SPSO Individual Decisions

Mrs A and her daughters were removed from the GP list following an incident at the practice involving her husband, who was not registered at the practice. Mrs A's father (Mr C) complained that the decision to remove Mrs A and her daughters from the list was unreasonably severe and lacked transparency and that the removal letter was vague. He also complained that previous problems experienced with a particular receptionist had not been addressed and that the complaints process was lengthy and unclear. We found that while the decision to remove Mrs A and her daughters from the list was reasonable, the practice did not follow NHS guidance which states that where no warning about the patient's or their representative's behaviour is given within the preceding 12 months, patients can only be removed if the police or the procurator fiscal had been informed of the incident which led to the removal. This did not happen in Mrs A's case. Although we did not uphold this part of Mr C's complaint, we made a recommendation to the practice. The letter informing Mrs A of her removal reached her on a Saturday and she had an appointment booked at the practice for the following Monday. The letter did not make it clear that this appointment could still go ahead and repeat prescriptions could be issued until Mrs A was registered with a new GP. The practice has now changed the wording of such letters to make the transition arrangements clear. Therefore while we upheld Mr C's complaint in relation to this, we made no further recommendations. We reviewed the actions taken to address the previous problems that the family had experienced with a particular receptionist and found that these had been appropriately addressed. We did not uphold this part of the complaint. In relation to the handling of the complaint, we found evidence of delays. Although the delays were not a result of inaction by the practice, Mr C was not kept informed of the reasons or given a timescale by which he coul

Mr C attended his medical practice with a persistent cough. He was referred for a chest x-ray and breathing tests. His x-ray was clear but he was unable to complete the breathing tests. Mr C's symptoms worsened so he made a further appointment and was prescribed an inhaler. His symptoms further worsened so he made another appointment and was prescribed a different inhaler. Mr C began to experience hoarseness and a feeling of blockage in his throat. He made an appointment with a different GP, who requested blood tests and x-rays and made an ear, nose and throat (ENT) referral. A biopsy confirmed Mr C had throat cancer. Mr C complained that the initial GP had failed to provide him with appropriate treatment in view of his presenting symptoms. We sought independent medical advice. They found that the care provided by the practice was of a reasonable standard and was in line with national guidelines. We accepted the adviser's view and did not uphold Mr C's complaint. Related reading View Decision Report 201602299 as a PDF (11.09 KB) Updated: March 13, 2018

Mr C complained that his GP practice did not offer him an urgent appointment with a doctor after he attended the practice with chest pain. Mr C turned down the offer of an appointment with the nurse as he felt his symptoms were too severe. The duty doctor called him later that day and offered an appointment for the next working day (which was a Monday). Mr C chose instead to attend A&E where it was identified that he had a pneumothorax (collapsed lung). The practice accepted and apologised that Mr C should have been offered an urgent appointment to be seen the same day given his reported symptoms. We took independent advice from a GP. We were concerned about the procedures in place at the practice for managing patient appointments. There was a lack of evidence to demonstrate that non-clinical staff were adequately trained and supervised in the procedures. We concluded that the care provided by the practice fell below a reasonable standard, and we upheld Mr C's complaint.

Mrs C complained to us that the medical practice had failed to provide appropriate care and treatment to her late husband (Mr C) who died following an overdose. Mrs C said that her family had reported their concerns about Mr C's behaviour and that he should have been referred to the mental health services but the practice did not listen to their concerns. The practice maintained that, on examination, there was no indication that Mr C suffered from mental health issues or that there was the possibility of a suicide risk. We took independent advice from a GP. We concluded that as Mr C was showing signs of paranoid ideation (having beliefs that you are being harassed or persecuted, or beliefs involving general suspiciousness about others' motives or intent), verbal aggression, and transient confusion this would warrant a mental health assessment in the first instance with the possibility of referral for a specialist opinion. We also found that the practice should have taken action in view of the concerns voiced by the family. Although there was no evidence that the inactions of the practice directly led to Mr C taking an overdose, we upheld the complaint in light of the failings identified.

Miss C's father (Mr A) attended the medical practice on two occasions over a four week period with chest and abdominal problems and breathlessness. He also had a phone consultation with the practice about his condition. Whilst waiting for x-ray results, Mr A died suddenly. His post mortem gave his cause of death as cardiac enlargement (an enlarged heart which may not pump blood effectively, resulting in congestive heart failure). Miss C complained that the practice failed to provide appropriate care and treatment to her father. She raised a number of concerns including that a nurse practitioner and a GP at the practice failed to carry out appropriate assessments and examinations of her father and provide appropriate treatment. We obtained independent medical advice on Miss C's complaint from a nursing adviser and a GP adviser. The nursing adviser explained that the nurse practitioner's assessment and examinations of Mr A were reasonable and Mr A was provided with appropriate treatment. The GP adviser said that the GP's assessment, care and management of Mr A were reasonable and in accordance with relevant guidelines. The GP adviser said the details recorded in the consultation together with the examination of Mr A were not significantly suggestive of a heart condition as the primary underlying cause of Mr A's condition. They explained that chest infection was a reasonable diagnosis for the GP to have made based on the symptoms and signs presented to them. Therefore, we did not conclude that the practice failed to provide appropriate care and treatment to Mr A. Related reading View Decision Report 201500063 as a PDF (11.31 KB) Updated: March 13, 2018

Mr C complained that the GP who examined his late father (Mr A) at a consultation had not provided a reasonable standard of care and treatment.  When Mr C visited Mr A later the same day, he was distressed by his father’s condition and called an ambulance.  When Mr A was admitted to hospital he was found to be dehydrated, with a chest infection.  He died four days later from aspiration pneumonia (caused by a poor swallowing mechanism whereby foreign matter enters the lungs).  Mr C also complained that his father’s medication had been unreasonably increased, despite previous knowledge that an increased dose previously reduced Mr A's appetite and he would therefore lose weight. We took independent advice from a GP adviser.  They found the increase in the medication dosage to have been reasonable.  However, they noted that there was not a documented consultation for the day Mr A was admitted to hospital.  The adviser said this was not in line with General Medical Council (GMC) guidance. On balance, we upheld the complaint as the practice were unable to demonstrate they had provided a reasonable standard of care and treatment.  We also noted they had failed to refer Mr C to us at the end of their complaints investigation.

Ms C complained that her GP practice had failed to diagnose her or refer her appropriately, despite consistent reports of stomach pain. This pain persisted until she was diagnosed with Helicobacter infection (Helicobacter pylori is a germ that can live in the stomach), and it was successfully treated. Ms C said she felt she had been ignored and treated with a lack of respect. Ms C added that, even once Helicobacter infection had been diagnosed, she felt the practice had not treated her within a reasonable time-frame. We took independent advice from one of our GP advisers. The advice received was that the practice had followed national guidelines in its attempts to diagnose and treat Ms C for the pain she was experiencing. The practice performed the appropriate tests on Ms C and it was noted that, on occasion, she had declined medical advice and declined appropriate referrals, which would have speeded up her diagnosis. On the basis of the advice received, we found that the practice had acted reasonably and that they had not delayed in referring Ms C for specialist opinion. Related reading View Decision Report 201405246 as a PDF (11.12 KB) Updated: March 13, 2018

Mrs C complained about the care and treatment that her husband (Mr A) received from the practice. Mr A, who had a history of anxiety, had been suffering from episodes of breathlessness. Mr A was diagnosed with panic attacks and adjustments were made to his existing anxiety medication to treat this. He was later prescribed further medication following a phone consultation and when this proved ineffective, he was seen at home as his anxiety was preventing him from going outdoors. During this visit, no abnormal findings were made during a physical examination and a referral to the community mental health team was declined. Two days later, Mr A suffered a stroke. When he was admitted to hospital, he was also found to be suffering from a chest infection. Mr A did not recover from the stroke and passed away around three weeks later. Mrs C complained that Mr A had not been properly examined by doctors from the practice as they had failed to diagnose his chest infection. After taking independent advice from one of our GP advisers, we found that the actions taken by the practice were reasonable. Mr A's symptoms suggested that he was suffering from anxiety/panic attacks and there was no evidence that he had a chest infection at either of the consultations with doctors from the practice. We did not uphold Mrs C's complaint but made a single recommendation as a result of record-keeping issues identified during our investigation.

Ms C complained that a GP inappropriately gave her father (Mr A) a cortisone steroid injection without taking account of his existing medication and health condition, and without advising Mr A about possible side effects. Ms C was also unhappy with how the GP dealt with her complaint. We looked at Mr A's medical records and took independent advice from one of our medical advisers. We found that there was no record that the GP had discussed side effects with Mr A, although the GP said they did this. Although we made no formal recommendations, we asked the GP to reflect on their record-keeping. There was no indication from Mr A's existing medication and health condition that he could not be given the injection. We also found that the GP was aware of Mr A's history and, therefore, put themselves in the position of being able to make a reasoned decision that the injection was appropriate. In addition, we found that the GP's response to Ms C's complaint was reasonable in the circumstances. We did not uphold Ms C's complaints. Related reading View Decision Report 201404695 as a PDF (11.1 KB) Updated: March 13, 2018

Mrs C's mother (Mrs A) had a distended abdomen and her GP arranged tests for her. Mrs A made an appointment, as requested, to discuss the test results with the GP, and Mrs C said that at the consultation her mother was shocked to be told that she had ovarian and bowel cancer and was given details of the sort of treatment that was available. Mrs C complained to us that the medical practice should have warned her mother she was to be given bad news, so she could take a family member with her. We took independent medical advice from an adviser who is a GP, who said that it was not for reception staff to interpret test results. We also considered Mrs A's GP's explanation to be reasonable, in that he said Mrs A knew what the tests were for and that it would have been for her to decide if she wanted to bring someone with her to her consultation. We did not uphold this part of the complaint. Mrs C also complained about the consultation itself. Subsequently, it turned out that her mother did not have cancer, and Mrs C said the GP had jumped to the conclusion that her mother had bowel and ovarian cancer, based on inadequate information. We considered the GP had been thorough in trying to establish whether Mrs A had cancer. However, our adviser considered that, strictly speaking, the GP could be considered to have acted prematurely in arranging blood tests and in arranging a scan at the same time as the blood tests, as clinical guidance suggested a different approach. We also found the GP had used a test which was not indicated in the diagnosis of bowel cancer. There was no evidence that he had told Mrs A she had cancer, other than indicating that some of the test results raised the possibility of ovarian cancer and should be investigated further. On balance, we considered that the GP had acted reasonably and we did not uphold this part of the complaint. However, we did recommend that the GP review the relevant NHS guidance as a learning opportunity, to help guide h

Mr C complained to us about the care and treatment his mother (Mrs A) received from the medical practice after a GP visited Mrs A's home as she had abdominal pain. Mr C told us that the GP examined his mother, gave her a injection for pain and called an ambulance. He said that the GP spent approximately 15 minutes with his mother before leaving. Mr C said that the ambulance arrived two and a half hours later and during this time his mother's pain worsened. He said that the ambulance crew expressed shock at Mrs A's condition and gave her more pain medication before taking her to hospital. When he went to the practice to complain, he felt that the GP was aggressive towards him. He also said that he asked for information on making a complaint and was told there were no specific forms and that each practice is different. The practice said that they provided proper care and treatment. The GP said that as Mrs A had family support and her condition was not considered life threatening, it was appropriate to leave and return to other patients at the surgery. The practice said that Mrs A's family did not call them to say that she was worse. They apologised for confusion about the complaints form and explained that although they do not have such forms they do have a procedure, and complaints can be made in writing. They said that they were not aggressive towards Mr C – they in fact felt that he had been aggressive towards them, and they had sent him a formal warning. We took independent advice from one of our GP advisers, who said that the GP provided reasonable care. Our adviser was of the view that the pain relief given and the decision to request an ambulance within a two hour window were reasonable. The Scottish Ambulance Service provided evidence during our investigation that their crew that day had no recollection of criticising the GP and or of expressing shock at Mrs A's condition. We did not uphold this complaint. We did uphold Mr C's complaint about the

Ms C, an advice worker, had written to her client (Mr A)'s medical practice to seek clarification about whether a request that Mr A made to his GP for a referral had been carried out. She received no response. After two follow-up letters were also ignored and two months had gone by, Ms C complained to us. The practice told us that they did not consider that entering into correspondence with Ms C would serve any practical purpose as the issues Mr A was concerned about had been dealt with some years previously. We decided, however, that the practice should have explained this to Ms C. We, therefore, upheld her complaint that the practice did not reasonably respond to her correspondence.

Mrs C complained that her medical practice had not provided her with reasonable care and treatment. Mrs C had suffered from cancer before so, when she noticed swelling on her leg and groin, she suspected it had returned and went to the practice immediately. During the following months she went there a number of times and various tests were arranged. When the practice then referred her to hospital, cancer was diagnosed. Mrs C did not feel that the care she received from the practice was appropriate. We took independent advice from one of our advisers, who is an experienced GP, who reviewed Mrs C's medical records and explained that they showed that the practice had been alert to the possibility of cancer throughout Mrs C's consultations and had arranged appropriate tests and investigations. The adviser also said that the practice made reasonable referrals, on the basis of the information available at the time, and had considered the whole picture of Mrs C’s symptoms. Although we recognised that this was a most significant and distressing matter for Mrs C, our role was to consider whether, based on the evidence available to the practice at the time and without hindsight, they had provided her with reasonable care and treatment. The advice we received was clear - that the practice had investigated and referred Mrs C appropriately - and on this basis we did not uphold her complaint. Related reading View Decision Report 201305957 as a PDF (11.28 KB) Updated: March 13, 2018

Ms C's aunt (Ms A) had multiple health issues and lived in a nursing home. Ms C complained that on one occasion when Ms A became distressed, a GP who was in the nursing home at the time decided not to examine her, despite the symptoms that were reported. Ms C thought it inappropriate that the GP decided there were no grounds to examine Ms A, without having seen her. The medical practice said that the GP was there to see a number of patients for whom consultations had been pre-arranged. He had told staff to contact the practice so that another GP could make an arranged home visit to Ms A. The practice told us that when staff told the GP of the specific circumstances, he decided that there was no requirement for a consultation at that time as there were no medical issues that needed to be addressed. Having taken independent advice from one of our medical advisers, we found that the GP had made a reasonable decision that there was no need for an immediate medical assessment. Although it was clear that Ms A had been distressed, this appeared to have been triggered by an environmental, rather than a medical, issue. Related reading View Decision Report 201303807 as a PDF (11.18 KB) Updated: March 13, 2018

Ms C, who is an advice worker, complained on behalf of her client (Miss A) that the medical practice unreasonably failed to investigate Miss A's reported symptoms and make timely and appropriate referrals. Ms C also complained that when a referral was made, it was marked as routine, rather than urgent. Miss A had suffered for a number of years with a condition causing discomfort and pain in her joints, for which she had received various treatments and referrals, including physiotherapy. Since January 2012, however, she had also been reporting a lump and pain in her right groin and felt that physiotherapy was making matters worse. Her GP then referred her to a specialist physiotherapist who in turn referred her to an orthopaedic surgeon (dealing with conditions of the musculoskeletal system). After tests and examinations, the orthopaedic surgeon referred Miss A to a bone cancer specialist. Miss A was then diagnosed with chondrosarcoma (cancer of the cartilage) with an overlying osteochondroma (a benign (not progressive or destructive) bone tumour). Miss A has since had successful treatment. Our investigation, which included taking independent advice from one of our medical advisers, found that the GPs had acted reasonably in referring Miss A for physiotherapy for her pre-existing condition. We also found that when she reported the lump in her groin that she thought was increasing in size, appropriate and timely referral was made. The adviser said that the osteochondroma was masking the more aggressive and serious chondrosarcoma so that it was not unreasonable for the GP to have made a routine, rather than urgent referral. The adviser said that overall the care and treatment provided to Miss A was reasonable, and we did not uphold this complaint. Related reading View Decision Report 201300371 as a PDF (11.48 KB) Updated: March 13, 2018

Miss C suffers from an anxiety disorder, and had been prescribed diazepam (a medicine which helps to control feelings of anxiety) for a number of years. When she requested a repeat prescription, Miss C was told to call the practice. Miss C said she was then told in a phone conversation with her GP that her prescription for diazepam would be stopped after a period of reduction and that, in future, she would have to attend an appointment at the practice before a repeat prescription would be issued. Miss C told us that her prescription had not previously been monitored, and had been increased over the previous years. Miss C considered that it was wrong to stop the medication. She was dissatisfied with the explanation provided by her GP and also the manner in which he responded to the complaint, which she considered to be inappropriate and unsympathetic. We took independent advice on this case from one of our medical advisers. The advice, which we accepted, was that the practice had not failed in their care of Miss C in relation to prescribing medication. However, in relation to the complaints handling, we found that although the GP provided reasonable explanations, the tone of his letters was unnecessarily sharp and at times insensitive, and his response could and should have been more considerate and empathetic.

Ms C complained about a delay by her GPs in diagnosing that she was pregnant. She initially went to the practice to report a missed period, and was advised to take a further pregnancy test, which was negative. She attended the practice five months later saying that she had bloating and constipation. The GP thought she was constipated and prescribed a laxative. Ms C then went on holiday where she participated in various activities. She returned to the practice and it was then diagnosed that she was pregnant. The practice apologised for the missed diagnosis of pregnancy, but said that the GPs had dealt with the symptoms that she reported and had focused on the history of bloating and constipation. They also said that Ms C's complaint would be included in the appraisal folder and discussed at appraisals later in the year, where lessons learned are shared with colleagues. We obtained independent advice on the complaint from one of our medical advisers, who considered Ms C's medical records in detail. Their advice was that the actions of the GPs were appropriate, although the diagnosis of pregnancy was missed. In such cases, as long as the clinicians involved took reasonable action based on the symptoms that were presented, we have no grounds to criticise their actions. Our adviser had no concerns about the GP's actions and prescription, and noted that the GP had told Ms C to return for re-evaluation if the symptoms did not settle. Related reading View Decision Report 201204022 as a PDF (11.3 KB) Updated: March 13, 2018

Mr C complained about the care and treatment provided to his late mother (Mrs A) by her medical practice. He also complained that they failed to refer her to hospital for definitive diagnosis. Mrs A had been living in a care home. She was examined by a doctor from the out-of-hours service in the early hours of the morning. He recorded that there were signs that she had vomited blood and that her abdomen was soft and 'non-tender'. He recorded that his diagnosis was gastritis and that the care home should observe Mrs A. Mrs A was seen by a GP from the practice later that day. The GP considered that she had melaena (passing blood in the stool), haematemesis (vomiting blood) and an upper digestive tract bleed. He did blood tests and stopped some of her medication. He also prescribed omeprazole (medication used to reduce the amount of acid produced in the stomach). Mrs A was examined by the practice on a number of occasions over the next few weeks and was admitted to hospital three weeks after the first GP had examined her. Mrs A died of a small bowel obstruction in the hospital nine days later. The practice GP who examined Mrs A decided to keep her at the care home and carry out non-invasive investigations, and to adapt her medication. After taking independent advice from one of our medical advisers, we considered that this was reasonable. Mrs A was bleeding from the digestive tract, and there was no evidence to suggest that she had a small bowel obstruction at that time. Our adviser said that even if she had been admitted to hospital earlier, the decision not to carry out invasive procedures would still likely have been made, given her overall frailty and general poor health. There would also have been no benefit in admitting Mrs A to hospital as an emergency, when there were nursing staff in the care home who could monitor her condition. We found that the practice's management of Mrs A's care and treatment was reasonable and there were no failings in t

Mrs C's late mother (Mrs A) was prescribed methotrexate (a disease-modifying anti-rheumatic drug) from October 2008 for rheumatoid arthritis. She was monitored on a four-weekly basis, her GP practice took blood tests and she was seen regularly by the rheumatoid clinic at the hospital. In April 2012, however, Mrs A was admitted to hospital where she was diagnosed with pancreatic cancer. She died the following month. Mrs C complained that her mother should have been taken off the medication because her immune system started to deteriorate and because she had a sore stomach around mid-2011. She also complained that the practice failed to reasonably treat her mother's stomach pain, which Mrs C believed was an indicator that her mother had pancreatic cancer. Finally, Mrs C said that in October 2011 a blood test was carried out showing high levels of inflammation, which she believed indicated cancer, but the practice then failed to carry out any further tests. After taking independent advice from one of our medical advisers, we found that the practice had properly monitored Mrs A while she was prescribed methotrexate. Moreover, there were no specific entries in Mrs A's medical records in 2011 showing that she attended the practice complaining of a sore stomach. We were, therefore, satisfied that there was no evidence that the care and treatment Mrs A received fell below a reasonable standard. Related reading View Decision Report 201203106 as a PDF (11.4 KB) Updated: March 13, 2018

When Mr and Ms C's young daughter became ill, they took her to their medical practice. She was examined by a GP, who said that she was suffering from a yeast infection and nappy rash. Later that day Mr and Ms C's daughter’s condition deteriorated and she was taken to hospital, where she was diagnosed with scarlet fever. Mr and Ms C complained to the practice that the GP did not diagnose their daughter correctly. The practice responded but Mr and Ms C felt that the response was inaccurate and did not deal with the complaint. As part of our investigation, we took independent advice from a medical adviser. He explained that the diagnosis of scarlet fever is rare, and that there was evidence that the GP had taken appropriate steps to diagnose Mr and Mrs C's daughter's condition. Taking this into account we did not uphold the complaint. When investigating the complaint about the practice's complaints handling, we looked at the practice's complaints procedure and response. We found that the practice had not followed their complaints process. We also found that the GP had not written detailed medical notes which meant that the practice's response was incomplete. We, therefore, upheld this complaint and made recommendations to address these failings.

Mr C complained that his medical practice failed to provide appropriate care and treatment when he had an eye infection and unreasonably refused to allow him to see a GP. Mr C developed an eye infection, and called his practice on a Friday to request an appointment. He was told that there were no appointments available and that he should call again on Monday. By Monday his eyes had not improved, and he contacted NHS 24 (a national phone helpline service for advice on health matters). They advised him to see his GP. His workplace occupational health team also advised him not to work, and to see his GP. When Mr C contacted the practice again, he was told that when he first called he should have been referred to the LENS service (a service set up by the regional NHS board, providing direct access to treatment for minor eye conditions). The receptionist he spoke to on this occasion apologised that he was not told this when he first called, and advised him to contact a local optician, a participant in the LENS scheme. Mr C was treated with various eye drops but his condition was slow to resolve. He contacted the practice several times over the next two weeks asking to see a GP. Although he twice saw a nurse from the practice, he was never able to see a GP. As he was unable to see a GP, Mr C continued with the treatment provided by the LENS service and was discharged the next month with the infection resolved. Our investigation, which included taking independent advice from a medical adviser, concluded that it was reasonable that Mr C should have been referred to and treated by the LENS service. We, therefore, did not uphold the complaint about his initial treatment. The adviser said that the care and treatment provided by the service was reasonable and appropriate, and would not have been different from the treatment provided by a GP. However, we did find that when his condition was slow to resolve, it was unreasonable that Mr C was not given the opportunity

Mrs C complained about the care given to her mother (Mrs A) by the practice GPs. Mrs A had rheumatoid arthritis (an inflammatory condition that mainly affects flexible joints) and osteoporosis (a condition that affects the bones, causing them to become fragile and more likely to break). She injured her ankle, which caused her severe pain, and she could not put weight on her foot. Mrs A's medical practice did not arrange for this to be x-rayed, and it was some time later that an out-of-hours doctor sent her for an x-ray, which identified a fractured tibia (shin bone) and fibula (bone on the outside of the lower leg). Mrs C complained that the practice unreasonably failed to arrange for Mrs A to be x-rayed. Our investigation found that, over a two week period after the injury, the GPs twice visited Mrs A at home as well as having a phone consultation, yet did not arrange an x-ray. They instead diagnosed a flare up of arthritis and prescribed pain relief, with increased dosages when the pain did not subside (and indeed worsened). We found that the GPs should have arranged for an x-ray to be taken, particularly as Mrs A had osteoporosis and taking into account her age, frailty and the fact that she could not put weight on her foot. We also upheld the complaint that a phone consultation was inappropriate after the two home visits. We found that further action should have been taken at this time and that the decision to simply increase pain medication during a phone consultation was unreasonable.

Mrs C complained that her late husband Mr A (who had terminal cancer), had suffered during his illness up to his death. Mrs C stated that in her view, she could not believe so many things had gone wrong with the care and treatment Mr A had received from the practice over 17 months. These issues were a failure to follow up Mr A’s admission to a hospital in the board’s area after the hospital had discharged him; that a practice GP had provided incorrect information about Mr A during a home visit and that the practice failed to follow the appropriate processes and procedures when completing the Do Not Resuscitate Form (the DNR). Our adviser considered all aspects of Mrs C’s complaint and said that Mr A had lung cancer and that it was the responsibility of the hospital clinician that arranged Mr A’s investigation to follow up and act on the results, not the practice. Our adviser stated that a practice doctor had provided incorrect information during a home visit; however, the practice doctor had speedily corrected this and apologised. The adviser stated that the DNR Form (as part of end-of-life care), assists with the management of terminally ill people and compliments the expertise of those using it. We took account of the adviser’s advice and considered that the practice had followed the correct DNR procedures. Mrs C’s complaint was partially upheld.

Mr C suffers from a number of painful conditions. He takes codeine (a pain relief drug) to manage the pain, but it causes severe constipation. He was prescribed Orlistat (a weight-loss drug) by his GP some years ago to help him reduce and maintain a steady weight. Mr C found that the drug also relieved his constipation. When reviewing Mr C's medication, however, his GP felt that it was no longer appropriate to continue to prescribe this. Mr C was referred several months later to a pain clinic for pain management and to explore alternatives to codeine, and to a dietician about his weight problem. However, he continues to suffer from weight gain and constipation and maintains that the benefits of taking Orlistat outweigh the risks of both that medication and the alternatives. He complained to us that the decision to stop prescribing it was unreasonable. After taking advice from one of our medical advisers, we did not uphold Mr C's complaint. We found that the GP's decision was reasonable as Mr C had not lost weight since early 2009, and the medication is not licensed for use as a laxative. We also found that the decision followed the health board's guidelines on its use. Related reading View Decision Report 201200022 as a PDF (11.26 KB) Updated: March 13, 2018

Mr C was unhappy about the poor service he said he received from his medical practice, in particular the long wait for an appointment. He also said the practice had failed to advise him of the appointment procedure when he and his wife joined the practice and that their complaints procedure was not fit for purpose. We found that the practice did operate an appropriate appointments procedure which complied with the guidance set out by Health Rights Information Scotland. We also found no evidence to suggest that the practice had failed to advise Mr C about the appointments procedure when he joined. Our investigation of Mr C's complaint showed that the practice's complaints procedure was accessible and fit for purpose. Related reading View Decision Report 201104528 as a PDF (16.53 KB) Updated: March 13, 2018