thought he was suffering from a urine infection but the practice dismissed the suggestion and did not provide medication. Mr A subsequently developed chest and back pain over the next week. A house visit was then requested early in the morning but it took until early evening for a GP to visit. The GP felt that Mr A required a hospital admission and an ambulance was called to take Mr A to hospital. He died the following day. Mrs C complained that the practice failed to diagnose that Mr A had a urine infection and that, on the day he was taken to hospital, there was an unreasonable delay in a GP making a home visit. We took independent advice from an adviser in general practice medicine and found that the practice provided Mr A with reasonable treatment regarding his perceived urine infection. The practice carried out an appropriate assessment, including testing for a urine infection, which was reported as negative. Therefore, we did not uphold this aspect of Mrs C's complaint. In relation to the home visit, we found that there was an unreasonable delay in arranging the home visit to Mr A as there was a breakdown in communication when the request for a home visit was considered. Initially, it was felt that an advanced nurse practitioner should visit but they felt that it was outwith their remit and there was a delay in the request being picked up by the GP. Therefore, we upheld this aspect of Mrs C's complaint.

Mrs C complained to us that the medical practice had failed to provide appropriate care and treatment to her father (Mr A) who had fallen whilst coming out of the shower. Mr A was seen by three GPs from the practice over a two week period, who treated him for a knee injury. Mr A then called an out-of-hours service and was seen by a different GP. It was found he had a fractured hip and he was taken to hospital where a rod and pins were inserted into his leg. Mrs C felt the GPs at the practice had failed to diagnose the hip fracture. We took independent advice from an adviser in general practice medicine and concluded that at no time during the three GP consultations did Mr A complain of hip pain or hip injury and that there were no symptoms which indicated that his hip was fractured. There was also no report that he was unable to walk or bear weight which would have been an indication of a hip problem. We found that the GPs involved reasonably concluded from Mr A's reported symptoms that he had injured his knee and they provided appropriate treatment. We did not uphold the complaint. Related reading View Decision Report 201703692 as a PDF (11.14 KB) Updated: March 13, 2018

Mrs C complained about the care and treatment provided to her late mother (Mrs A) by the practice. Mrs C complained that the practice failed to appropriately monitor and treat Mrs A's symptoms after she was diagnosed with a heart condition. Mrs A was referred to cardiology by the practice a number of years ago and was diagnosed with a heart condition known as mitral regurgitation (when blood back flows through a valve in the heart called the mitral valve). She was prescribed diuretic medication (also known as water tablets - tablets which can help reduce the fluid build up that can occur when the heart is not working normally). When Mrs A was reviewed by cardiology again two years later, the condition was noted to have resolved and the cardiology clinic advised that the diuretic medication could be reduced and stopped. In line with Mrs A's wishes, she continued to take the medication for a further three years before it was stopped when she was found to have low sodium levels. In the interim, Mrs A had also been given a steroid inhaler for suspected asthma. Mrs A suffered a heart attack and died less than two months after stopping the diuretic medication. Mrs C complained that stopping the diuretic medication contibuted to her mother's death. She raised concerns that closer monitoring of Mrs A's known heart condition did not occur. She also raised concerns that the steriod inhaler prescribed for breathlessness may have masked the underlying problems with Mrs A's heart. In particular, Mrs C did not consider that Mrs A received the appropriate attention required to properly identify the cause of the symptoms she presented with in the final months of her life. We took independent advice from a GP adviser. We found that the management of Mrs A's symptoms was reasonable. The adviser noted that the cause of the mitral regurgitation was never established and that, when it appeared to have resolved, no ongoing cardiology follow-up was arranged. Had heart valve d

Mrs C complained about the care and treatment her late husband (Mr A) received from his medical practice. She said that over an eight week period, staff at the practice failed to provide her husband with appropriate clinical treatment in view of his reported symptoms. Mrs C said her husband was subsequently diagnosed with terminal lung cancer and died shortly after. Mrs C complained that the practice failed to look at, examine and listen to her husband. She complained that they were dismissive and that they took too long to recognise how ill he was. She said her husband had a past diagnosis of cancer and that this should have alerted the practice to the possibility of a return of the cancer. We obtained independent advice on the case from a GP. We found that the care and treatment the practice provided to Mr A was appropriate. We found that Mr A's medical records did not evidence any failure in taking his history or in examining him, that Mr A's investigations and referrals were of a reasonable standard and there was not any significant delay in these being carried out. The adviser did not consider that a history of treated cancer 37 years earlier should have alerted the practice to consider an alternative diagnosis in Mr A's case. We found that Mr A's chest x-ray, taken in hospital approximately six weeks after Mr A first attended the practice, was normal with no evidence of lung cancer. We found his case records did not contain evidence of him reporting red flag symptoms or signs to either the GP or to the hospital doctor. We concluded that the practice did not fail to provide Mr A with appropriate clinical treatment in view of his reported symptoms and we did not uphold Mrs C's complaint. Related reading View Decision Report 201604553 as a PDF (11.39 KB) Updated: March 13, 2018

Mr C complained that his GP practice had unreasonably delayed in informing him that he had a stroke diagnosis. Mr C presented at the emergency department with symptoms that were initially considered to be consistent with Bell's Palsy (weakness down one side of the face sometimes due to nerve damage). Mr C had a history of labyrinthitis (inflammation of the inner ear) and was also vomiting and dizzy when he presented to the emergency department. Staff were satisfied that Mr C had responded well to treatment/medication at that time. Mr C was seen about four months later at the ear, nose and throat department (ENT) when a scan showed what appeared to be a lacunar infarct (a type of stroke that occurs when blood flow to one of the small arteries deep within the brain becomes blocked). The practice printed the results of the scan but assumed that the ENT department would follow up the diagnosis and the results with Mr C. However, the registrar who had seen the scan had missed the significance of the diagnosis. Mr C was advised of the diagnosis two months later after asking at his practice why he was eligible for a flu jab. He complained that the practice had unreasonably delayed in informing him of the diagnosis after printing the results of the scan. We took independent GP advice. Despite the practice stating in their response to Mr C's complaint that they accepted they were partially responsible for following up the scan results due to the abnormalities identified (although they felt that ENT should have followed up on the results with him), we found that the practice could not be held responsible for the failure of the ENT department to follow up on the scan results or the failure to refer management of the findings back to the practice. As a result, we did not uphold the complaint by Mr C although we did make a recommendation.

Mr C said that although he attended his medical practice concerning his back pain on a number of occasions over a period of two months, doctors failed to note his deteriorating condition. He said that he was given increasingly strong painkillers which failed to work and that although he was exhibiting 'red flag' symptoms, he was not referred for further investigation or imaging. Mr C said that it was not until he attended with his son that he was taken seriously and admitted to hospital as an emergency. He required an immediate operation. Mr C complained to the practice who said that while they noted that he was in significant pain, Mr C did not show any symptoms or clinical signs that would have triggered an immediate referral for surgery (there were no red flags). They believed that he had been treated appropriately and in accordance with guidance. We took independent advice from a GP and found that the practice had carried out appropriate examinations. Mr C's pain was regularly reviewed and his painkillers were increased accordingly. They repeatedly checked Mr C for red flag symptoms and an appropriate referral was made for him when his symptoms changed. We therefore did not uphold Mr C's complaint. Related reading View Decision Report 201602357 as a PDF (11.21 KB) Updated: March 13, 2018

Mr C complained about statements made by a GP at an adult protection case meeting held in relation to the care of his wife (Mrs A). Mrs A suffered from an illness that affected her ability to care for herself and was in hospital at the time of the meeting, which was organised to discuss the possibility of discharging her home. We took independent advice from a GP adviser. The adviser noted that Mrs A was a patient who did not have capacity to make decisions about her care, which meant that the GP was responsible for deciding on the appropriate medical treatment to safeguard or promote the physical or mental health of Mrs A. The adviser considered that the statements made by the GP were supported by the medical records and were, therefore, accurate. The adviser explained that an adult protection meeting is a forum in which care providers share information and that in this context, it was appropriate for the GP to share their concerns with the meeting. We did not uphold this complaint. Mr C also raised concerns about a letter the GP had sent to him following the meeting. In particular, Mr C felt that the letter inferred that he had mistreated Mrs A. We found that the letter from the GP sought to explain the GP's reasons for the statements made in the previous meeting. The adviser did not consider that the letter inferred that Mr C had mistreated Mrs A, and overall felt that the letter was appropriate. We therefore did not uphold this aspect of Mr C's complaint. Finally, Mr C expressed concern that the practice had not communicated with him reasonably in relation to arranging a meeting to discuss his complaint to them. We found that Mr C had spoken to the practice manager about a meeting, yet we noted that this did not take place. We considered that both Mr C and the practice manager had different expectations about who would take the next step to arrange a meeting. It was not possible for us to determine what was said and agreed in this conversation, and f

Mr C complained to us that the medical practice had failed to provide appropriate care and treatment to his son (Mr A). He said that a GP had prescribed oxycodone (opiate medication) over the phone to Mr A on the morning that he died from a medication overdose. Mr C was also concerned that there had been an entry in Mr A's clinical records from his previous GP surgery noting that Mr A was not to be prescribed opiates. The practice said that practitioners are aware of the need to balance the potential benefits of a drug against any possible harm. The practice were aware of the previous GP surgery concerns that Mr A used illicit drugs and that care should be taken about the strength of any opiates prescribed. Mr A had recently undergone significant surgery and he reported that his pain control was ineffective. It was also noted that Mr A was attending orthopaedics and the pain clinic. We took independent medical advice from a GP who noted that Mr A had been referred to orthopaedics and the pain clinic and that he was regularly reviewed in either face-to-face consultations or phone contact. When required, his pain relief was increased and this was considered reasonable care. The adviser had no concerns about the actions of the GP who prescribed the oxycodone, as they had taken note of the previous GP practice's concerns about drug misuse and made a reasonable clinical judgement based on the recorded evidence available. We did not uphold the complaint. While we did not uphold the complaint, we noted that the practice and the previous GP practice operated different electronic record recording systems and that there was a failure of the first practice to transfer all relevant information over when Mr A joined the new practice. We made a suggestion to both practices which may have allowed more clarity, although it may not have altered the GP's decision to prescribe the oxycodone. Related reading View Decision Report 201606304 as a PDF (11.51 KB) Updated: March 13,

Mr C had been taking warfarin (a blood-thinning medication). Following a review at an out-patient cardiology clinic, his International Normalised Ratio (INR, a blood test that checks how long it takes for blood to clot) target range was changed to between 2 and 3. Previously, it had been 2.5 to 3.5. Mr C's GP practice did not update the change on their systems and Mr C only became aware of the change 18 months later. Mr C complained to the practice and was dissatisfied with their handling of his complaint. Whilst the practice accepted that they failed to update Mr C's INR target, the advice we received was that this failing was not significant. The adviser said the change in Mr C's INR target was not clearly communicated by the cardiologist to the practice as it did not contain a sufficient alert to notify the change in his INR target level. Furthermore, the practice could not be expected to be aware of national changes. We accepted this advice. The adviser also commented that as Mr C's INR target was to be reduced rather than increased, there was no significant clinical risk resulting from the failure of the practice to update the target. Taking account of this advice, we did not uphold this aspect of the complaint. We accepted that the practice had provided Mr C with an apology and an explanation for the error but they had delayed in doing so. While we accepted the delay was due to difficulty in obtaining information that they needed from the cardiology department, we considered the practice could have made Mr C aware of this. We also found that the practice's response to Mr C's complaint did not contain details for this office. We upheld this aspect of the complaints.

Mrs C complained about the care and treatment provided to her mother (Mrs A) when she attended her GP practice complaining of breathlessness and collapse. During this period, Mrs A also had three admissions to hospital. Shortly after her third admission to hospital, she suffered a heart attack and died. Mrs C said that the practice failed to take Mrs A's symptoms seriously and delayed in taking appropriate action. She also said that the practice should not have prescribed a certain medication in light of Mrs A's heart condition. We took independent advice from an adviser who specialises in general practice. We found that while the standard of medical care in relation to Mrs A's symptoms was reasonable, there were shortcomings in relation to a referral to hospital and the prescription of medication. While these shortcomings did not contribute to Mrs A's death, we upheld the complaint because of the prescription of medication that should not be given to patients with heart conditions.

Mr C complained that he was not warned about the possible specific side effect of developing cataracts (a clouding of the lens of the eye leading to a reduction in vision) when taking steroid drugs via an inhaler. Mr C had been treated by his GPs and specialists for a number of years for respiratory conditions. He was prescribed inhalers and nasal drops, some of which were steroids. Mr C was diagnosed with cataracts on both eyes while on holiday overseas and had surgery there to remove the cataract from one eye. He was told by his surgeon that the cataracts had been caused by his steroid inhaler. We took independent medical advice and found that although recognised as a possible side effect, cataracts were such a rare occurrence that it was reasonable that this would not have been specifically discussed with Mr C. Information was available about this in the patient information leaflet supplied with each new batch of the drug. Our view, therefore, was that the actions of the practice were reasonable and in line with relevant General Medical Council guidance to GPs. Related reading View Decision Report 201600319 as a PDF (11.16 KB) Updated: March 13, 2018

Miss C complained that her medical practice failed to fit her intrauterine contraceptive device (IUCD) appropriately and that it had perforated her uterus. She complained to the practice but it was their view that it had been fitted reasonably. We took independent medical advice and found that prior to the procedure to fit the device, in accordance with national guidance, Miss C had been fully informed about its risks and benefits, including that the IUCD could perforate the uterus. There was no evidence to suggest that the IUCD had been fitted inappropriately and the complaint was not upheld. Related reading View Decision Report 201600303 as a PDF (10.87 KB) Updated: March 13, 2018

Mrs C said that her medical practice did not provide a reasonable response to phone calls she made when she became unwell. Specifically, she had to phone three times before her call was returned towards the end of the working day by a GP. We found the practice had no record of the first two phone calls Mrs C made, although they did not dispute she had made them. We took independent advice from a GP adviser. We concluded that the response from the practice to Mrs C's calls was a reasonable one as she received a return call and telephone consultation the same day she requested it. Therefore we did not uphold Mrs C's complaint. Mrs C also complained that the GP she spoke to on the phone failed to check her records for allergies. In doing so, the GP missed that a drug prescribed to Mrs C by an emergency out-of-hours GP was one that she had previously suffered an adverse reaction to. We therefore upheld this complaint. The GP practice apologised to Mrs C for the distress and discomfort she suffered. Related reading View Decision Report 201602009 as a PDF (11.1 KB) Updated: March 13, 2018

Mr C complained that the medical practice unreasonably failed to offer his son (Mr A) a referral for varicose vein surgery. Mr C was concerned that this was affecting Mr A's mental health. He was of the view that the practice were refusing to refer him for surgery because of Mr A's mental health problems. We took independent clinical advice. We found that the practice had carried out a proper examination of Mr A and had noted that his varicose vein was not causing him discomfort. As a result of this, the practice were correct in following the board's guidance on the treatment of varicose veins which said that in instances such as this, varicose veins should be treated conservatively and surgical referrals should not be made. As a result, we did not uphold Mr C's complaint. Related reading View Decision Report 201600674 as a PDF (10.96 KB) Updated: March 13, 2018

Ms C complained about a decision to reduce her thyroid medication following the results of a blood test. We sought independent medical advice. The adviser said the change in medication dosage was reasonable and in line with guidance for managing thyroid disease. We accepted this advice and did not uphold the complaint. Related reading View Decision Report 201508379 as a PDF (10.74 KB) Updated: March 13, 2018

Mrs C complained about the practice's failure to make reasonable adjustments to her medication regime regarding repeat prescriptions required following her consultation with a consultant ophthalmologist. Mrs C felt that there had been delays in the provision of eye drops and ointments. We took independent advice from a GP adviser who said that the practice had provided details of their repeat prescription policy which was reasonable. They said the practice had acted reasonably in regard to the issue of ophthalmic prescriptions, and where they were unable to provide a prescription when requested this was due to either there being a need to clarify the prescription or due to medication supply issues. We did not uphold the complaint. Related reading View Decision Report 201600330 as a PDF (10.95 KB) Updated: March 13, 2018

Mr C attended two consultations with the nurse at the medical practice. Mr C said that at the first consultation he was not prescribed antibiotics. At the second consultation, Mr C said he had taken antibiotics prescribed for his wife. The nurse prescribed antibiotics so that Mr C could complete the course. There was an error in the number of antibiotics prescribed and Mr C was required to be issued with another three-day course. Mr C complained to us about the treatment he received. He said that the nurse had been dismissive of his symptoms. We obtained independent advice from a nursing adviser and a GP adviser. They noted that the actions of the practice nurse at the first consultation had been reasonable and that Mr C did not require antibiotics at that time. It appeared that the second consultation had been difficult for both Mr C and the practice nurse. We were advised that it had been reasonable for the practice nurse to have told Mr C that he should not have taken his wife's antibiotics. The prescribing error had been accepted by the practice and no harm had been caused to Mr C. We did not uphold Mr C's complaint. Several months later, Mr C attended an appointment with a GP. Mr C complained to us about his treatment and the attitude of the GP. The GP adviser found that the treatment received by Mr C was appropriate. We therefore did not uphold this complaint. It was clear the consultation had been challenging and unsatisfactory for both Mr C and the GP, who recorded personal comments about Mr C in the clinical records. We were advised that it was at times helpful for the management of future consultations for a doctor to record an objective description of a challenging consultation. However, during our investigation we found that the comments about Mr C were subjective and unnecessarily personalised and so could have a negative effect on the doctor/patient relationship. We therefore made a recommendation to address this.

Mr C complained to us about the treatment which he received from a GP at the medical practice. He said that he had been unwell for a period of years and that it was suspected he had Irritable Bowel Syndrome. He reported to the GP that he had further bowel problems and that he wanted to be referred to hospital. Mr C said that the GP refused to refer him to hospital. He continued to be in pain for a further week, and attended hospital himself where he was diagnosed with septicaemia and a cancerous tumour. The practice maintained that due to the symptoms reported by Mr C there was no indication that an immediate hospital admission was required. The practice were aware that Mr C had already been referred for a colonoscopy and the GP took steps to give the referral more priority. We took independent advice from an adviser who is a GP. We found that Mr C's GP was aware of his clinical history, took note of his presenting symptoms and made out an appropriate prescription. There was no indication that Mr C reported acute abdominal pain which warranted emergency hospital admission that day, and it was appropriate to speed up the priority of the colonoscopy referral. We did not uphold Mr C's complaint. Related reading View Decision Report 201508472 as a PDF (11.19 KB) Updated: March 13, 2018

Mrs C complained to us that she had repeatedly asked the medical practice whether they had access to a report on the colonoscopy procedure (examination of the bowel with a camera on a flexible tube) which she underwent in hospital. The practice said that they would have to wait until the hospital advised them of the result. Mrs C contacted the hospital and was told that the practice could have obtained the report electronically. Mrs C complained to the practice and they said that while the result of the report was available electronically it would be for the hospital clinician who requested the report to advise the patient and the practice of the result. We took independent advice from a GP adviser and concluded that while the result was available electronically it was outwith the role of a GP to report the result to the patient. It was the responsibility of the clinician who arranged the test to report the result. A GP would not be able to interpret the result of the test or know what the patient's management plan was. We also found that the practice had made contact with the hospital who explained that there was a backlog in the reporting of the results and that their involvement actually meant that the result was reported earlier than it would otherwise have been. We did not uphold the complaint. Related reading View Decision Report 201507833 as a PDF (11.17 KB) Updated: March 13, 2018

Mr C brought this complaint to us on behalf of his late wife (Mrs C), following a rapid deterioration in her health. He raised concerns that GPs should have identified her deteriorating condition over the course of three consultations she had with them prior to her admission to hospital. She was admitted to hospital suffering from shock within 24 hours of her last GP visit. The hospital doctors were unable to save her, as she did not respond to the treatment she was given, and she died a week after admission. We took independent advice from a GP adviser. The adviser reviewed the consultations that Mrs C had with GPs, and was satisfied that the assessments had been reasonable and the treatments were appropriate. She noted that the main issue discussed had been back pain. There had been no mention of diarrhoea, though Mr C said that his wife had been suffering from this for several weeks. He reported that he mentioned it to the GP at the final consultation. However, it was not noted in the medical records, and the adviser was satisfied that the GPs had made reasonable decisions based on the information they were given. The adviser also noted that the GPs may have made different decisions if they had been told of Mrs C's persistent diarrhoea. We noted the sequence of events that led to Mrs C's death, but concluded that GPs could not have predicted this, based on the information she gave them. We were satisfied that the GPs had assessed and treated Mrs C reasonably for the back problems she presented with, and noted that they were also reasonable not to ask about diarrhoea when she had not raised this as an issue. We were satisfied that the practice provided Mrs C with appropriate clinical treatment in view of the symptoms which she presented with. Related reading View Decision Report 201407287 as a PDF (11.43 KB) Updated: March 13, 2018

Mr C complained to us that the medical practice failed to provide him with appropriate clinical treatment when he turned up for a consultation and was in need of medical attention. He was also told that he had been removed from the practice list of patients and he complained that they did not provide an explanation for this. The practice explained that when Mr C attended the practice there was no indication that he required medical treatment and that he did not mention this to the staff who saw him. They also explained that the reasons he had been removed from the practice patient list were that he had previously intimated he was leaving the country and they had received a medication enquiry from another medical practice outwith Scotland. Further, they explained that contact was made to Mr C's registered address and staff were informed he was no longer resident there, and that he had failed to attend a pre-arranged consultation. We took independent advice from an adviser in general practice medicine and concluded that if there was no indication that a patient required immediate medical attention then there was no requirement for a GP to see a patient immediately. In addition, as the practice had confirmed that Mr C was no longer at the address stated then it would be reasonable for them to remove him from the practice patient list. The clinical records substantiated the explanations provide by the practice. We did not uphold the complaints. Related reading View Decision Report 201505763 as a PDF (11.24 KB) Updated: March 13, 2018

Mr C's father (Mr A) was diagnosed with stomach cancer and died five months later. Mr C complained that the medical practice should have investigated his father's symptoms sooner as an earlier scan may have allowed some level of preventative treatment. We took independent advice from a medical adviser who is a GP. We found that until he was under the care of hospital specialists, Mr A had not reported or exhibited symptoms of more serious underlying disease which would have suggested urgent referral in accordance with national guidelines for the investigation of cancer. The adviser therefore considered that there was no evidence from Mr A's medical records that the practice failed to identify or act on any concerning symptoms, so we did not uphold Mr C's complaint. Related reading View Decision Report 201503737 as a PDF (11 KB) Updated: March 13, 2018