SPSO Individual Decisions

Mrs C complained about the care provided to her mother (Mrs A) by the practice. In particular, Mrs C complained that the practice unreasonably failed to re-start Mrs A's diuretic medication (medication that can help reduce fluid build-up in the body which occurs when the heart is not functioning properly) which had been stopped in hospital. Mrs C felt that this resulted in a deterioration of Mrs A's longstanding heart condition. Mrs C complained that the practice unreasonably failed to liaise with Mrs A's cardiologist in this regard. Mrs C also raised concerns about the decision to commence Mrs A on anti-depressant medication. Mrs A was subsequently reviewed by a consultant geriatrician (a doctor who specialises in the medicine of the elderly) who restarted the diuretic medication and stopped the anti-depressants. We took independent medical advice from a GP. We found that there was no evidence that Mrs A's diuretic medication should have been restarted earlier, or that the practice missed any significant signs of deteriorating heart failure. We also took independent advice from a consultant geriatrician on the timescale for restarting this medication. They explained that restarting diuretic medication is difficult to balance as restarting too soon can worsen dehydration, but leaving it too late can worsen the heart condition. The adviser considered that Mrs A's diuretic was restarted within a reasonable timeframe. We also found that an earlier cardiology review was not indicated, and that there was not a failure by the practice to liaise with Mrs A's cardiologist. As such, we did not uphold these aspects of Mrs C's complaint. In terms of the decision to prescribe anti-depressants, we found that Mrs A had indicated that she was feeling low and anxious and that, as such, the prescription was not unreasonable. We did not uphold this aspect of the complaint. However, the GP adviser said that the medical records kept by the practice were sparse in detail an

Ms C complained about a number of consultations, for different medical complaints, that she had at her GP practice. Ms C also complained that she had been unreasonably removed from the practice list, and she complained about how the practice had responded to her complaint. We took independent advice from a GP adviser. We found that Ms C had received a reasonable standard of care and treatment, and so we did not uphold this aspect of the complaint. However, we did find a consultation which had happened had not been noted in the clinical records. We made a recommendation to address this. We found that the practice had followed the correct procedure when removing Ms C from their patient list and that they had responded thoroughly to her complaint. We did not uphold these complaints.

Mr C complained that his GP practice unreasonably failed to arrange a scan of his shoulder and that they failed to refer him to an external psychology service. Mr C also had concerns that the practice failed to consult with him following a review of his medication, and that they failed to act on a letter sent to them by a consultant neurologist regarding changes to his medication. Mr C also complained that the practice failed to provide adequate responses to his letters and that they failed to apply the correct complaints handling procedure. Mr C required a cortisone injection in his shoulder and he requested that a scan be performed prior to receiving the injection. We took independent advice from a GP adviser and found that giving a scan prior to a cortisone injection is not standard practice in Scotland, therefore it was reasonable that the GP did not request this. We did not uphold this complaint. We found the standard procedure would be for a clinician to make a referral to external services, such as an external psychology service, and that a GP would not usually make such a referral. We, therefore, saw no evidence of failure on the part of the practice in this regard, and did not uphold this aspect of Mr C's complaint. We found that changes to Mr C's medication were discussed with him by his consultant, and that the GP correctly followed the consultant's instructions to amend the prescription. We found that when Mr C enquired with the practice about this change, they correctly advised him to make an appointment with his GP to discuss the review of his medication. We did not uphold this complaint. We found no evidence that the practice had failed to respond to Mr C's queries in a reasonable manner, and we did not uphold this complaint. However, we did find that the practice failed to follow the correct complaints procedure, and that they provided Mr C with the incorrect complaints procedure. The practice acknowledged this mistake, and we upheld this as

Mrs C complained about the care and treatment provided by her medical practice for her back pain. She said that she was not appropriately investigated or diagnosed, and that there was a delay in her being referred for a scan. We took independent advice from a GP. We found that when Mrs C presented with back pain, she was appropriately assessed and examined, and that appropriate action was taken as a result of these assessments. We also found that she was referred for a scan within two and a half weeks of presentation. We found that the care and treatment provided by the practice was reasonable and we did not uphold Mrs C's complaint. Related reading View Decision Report 201608069 as a PDF (10.86 KB) Updated: March 13, 2018

Mr C complained to us that the medical practice had failed to provide appropriate care and treatment to his wife (Mrs A). He said that Mrs A had been seen by two GPs at the practice within three days with complaints of severe abdominal pain and dehydration, and that she had not taken food or fluids for a week. Mrs A deteriorated and was admitted to hospital where she underwent surgery for a small bowel obstruction. Mr C believed that the GPs at the practice should have realised that his wife was in severe pain and that she should have been admitted to hospital as an emergency. The practice told us that on initial assessment, taking into account the medical history and examination findings, the GP did not believe there was any indication for a hospital admission at that time. The GP felt it was reasonable to diagnose a possible flare of diverticulitis (a common disease of the digestive system). The GP prescribed appropriate medication and gave advice to contact the out-of-hours service if required. The second GP visit was due to Mrs A not taking her medication due to nausea and the inability to swallow. The GP was inclined to agree with the first diagnosis and decided that Mrs A could be managed at home if she could tolerate her medication. Advice was given to assist taking the medication but that a hospital admission would be considered if Mrs A was unable to comply with the treatment plan. We took independent medical advice from a GP and concluded that the practice had provided a reasonable level of care. It was felt that at both consultations the GPs had carried out an appropriate history and examination of Mrs A. In particular there was assessment of her abdomen so as to rule out any acute problem necessitating emergency hospital admission. The prescribing appeared to be appropriate and the working diagnosis of a flare-up of pre-existing diverticulitis was not unreasonable. In addition, Mrs A was not showing symptoms or signs which necessitated emerge

Miss C complained about the care and treatment provided to her father (Mr A) when he attended his medical practice with urinary problems. Tests and investigations indicated prostate cancer that had spread to Mr A's bones and he was admitted to hospital shortly after. Mr A's condition deteriorated significantly due to sepsis (a bacterial infection of the blood) and he died a few days later. Miss C complained that the practice failed to properly investigate Mr A's symptoms, that the treatment decisions were unreasonable and that the family's concerns were not taken seriously. We took independent advice from a specialist in general practice. We found the standard of care and treatment provided was reasonable, including the investigations carried out and Mr A's referral to hospital. We did not find that the practice failed to take seriously the concerns of Mr A's family. We therefore did not uphold Miss C's complaint. Related reading View Decision Report 201507658 as a PDF (11.05 KB) Updated: March 13, 2018

Mrs C complained to us that her husband (Mr C) did not receive a reasonable standard of care from his GP practice. Mr C had been a patient at the practice for three months, having transferred from a different practice, when he suffered a heart attack and died. Mrs C felt that the practice should have requested a chest x-ray and an echocardiogram (a test which records the rhythm and electrical activity of the heart). She said that there had been a sequence of failed attempts to diagnose and treat Mr C. We took independent advice from a GP adviser. They found that Mr C had received reasonable care from the practice. The adviser noted that Mr C had been appropriately referred to the hospital respiratory medicine department and consequently considered that it was not unreasonable that Mr C was not referred for a chest x-ray or an echocardiogram. We accepted the adviser's comments and we did not uphold this complaint. Related reading View Decision Report 201507985 as a PDF (11.06 KB) Updated: March 13, 2018

Mrs C was removed from the treatment list of her GP practice following a difficult visit to the practice. Her husband (Mr C) complained about this and Mr and Mrs C were invited to a meeting to discuss the investigation. At the meeting they felt that no investigation had been undertaken and subsequently complained to us. The reasons the practice gave us for removing Mrs C from their treatment list did not meet the relevant criteria in legislation, policy or guidance for the immediate removal of a patient from a treatment list and we could see no other evidence that immediate removal was warranted. We saw no evidence that Mr C's complaints were dealt with in line with the NHS Scotland complaints procedure. As a result, we upheld both complaints.

Mrs C complained that the practice failed to take her late husband (Mr C)'s symptoms seriously between January and March 2014, in particular his weight loss. She also said that they were given inaccurate information about the length of time Mr C would be admitted to a hospice. We took independent advice from a general practitioner and we found that Mr C had a history of back pain and diabetes, and in 2013 had been given advice about his diet. He lost weight as a consequence and, when he went to the GP a few months later suffering from leg pain, it was noted that he was still losing weight but this was considered to be because of his healthier diet. Nevertheless, Mr C's pain was investigated: blood tests were taken, he was referred for physiotherapy and an MRI (magnetic resonance imaging) scan of his back was carried out. Mr C's blood tests showed an abnormality, and he was, therefore, referred to hospital where he was later diagnosed with cancer. Mr C's pain was very difficult to control and he was admitted to a hospice on two occasions. On the second occasion, Mrs C felt that she had been misled as it was indicated his stay would only be short. However, because of the complexity of his needs, it took a considerable time to provide a solution to his pain. We acknowledged that Mrs C had coped with a very stressful situation but we did not uphold her complaint. However, as we found that Mr C's referral to hospital should have been an urgent one (because of the presence of weight loss), we made a recommendation for the practice to familiarise themselves with appropriate guidance.

Ms C complained that a member of staff at her GP practice had divulged confidential medical information about her to a mutual acquaintance and the practice did not thoroughly and appropriately investigate her complaint to them about this. Our investigation found that the practice had taken reasonable and appropriate action to investigate the matter, including taking statements from Ms C's friend (who had overheard a conversation between the staff member and the mutual acquaintance), the mutual acquaintance and the staff member. Despite this, it was not possible to determine exactly what had been said. In these circumstances, we were unable to uphold the complaint. Related reading View Decision Report 201504847 as a PDF (10.92 KB) Updated: March 13, 2018

A GP was called to Mrs A's home when she was experiencing breathing difficulties. The GP examined Mrs A and prescribed medication. Two days later Mrs A was admitted to hospital with respiratory failure. Mrs A subsequently complained to the practice about the care and treatment she received at the home visit. The practice explained the reasons why the GP had made his decisions and indicated that they considered that these had been reasonable. Mrs A remained dissatisfied and Mrs C, who works for an advice agency, complained to us on behalf of Mrs A. Specifically, Mrs A wanted to see if there was a preventable delay in her care. We took independent advice from a GP adviser. The adviser reviewed the medical records for the home visit and considered that the symptoms and signs recorded were consistent with the diagnosis made, which was an acute exacerbation of Chronic Obstructive Pulmonary Disease (COPD). The adviser told us that the GP had identified this appropriately and treated Mrs A in line with the National Institute for Health and Care Excellence (NICE) guidance relevant to COPD in Scotland. Overall, the adviser was satisfied that the practice's care and treatment of Mrs A was reasonable. We agreed with this advice, and did not uphold the complaint. Related reading View Decision Report 201502980 as a PDF (11.25 KB) Updated: March 13, 2018

Mrs C complained that the practice had not contacted her to tell her about the need for blood tests to be repeated. The practice responded to her complaint advising that they held a recording of a phone conversation in which she was told about the need for blood tests to be repeated. They offered Mrs C the chance to hear the recording. Mrs C brought her complaints to us. We received a transcript of the call from the practice, which supported their view. We decided we would not pursue the matter further in those circumstances. Related reading View Decision Report 201502371 as a PDF (10.84 KB) Updated: March 13, 2018

Miss C complained that her mother-in-law (Mrs A) had not been properly assessed by a GP following episodes of dizziness and elevated heart rate and blood pressure. Mrs A had suffered a fatal heart attack three days after visiting the GP. The GP said that Mrs A had suffered from a number of health problems. At the consultation in question she had been extremely anxious and had been prescribed medicine to counteract this. Her pulse and blood pressure had also been taken. We took independent advice on the care and treatment provided. Our adviser said the medical records did not show that a comprehensive examination of Mrs A had been carried out. Our adviser noted that Mrs A suffered from diabetes and that the appropriate Scottish guidance for management of patients with this condition had not been followed, which was unreasonable. We found that the GP had not carried out an adequate examination of Mrs A. However, our adviser also said that Mrs A's death had been impossible to predict and that even had a more thorough examination been carried out, it would not have been possible to prevent her fatal heart attack.

Mr C complained about the care and treatment that his wife (Mrs C) had received from the GP practice before her death from bowel cancer. Mr C said that Mrs C had attended the practice on a number of occasions over a three-year period with abdominal pain. He said that the practice had failed to provide Mrs C with appropriate treatment and had delayed in referring her to a specialist. We took independent advice on Mr C's complaint from one of our medical advisers, who is a general practitioner. We found that Mrs C had initially attended the practice on a number of occasions with heart burn/dyspepsia (persistent or recurrent abdominal discomfort or pain located in the upper abdomen). Heart burn/dyspepsia are not clinical symptoms identified in patients presenting with bowel cancer and Mrs C had received appropriate treatment for this. Mrs C had subsequently attended the practice with symptoms of abdominal pain, change in bowel habit and anaemia. She was then urgently referred to the colorectal service in line with the relevant guidelines and was diagnosed with bowel cancer. We found that Mrs C had attended the practice with two different sets of symptoms, which were not related. The practice had provided a reasonable standard of care to Mrs C and we did not identify any failings. We did not uphold the complaint. Related reading View Decision Report 201406670 as a PDF (11.22 KB) Updated: March 13, 2018

Mr C complained that there was a delay in his GP practice diagnosing him with skin cancer. He also said that they did not take his concerns seriously and that there was a delay in him receiving medication for nerve damage. We took independent advice from one of our medical advisers who is a GP and found that the GP practice provided Mr C with a reasonable standard of treatment, making referrals to hospital specialists based on his symptoms. Whilst we were critical that Mr C could have been referred to a dermatology specialist sooner, this was not a significant delay. Furthermore, we did not consider it had any material impact on the time it would have taken for him to be seen. In addition, there was evidence to show that reasonable attempts were made by the GP practice to communicate with Mr C following his surgery. Although the GP practice apologised for the delay in giving Mr C his medication, we found that they were not entirely at fault. However, we upheld Mr C's complaint that the GP practice did not provide him with appropriate explanations about the reasons for the delay in prescribing his medication. Related reading View Decision Report 201404508 as a PDF (11.15 KB) Updated: March 13, 2018

Mrs C, who is an advice worker, complained on behalf of Mr A about the care and treatment he received from the medical practice. Mrs C said Mr A, who has cerebral palsy, was seen by doctors at the practice for a year with sharp abdominal pains but the practice failed to diagnose that Mr A had a hernia (a condition where an internal part of the body pushes through a weakness in the muscle or surrounding tissue wall). Mrs C also complained that one of the doctors at the practice failed to carry out a physical examination of Mr A at one of the appointments. We obtained independent medical advice from one of our GP advisers. They said that they could see no evidence in Mr A’s medical records that he had either the symptoms or signs of a hernia during the 12 months that he was seen by the practice, and that the hernia identified at the end of the 12 months was most likely a new presentation. We found that Mr A was provided with a reasonable standard of care by the practice. Our adviser also explained that there was no requirement for a patient to be examined for a chronic condition every time they attended a GP practice and that if a patient presented with new symptoms or a significant change, then an examination would be reasonable. When Mr A was seen by the doctor, he did not present with any new symptoms, and as he had been seen 24 hours previously by a senior surgical doctor at Perth Royal Infirmary for an examination, we did not consider it unreasonable that the doctor did not physically examine Mr A. We did not uphold Mrs C's complaints. Related reading View Decision Report 201407708 as a PDF (11.37 KB) Updated: March 13, 2018

Mrs C complained that she had contacted the practice in the late afternoon to request that a GP attend and assess her partner (Mr A)'s mental health condition as she was seriously concerned that he was having a psychotic episode. Mr A was at another address and she was concerned about his safety. The GP listened to Mrs C's concerns and sought advice from the mental health services. It was decided that it would not be appropriate for them to visit Mr A that evening and that a visit would be made the following morning. Mrs C subsequently reported Mr A missing to police and he was found dead near to the address that Mrs C had highlighted. The GP explained that he had taken Mrs C's concerns seriously, and that he had sought specialist advice and reviewed Mr A's previous medical history and, as there was no immediate risk to Mr A or others, a visit the following morning was appropriate. We took independent advice from a GP adviser who felt that the GP had not put himself in a position to obtain a first hand assessment of Mr A's mental health condition. The adviser felt that Mrs C's information was concerning enough to warrant action that evening. However, after careful consideration we felt that the GP had acted appropriately by seeking advice from the mental health services about Mr A's previous contact with them, and that there was no indication that Mr A was at risk to himself or others at the time. We found that the GP had treated Mrs C's concerns seriously and that a mental health assessment was appropriate, but that it could wait until the following morning. We did not uphold the complaint. Related reading View Decision Report 201406447 as a PDF (11.33 KB) Updated: March 13, 2018

In January 2013, Mr A attended the medical practice as he had ongoing chest pain and a cough. A chest x-ray and blood tests were arranged and the results came back normal. However, as his pain was continuing he was given painkillers. In March 2013, Mr A attended the practice again because his symptoms were continuing and he was referred to hospital for a specialist opinion. Mr A was seen in hospital in May 2013 although, in the meantime, the practice prescribed him increasing painkillers and his tests were repeated but again with no result. After a difficult diagnosis pathway, Mr A was advised over the phone by his GP in September 2013 that he had cancer, and he died in May 2014. Mr C complained to the practice on behalf of Mr A's widow (Mrs A) that it had taken the practice too long to refer Mr A for appropriate tests and opinion and that there was a lack of urgency to provide him with any meaningful treatment. He further complained that a GP within the practice told Mr A of his diagnosis over the phone, which he said was inappropriate and showed a lack of compassion. We took independent advice from one of our GP advisers and we found that while Mr A was treated reasonably and appropriately and that efforts were made to treat his pain, he was not referred to hospital in line with national guidelines for suspected cancer. His referral should have been urgent rather than routine. Because of this, there was a delay in him being seen in hospital and a delay in his treatment being started. While it was confirmed that Mr A had been told of his diagnosis over the phone, this was for the best of intentions in order to explain his increasingly strong painkillers. Nevertheless, this should not have happened and arrangements should have been made for a house call or for Mr A to attend the practice. In light of the advice we received, we upheld Mr C's complaint.

Mrs C complained on behalf of her client (Mrs A) who was unhappy with the care and treatment she received from her GP practice in relation to a finger injury. After injuring her finger, Mrs A attended the hospital minor injuries and illnesses unit, but she was discharged. A week later, she attended the practice as she was still unable to bend her finger. The GP examined her finger and prescribed antibiotics. Mrs A returned a week later and a different GP prescribed different antibiotics. Mrs A returned again another week later, and at this appointment she mentioned that soon after the first injury, she had had a second injury which stretched her finger. The third GP then considered that Mrs A might have an injury to her flexor tendon (the tendon that connects the muscles in the forearm to the bones in the finger), and referred her to the orthopaedic clinic as a routine referral. After further investigations, Mrs A was diagnosed with an incomplete tear of the flexor tendon. After taking independent medical advice from a GP adviser, we upheld the complaint. We found that, although the first two GPs did not know about the second injury, in view of Mrs A's symptoms they should still have considered the possibility of a flexor tendon injury and referred her for specialist assessment. Although the third GP acted appropriately in referring Mrs A to orthopaedics, this should have been an urgent referral, rather than routine. We were concerned that the GPs' failures to refer Mrs A appropriately led to a delay of over three weeks in her treatment, which our adviser said was significant as flexor tendon injuries are normally treated within a few days.

Mrs C, who is an advice worker, complained to us on behalf of her client (Mrs A), about the care and treatment of Mrs A's late husband (Mr A). A GP from the medical practice had examined Mr A earlier in the day and prescribed antibiotic tablets and a throat spray. Mrs C complained that the GP then failed to reattend Mr and Mrs A's home to visit Mr A when he began having breathing difficulties. Mr A died later that day. We took independent advice on this case from one of our medical advisers. Our adviser explained that the GP recorded a thorough history and examination in keeping with an upper respiratory infection. She said that the GP examined Mr A's chest and noted that it was clear. With regards to Mrs A's specific concern about the GP's failure to reattend, the adviser reviewed the notes relating to a phone call and was satisfied that it did not contain anything to suggest an increasing severity of Mr A's condition. Based on the advice received, we were satisfied that the GP's care and treatment was reasonable. Related reading View Decision Report 201402321 as a PDF (11.11 KB) Updated: March 13, 2018

Ms C said that she had a contraceptive implant fitted and when it was near the end of its life, she attended her GP for a replacement. She complained that she was told that because of her high blood pressure (BP) it was not possible to do so. As it appeared that Ms C was not taking her medication to reduce her BP, she was advised to do so and return to the practice in six to eight weeks time for review. Ms C attended again to have her implant reinserted but again her BP was noted to be very high. She was told that if there was an attempt to replace it there was a risk of uncontrolled bleeding and it was agreed that she should attend a local hospital for replacement. Ms C felt that she had been given unreasonable care and treatment because the reason why she had an implant fitted in the first place was because of her BP. She complained that the GP's actions left her without effective contraception. During our investigation, we took independent advice from one of our medical advisers, who is a GP. The adviser said that although the GP said she had acted in Ms C's best interests and followed national advice on implantable progesterone contraception like the type used by Ms C, she had in fact misunderstood the advice. In cases similar to Ms C's, the benefits of remaining on the contraceptive, despite her BP, would likely outweigh the risks as it was recognised as a safer option for women with high BP. In the circumstances, we considered it unreasonable that Ms C was left without an effective form of contraception for over seven weeks.

Mr C attended his medical practice suffering from vomiting, diarrhoea and pains in his stomach. A GP diagnosed gastroenteritis (inflammation of the stomach and intestines) but some five days later Mr C was taken to hospital, where it was found that his appendix had burst, leading to peritonitis (inflammation of the tissue lining the abdomen). He had to have further surgery when he developed complications including kidney problems and a haematoma (a localised collection of blood outside the blood vessels). Three months after the original appendectomy he developed a fistula (an abnormal opening between organs) which had to be closed with a skin graft. Mr C complained to us that the GP failed to diagnose that he was suffering from appendicitis. We took independent advice on this from one of our medical advisers, and did not uphold the complaint. The adviser said that the GP had made a reasonable assessment and diagnosis of Mr C's symptoms, which were highly suggestive of gastroenteritis. The GP had asked Mr C to return to be reviewed if his symptoms did not settle down, but he did not do this. Our adviser pointed out that there is a shared responsibility between doctor and patient, and it was not the doctor's responsibility that Mr C did not return when his symptoms did not improve. Related reading View Decision Report 201304080 as a PDF (11.28 KB) Updated: March 13, 2018

Mrs C complained that her medical practice had removed her from their list of patients. She had visited the practice to try to get an emergency appointment. She had a sore throat and had lost her voice so she used a pen and a scrap of paper to communicate with the receptionist. As a suitable appointment was not available she became frustrated and left the practice. The following day, the practice wrote to Mrs C saying that because of her behaviour, and after seeing relevant CCTV footage, they had no option but to immediately remove her from the practice list. Mrs C told us that she disputed the practice's interpretation of her behaviour. We explained that the practice were entitled to act on any concerns they had and that it was not our role to comment on the incident itself. We confirmed that our investigation would focus on the process the practice followed in removing her from their patient list. We reviewed the relevant regulations and guidance, and discussed the case with one of our medical advisers. In order to remove a patient with immediate effect, the incident must have been reported to the police. Failing this, the practice should send the patient a warning letter. Only where a warning has been issued in the preceding 12 month period can they remove the patient without having involved the police. We upheld the complaint, as we found that in this case, the practice did not issue Mrs C with a warning, nor did they contact the police.

Mr C complained that a GP provided him with inadequate care and treatment. Mr C visited the GP because he had pain on the left side of his head. He said the GP diagnosed shingles and prescribed inappropriate medication, an antidepressant. We looked at Mr C's medical records and took independent advice from one of our medical advisers. In the absence of any independent evidence from the consultation, however, we could not reach a definitive finding on exactly what was said there. We found that the medical records showed that the GP had noted that there was no shingles rash present, and had treated Mr C for nerve pain. We also found that the medication prescribed was appropriate for this, as although it is an antidepressant, it is also frequently used to treat nerve pain. We concluded that the GP provided a reasonable level of care and treatment in the circumstances. Related reading View Decision Report 201301600 as a PDF (11.02 KB) Updated: March 13, 2018

Ms C complained about the care and treatment that her father (Mr A) received from the medical practice during the weeks leading up to his admission to hospital with a chest infection and kidney failure. Mr A saw doctors from the practice several times in the four weeks before he was admitted. Ms C was concerned that an earlier diagnosis of chest infection could have improved his care at home, and reduced the need for hospital intervention. Mr A died three days after he was admitted to hospital. Mr A had seen doctors from the practice five times - in relation to fluid on his lungs, an ongoing urine infection and unsteadiness with walking. In addition, he saw a physiotherapist twice, had a chest x-ray and a chest scan. The final consultation was during a home visit, when signs of a chest infection were apparent. At first, the GP had assessed that Mr A could stay at home, and take antibiotics. However, when blood tests showed that his kidney function was poor, she decided that he needed admission to hospital for closer monitoring. We obtained independent advice on this complaint from one of our medical advisers, but did not uphold the complaint. The advice indicated that the chest infection was not apparent until the day Mr A was admitted to hospital, and was not evident on the chest scan. Our adviser considered that the care and treatment provided by the practice were of a good standard and that there was no delay in diagnosing the chest infection. We also found that the practice had acted promptly to secure Mr A's admission to hospital when the infection was identified. Related reading View Decision Report 201204850 as a PDF (11.43 KB) Updated: March 13, 2018