SPSO Individual Decisions

Mr C, who works for an advice agency, complained to the medical practice on behalf of his client (Mr A) who suffered from lower back and leg pain. Mr A said that there had been a delay by the practice in referring him for a MRI scan (magnetic resonance imaging - a scan used to diagnose health conditions that affect organs, tissue and bone) and it did not appear that they had followed the correct referral process and that had contributed to the delay. It was only after an appointment with a private physiotherapist that a MRI scan was arranged. We took independent advice from a GP adviser and concluded that the practice had made appropriate referrals for specialist opinions from physiotherapy and orthopaedics and that initially there were no indications that, from a clinical perspective, a MRI scan was appropriate. By the time Mr A had seen the private physiotherapist, the clinical situation had deteriorated and at that time it was then appropriate to make a referral for an MRI scan. We did not uphold the complaint. Related reading View Decision Report 201502370 as a PDF (11.11 KB) Updated: March 13, 2018

Mrs C, who is an advocacy worker, complained on behalf of her client (Mrs B). Mrs B said that her mother (Mrs A) was left without proper care and support from her local medical practice. She said that they failed to recognise the seriousness of Mrs A's condition and she died as a consequence. We took independent advice from a medical adviser who is a GP. We found that Mrs A had very complex medical problems. She had severe artery disease and had already had a leg amputated above the knee. She also had severe heart disease. Mrs A was being cared for in the community. When the practice were alerted to the fact that she had a small necrotic area (a patch of dead tissue) on her leg stump which had been there for three to four weeks, a GP assessed Mrs A at home and decided that she be reviewed urgently. A day later, the practice were advised that the affected area was deteriorating. Contact was attempted with both Mrs A and the warden of her accommodation but this proved impossible as neither answered the phone. A home visit was then arranged for the next day. Meanwhile, Mrs A was taken into hospital where she died a few days later. We did not uphold the complaint as we were satisfied that the practice had taken all reasonable action in the circumstances. Related reading View Decision Report 201502051 as a PDF (11.28 KB) Updated: March 13, 2018

Mrs C complained about the treatment her mother (Mrs A) received from the practice. Mrs A had been unwell with cold/flu-like symptoms and a sore chest. She was prescribed antibiotics and advised to return if there was no improvement so that a chest x-ray could be arranged. Mrs A returned a few days later as she was still unwell. No shortness of breath or chest pain was noted and Mrs A was sent for a chest x-ray. The next day, Mrs A requested a home visit but was asked to attend at the practice following a phone conversation with a doctor. During the consultation, Mrs A collapsed. Cardiopulmonary resuscitation (CPR) was started and an ambulance was called but Mrs A died. Later, the family had difficulties in arranging a time to speak with a doctor about what had happened. Mrs C complained about the clinical treatment that was provided as she considered there was a failure to diagnose Mrs A's heart attack or take appropriate action. She also complained that the practice had failed to communicate adequately following Mrs A's death. After taking independent advice from one of our medical advisers, who is a GP, we did not uphold Mrs C's complaint about the treatment provided. The adviser considered that the standard of care provided to Mrs A was reasonable and that practice staff had tried to resuscitate her to the best of their ability. We found that there is no formal requirement for practices to have a defibrillator available and that defibrillation would not have saved Mrs A's life. However, we did make a recommendation that the practice consider obtaining a defibrillator. We found the practice had acknowledged failings in their communication with the family and had apologised for this. We noted that their protocol had been updated to prevent a recurrence of such an error in future. We upheld this element of Mrs C's complaint, but in light of the action already taken by the practice, we did not make any recommendations about this.

Mrs C complained on behalf of her mother (Mrs A). Mrs A had been diagnosed late with Hodgkin lymphoma (a type of cancer of the lymphatic system, a network of vessels and glands throughout the body). Mrs C believed that the practice had failed to spot clear symptoms of the disease over an extended period. We took independent advice from a medical adviser who is a GP. The adviser reviewed Mrs A's medical records in detail. They noted that some of the tests Mrs C believed should have been performed could only be requested by a specialist following review in hospital. The adviser stated that Mrs A had not presented with typical symptoms of Hodgkin lymphoma and her existing medical conditions had made her diagnosis more complex. Mrs A had not met the criteria for referral under Scottish cancer referral guidelines and had been referred urgently for investigation by the practice on several occasions. We found that the practice had provided a reasonable standard of care and treatment to Mrs A. We found there was no evidence that symptoms of Hodgkin lymphoma had been overlooked, or that referrals should have been made sooner. Related reading View Decision Report 201501734 as a PDF (11.18 KB) Updated: March 13, 2018

Mr C visited the practice about his cough. He was referred for an x-ray, which took place the following day. Mr C contacted the practice three times for the results and was told that they had not arrived. Mr C's symptoms worsened and he was admitted to hospital with pneumonia and heart failure. Mr C complained that the practice did not have adequate procedures in place to identify that his x-ray report was missing. Normally, a paper copy of the x-ray report would be sent to the practice and uploaded to the practice's information management system. In this case, for reasons we were unable to establish, the report was not uploaded. This suggests the report may not have been received. The GP at the practice was able to access the report through the hospital's computer system when they realised that the report had not been received. However, the GP was only prompted to do this after receiving notification of Mr C's hospitalisation. The practice apologised to Mr C and explained that there was a gap in their protocols for occasions when information was not received in the normal way. They explained that they had updated their protocols for dealing with patient phone calls regarding x-ray results. The new protocol meant that, if a patient contacted the practice three weeks or more after an x-ray for which no report had been received, reception staff would advise the GP who requested the x-ray. The GP would then check for the report on the hospital's computer system. The practice were also piloting a new process to keep copies of x-ray requests with the aim of ensuring the practice followed up on any results not received after four weeks. We took independent advice from a GP adviser. We found that the practice did not have adequate procedures in place to identify that Mr C's x-ray report was missing and so we upheld his complaint. We recognised that the practice had apologised and made changes to their protocols to prevent a recurrence, and we felt that there

Mrs C complained on behalf of her sister (Miss A) about care received from her GP practice on two occasions. Mrs C complained that the practice did not thoroughly investigate Miss A's symptoms and did not provide reasonable treatment. We took independent advice from a medical adviser. The adviser said that, based on the consultation notes, the care Miss A received was of a reasonable standard, and we did not uphold the complaint. Related reading View Decision Report 201502550 as a PDF (10.8 KB) Updated: March 13, 2018

Ms C complained that a GP and a nurse had acted unreasonably by failing to provide treatment to remove ear wax. Ms C had attended the practice on three occasions with compacted wax. Initially, her ears were not syringed as it was suspected she may have had an infection. On the third occasion, she was referred to a community-based NHS treatment area for ear irrigation, however, there were no appointments available in the following month. We sought independent advice from one of our nursing advisers. Our adviser found that the evidence indicated that the care and treatment was reasonable and in keeping with best practice. We did not uphold the complaint. Ms C also complained about the way the practice had handled her complaint. Specifically, she was unhappy that there had been a delay in responding to her complaint, and that the response she received to a 16-page letter was inadequate. Ms C sent two letters - the first was responded to within 20 working days. The second (which raised some new issues) took three months to respond to. We recommended that the practice apologise to Ms C for the delay in responding to her second letter. Following careful review of the practice's response to Ms C's 16-page letter, we concluded that the response was appropriate and adequate. We considered that the overall handling of the complaint was reasonable and, therefore, we did not uphold the complaint. However, as the practice's complaints handling procedure was not in line with Scottish Government guidance, we made a recommendation to address this. Ms C also complained that a member of reception staff failed to tell the truth about what had happened when Ms C returned to the practice after visiting the NHS treatment area. She was also unhappy that the receptionist discussed confidential information in the waiting room in front of other patients. There was no objective evidence to support Ms C's version of events and, therefore, we could not uphold the complaint. We w

Miss C complained to her mother (Mrs A)'s medical practice about how they dealt with Mrs A in the last two days of her life. Miss C then complained to us that a GP failed to diagnose and treat Mrs A's condition; that reception staff wrongly referred her mother to NHS 24 rather than arranging for a house call from a GP; and about the practice's handling of her complaint. We looked at the practice's file on Miss C's complaint and at Mrs A's medical records, and we took independent advice from one of our GP advisers. We found that Mrs A had a number of risk factors for a heart condition, and we decided that the GP should have taken these into account by reviewing Mrs A's blood pressure and pulse, given the possibility of a heart-related cause for her symptoms. We concluded that the assessment and treatment provided by the GP was not of a reasonable standard. We also concluded, on the balance of the available evidence, that reception staff were wrong to refer Mrs A to NHS 24, rather than offering an emergency appointment at the practice or a home visit from the on-call GP. We also found that the practice's handling of Miss C's complaint was not in keeping with the principles set out in the national NHS complaints handling guidance. We upheld Miss C's complaints.

Ms C complained that when she first registered with her new GP she had difficulty in getting an appointment. When she first saw a GP, two weeks after joining the medical practice, she was refused a prescription for regular medication for various conditions as her medical notes had not yet been transferred from her old practice. Ms C also complained that she was removed from the practice list for alleged abusive behaviour, and that the practice failed to deal with her subsequent complaints. We took independent advice from one of our GP advisers. They told us that records can sometimes take up to 12 weeks to be transferred between NHS practices when a patient changes GP. Therefore, it is common practice for basic information, including details of repeat medications, to be faxed over to the new practice to prevent any delays in prescriptions being issued. The adviser was particularly concerned that Ms C was on medication that can have serious withdrawal symptoms if stopped suddenly. We upheld this aspect of Ms C's complaint. On the issue of Ms C being removed from the practice list, there was evidence that the staff at the practice found Ms C's behaviour, at times, to be unacceptable. While there does not have to be any intention to behave in an unacceptable way by the patient, where a GP considers that a patient's behaviour is unacceptable, they have the right to ask for that patient to be removed from their list. We did not uphold this aspect of Ms C's complaint. In relation to the handling of the complaint, Ms C said that she had hand-delivered four letters of complaint between October and December 2014 but the practice said they had no record of the letters being received by any staff member. Following contact with our office, the letters were copied to the practice and were dealt with within the timescales laid down by the NHS guidance on complaints handling. We did not uphold this aspect of Ms C's complaint.

Ms C complained that her medical practice unreasonably continued to prescribe a medication to her for significantly longer than they should have. She felt the practice should have informed her about the updated guidance on this medication, and she was also concerned that they had unreasonably failed to note that she was receiving double prescriptions. We obtained independent advice from a GP adviser, who said that prescribing this medication long-term was appropriate for Ms C's condition, although this medication was not recommended for long-term use for other conditions. We found that the practice acted reasonably in prescribing this medication for Ms C. We also noted that Ms C's prescribing had been regularly reviewed in line with the relevant guidance. We noted that, for a period, Ms C was obtaining a double prescription but, when this was brought to the attention of the practice, they correctly stopped the repeat prescription, and placed her on a fortnightly acute prescription. As we were satisfied with the practice's actions in this case, we did not uphold the complaint. Related reading View Decision Report 201405375 as a PDF (11.11 KB) Updated: March 13, 2018

Mr C raised numerous concerns about the way that the practice dealt with an incident when he attended the practice. There was a difference of opinion between Mr C and the staff about what had occurred. Mr C subsequently had a meeting with the practice to discuss his concerns and he was accompanied by an independent witness. Mr C complained to this office that the practice had failed to provide a note of the meeting or provide specific information relevant to the practice's investigation into his complaint. In particular, he wanted to know whether the practice staff had been spoken to prior to the practice contacting the Medical and Dental Defence Union of Scotland (MDDUS) for advice. We found that although the practice were trying to be helpful in arranging the meeting, they did not provide all the information which was requested. This appeared to be the result of a misunderstanding by the practice staff. The information would have assisted Mr C in determining whether he was going to consider further action in an effort to resolve his concerns. We also found that the practice had failed to include our contact details in their final letter of response which is a requirement under the NHS complaints procedure. We upheld Mr C's complaints.

Mrs C's husband (Mr C) had previously suffered from a brain tumour and had a craniotomy (surgery to remove the tumour). However, his symptoms returned about a year later, and he was diagnosed with another brain tumour. Mr C had another craniotomy, followed by six weeks of radiotherapy. Mr C died a few days after his radiotherapy. Mrs C raised concerns about the delay in diagnosing Mr C's second tumour, as well as the level of support provided during his radiotherapy treatment. Mrs C was dissatisfied that the GP did not arrange admission to hospital during Mr C's radiotherapy (although she asked about this); that the GP did not arrange district nurses or a care plan for Mr C, or carry out more home visits; and that the GP did not manage Mr C's medication appropriately, or provide reasonable care for his diabetes. Mrs C also raised concerns about the practice's communication. She said the GP never told her or Mr C that his condition was terminal, and refused to answer when she asked how much time Mr C had left to live. She was also unhappy that the GP told her it would be fine to go to work the next day when she asked about this, and Mr C died that day. The practice apologised to Mrs C for several aspects of their care, including not being more proactive about contacting the hospital on Mrs C's behalf, and for advising that it would be fine for Mrs C to go to work on the day Mr C died. In relation to district nurses, the practice said they had offered this, but Mr C had declined. The practice undertook a significant event analysis, and identified steps to improve their communication about palliative care in the future. After taking independent medical advice, we upheld one of Mrs C's complaints. Although most aspects of the practice's care and treatment were reasonable, we found the GPs failed to take action in response to a letter from the oncologists suggesting medication to help manage Mr C's aggression, and this was unreasonable. We also found the GP us

Mr C, an advice worker, complained on behalf of his client (Mr A) who had injured his back at home while breaking wood. Mr A was seen at the practice and complained of pain, pins and needles, and numbness. Mr A asked for an MRI scan (magnetic resonance imaging scan), but was referred for an x-ray which raised no concerns. He continued to experience severe pain and numbness in his legs. Following further consultations at the practice he was advised to attend the local A&E department. He was admitted to hospital and diagnosed with a compressed disc which required surgery. Mr C complained that the practice had ignored serious red flag symptoms of spinal injury on three occasions and considered that Mr A should have been referred for an MRI scan. We took independent medical advice from one of our GP advisers, and found that the practice would not have been able to refer directly for an MRI scan. However, the GPs at the practice followed the wrong diagnostic pathway and, as such, failed to identify three red flag symptoms. We concluded that, had the correct pathway been followed, Mr A would have been referred urgently to a specialist.

Mrs C complained about the delay in diagnosing her late husband (Mr C)'s cancer. Mr C suffered intermittent left-sided pain after a fall and attended the practice on numerous occasions over the next two years. Although Mr C had a number of tests and investigations, he was not diagnosed with cancer until a scan over two years after the fall. The practice apologised that it took so long to diagnose Mr C's cancer, but explained that his case was a challenging one and diagnosis was difficult. They said Mr C did not have symptoms suggesting a serious underlying problem until about two years after his fall, and also did not start losing weight until after this. While they immediately referred Mr C to the colorectal service (specialising in the colon and rectum), it took three specialist referrals (two to the colorectal service and one to the gastroenterology clinic (specialising in the digestive system) before Mr C's cancer was diagnosed about five months later. After taking independent medical advice, we did not uphold Mrs C's complaint. We found that Mr C's symptoms did not suggest a serious underlying problem until about two years after his fall. We found the practice then acted appropriately and timeously in referring Mr C to specialists for investigations. Our adviser explained that Mr C's symptoms first suggested an underlying colorectal problem, and it was appropriate to refer Mr C for colorectal investigations and a colorectal clinic review. However, when nothing was found but Mr C's problems persisted and he experienced ongoing weight loss, the practice acted appropriately in referring him to the gastroenterology clinic. Related reading View Decision Report 201405761 as a PDF (11.37 KB) Updated: March 13, 2018

Ms C complained her medical practice had failed to properly diagnose her pelvic infection, resulting in a long stay in hospital and an inability to have children. Ms C said her symptoms had not been properly investigated by the practice and that she had not been properly referred when the practice was unable to identify the cause of her problems. We took independent advice from one of our medical advisers. The adviser said that Ms C had presented with complex symptoms, from which a clear diagnosis could not be provided. The adviser said that the care and treatment Ms C had received had been appropriate and that the practice had responded reasonably to her reported symptoms, including referring her appropriately to specialists for examination. Our investigation found Ms C had received a reasonable and appropriate standard of care and treatment from the practice. Related reading View Decision Report 201403584 as a PDF (11.01 KB) Updated: March 13, 2018

Mr C, who is an advocate, complained on behalf of his client (Mrs A) about the care and treatment provided to Mrs A's late husband (Mr A) by his medical practice. Mr A had a history of chronic obstructive pulmonary disease (COPD, a disease of the lungs in which the airways become narrowed). Mr A called the practice and during the phone consultation reported having strained a muscle. The practice advised Mr A to take painkillers and prescribed him co-codamol (a painkiller formed of a mixture of paracetamol and codeine). They told him to contact them again if the condition got worse. Three days later Mr A attended the practice. The GP examined him and considered the possibility of a lung infection, however, decided it was more likely to be muscle strain and prescribed a stronger pain killer. Later that day Mr A was taken into hospital and died three days later from pneumonia (a serious lung infection). Mr C complained that Mr A's condition was not assessed properly by the GP. Mrs A also raised specific concerns that at Mr A's COPD review the practice did not have a pulse oximeter (an instrument used to measure oxygen levels in the blood). Mrs A also raised concerns that Mr A was prescribed co-codamol and that this medication is not recommended for patients with COPD. When Mr C complained to the practice the GP who had examined Mr A responded to the complaint and Mrs A and Mr C said this was not impartial. During our investigation we sought independent advice from one of our GP advisers. The adviser was satisfied that when Mr A attended the practice his symptoms were indicative of muscle strain and that the GP's actions were reasonable. The adviser was also satisfied that co-codamol is an appropriate painkiller to prescribe to patients with COPD as long as the prescriber is aware of the patient's COPD condition, as they were in this case. The practice told us that they are a small practice of only one GP. As the complaint related to clinical matters, the c

Ms C had been referred to a hospital specialist by the practice as she had reported having blood in her sputum (spit). She was told that she had developed terminal cancer. Ms C complained to the practice that she had reported the same symptoms to them for a number of years and that they had only prescribed antibiotics for a burst blood vessel in her throat. We took independent advice from a GP adviser and found that Ms C had a long history of chronic blood streaked throughout her sputum and that it had previously been investigated by specialists. The presumed diagnosis was inflammation of Ms C's pharynx (back of throat) aggravated by a chronic cough. The plan was that further investigations were not required unless there was a significant change in her symptoms or that new symptoms had developed. When a GP arranged a further x-ray for a possible diagnosis of lower respiratory infection, it was noted that Ms C had a lesion in her chest which was not present in a previous x-ray. This resulted in a further referral for specialist investigations and it was then discovered that Ms C had a lung tumour. There was no evidence to suggest that there had been a previous significant change in Ms C's symptoms which the practice had not taken action on and, when it became clear that the situation had altered, timely and appropriate action was taken in order to reach a definitive diagnosis. We did not uphold the complaint. Related reading View Decision Report 201406209 as a PDF (11.31 KB) Updated: March 13, 2018

Ms C said that when she changed her medical practice she had to see the practice nurse before she could be seen by a doctor. She said that this registration procedure created delays in her seeing a doctor. She also said that there were obstacles to accessing the medication she needed, and that other medications she was given put her at significant harm because they were contraindicated (should not be given) with drugs she was already taking for her complex health problems. Ms C was also unhappy because she said she had been blamed for an act of vandalism to the practice's premises and information about this had been added to her medical records. She complained about the way in which the practice dealt with her complaints about these matters. We took independent medical advice from one of our medical advisers, who confirmed that it was not a requirement of the General Medical Council contract for a patient to have a medical with a practice nurse before seeing a doctor, as this could lead to delay in prescribing or seeing a doctor. This was what happened in Ms C's case. When Ms C did see a doctor her initial prescription requests were dealt with appropriately but subsequently there was evidence that she was over-prescribed medication without being properly assessed or reviewed. Finally, the investigation showed that non-medical information had been added to Ms C's records inappropriately and that the practice had not handled her complaint in accordance with required timescales. We upheld all of Ms C’s complaints, except that about the medicines she was prescribed, as we found no evidence that any of these was contraindicated.

Mrs C contacted her medical practice to get the flu vaccine for her young son. The practice provided an appointment three weeks away, but Mrs C asked if an earlier appointment would be available as her son had some outstanding health conditions. The practice said there was no urgency for the appointment so an earlier appointment was not offered. Mrs C complained that the practice had not considered her son's individual health conditions, as they should have. She also complained that they had unreasonably told her she could leave the practice and did not respond to her complaint reasonably. We took independent advice from one of our medical advisers. The adviser was satisfied that Mrs C's son did not exhibit any of the conditions which would qualify him as a priority patient to get the flu vaccine. For this reason, we did not uphold this complaint. We also could not establish from the evidence available, the context in which the option to leave the practice was brought up and did not uphold this complaint. While we decided the practice had, on balance, reasonably responded to the complaint we did note areas for improvement and made a recommendation to address this.

Mr C's late father (Mr A) attended the medical practice and was seen by a GP who said that he had flu. He went back two days later because he had got worse, and was prescribed antibiotics. The GP told Mr A that if he did not improve he wanted to see him again and would arrange a chest x-ray. Mr A was also told that he not to go back to work. The following day Mr C's brother visited Mr A and, given his condition, took him to the A&E department of the local hospital. He was admitted and a significant infection or inflammation was diagnosed, the cause of which was unclear at that stage. Later test results suggested that Mr A had bacterial endocarditis (an infection affecting the tissues that line the inside of the heart chambers). Mr A was in hospital for five weeks and was diagnosed with heart valve leakage, which needed surgery. Mr A was then transferred to another hospital where he died shortly after. Mr C felt that the GP's treatment of his father was unreasonable and might have contributed to his death. We took independent advice from one of our medical advisers, who said that bacterial endocarditis is extremely rare, and most GPs will not diagnose it during their working lives. Accordingly, our adviser would not have expected the GP to diagnose this. They said that that the role of a GP in a patient with a flu-like illness is to take sufficient history and carry out a sufficient examination to exclude the likelihood of a cause other than a viral respiratory tract infection. We found that there were clear failings in how the GP recorded his consultations with Mr A, which made it impossible to say that the clinical history taken and the examination of Mr A were sufficient. While the GP said he had examined Mr A, the evidence from the medical records did not establish this. Our adviser said that the GP's actions did not meet the standards of good medical practice, in accordance with General Medical Council (GMC) guidance, so we upheld Mr C's complaint a

Mrs C, who is an advice worker, complained on behalf of her client (Mr A) that his medical practice had failed to properly assess his symptoms and provide him with further tests to determine his increased risk of stroke. Mr A had attended the practice on a number of occasions with various symptoms. There was a history of heart and circulatory disease in his family and he was concerned that he had had a stroke. We obtained independent medical advice on the complaint from one of our medical advisers. Although Mr A did subsequently have a stroke, the advice we received was that the symptoms with which he had presented to the practice did not suggest that he had suffered a stroke at that time. The adviser said that his symptoms were reasonably explained by other, more likely, diagnoses. Although we found that Mr A's concerns had not been fully addressed, the practice properly assessed the symptoms he presented with and arranged the appropriate tests. We found that they had acted reasonably and did not uphold this aspect of the complaint. Mrs C told us that Mr A later did have a stroke and phoned the practice as soon as he realised what had happened. The practice recorded that he said that he was struggling to hold a cup in his left arm and was now having to drag his leg. They recorded that there was no mention of his arm being affected in the previous notes and that he might have suffered a stroke. They arranged an appointment for him later that day. However, Mr A instead went to hospital and was admitted to the stroke unit. We found that, based on the record of the phone discussion with Mr A, the correct course of action in line with relevant national guidance would have been for the practice to phone a blue light ambulance to take him to hospital. If the practice considered that there were good reasons for not doing so, at the very least, they should have recorded the reasons and arranged to examine Mr A immediately. The action they took was not appropria

Mrs C complained on behalf of her daughter (Ms A) that a medical practice would not register Ms A because she did not attend a new patient medical consultation. Mrs C also complained that the practice manager did not return Ms A's phone calls when she was trying to explain why she missed the consultation. We found that the practice's policy at the time was to refuse registration to people who failed to attend for a new patient medical consultation. However, two months later, the health board wrote to all practices in their area to clarify the regulations for registration. In their letter to us, the practice acknowledged that their policy and their actions were incorrect when they did not register Ms A. The regulations for registration, set out in The National Health Service (General Medical Services Contracts) Regulations 2004, say that new patients shall be invited to a consultation, but do not say that attendance is mandatory. The regulations also say that registration could only be refused on reasonable grounds, which did not appear to include failure to attend a new patient medical consultation. The practice also explained that the practice manager did not return Ms A's phone calls because there was a breakdown in communication. They said they would apologise to Ms A, and explained to us what they had done to address all these failures, including carrying out a significant event analysis to understand what had gone wrong and how they could improve.

Mrs C complained that a GP at her medical practice failed to deal with her mental health problems in an appropriate manner. She said that over a two-year period they failed to provide her with a reasonable service for her mental health problems and refer her for specialist support. Mrs C said she asked the GP to refer her to a psychiatrist on a number of occasions and that her counsellor had also made a request for this on her behalf, but no referral was made. Mrs C also complained about how the GP handled the reduction of her sleep medication. We took independent advice from one of our medical advisers, who is also a GP. We found no evidence that the GP failed to consider Mrs C's requests for referral for specialist support, or failed to refer Mrs C to a psychiatrist in response to her counsellor's request. However, the evidence showed that the practice were copied into a letter from a consultant psychiatrist to Mrs C's counsellor indicating that an appointment would be arranged for Mrs C in the 'near future'. Our adviser said that as the GP continued to see Mrs C for over a year after the letter was sent, and as Mrs C was still having mental health problems and no appointment with the psychiatrist had been forthcoming, it would have been reasonable for the GP to have enquired about this. Our adviser also expressed some concerns about the tone and content of the GP's letter in response to Mrs C's complaint. We were particularly concerned that they referred to Mrs C in the letter as 'patient', which was inappropriate. We were also concerned that the GP took nearly two months to respond to the complaint and that no updates appeared to be sent to her during this time. On the matter of the sleep medication, it was clear that the guidance in this area was that such medication should be for short-term use and that the doctor was correct to explore the reduction in Mrs C's dosage. On balance, however, we upheld Mrs C's complaint as we concluded that the GP failed

Mrs C wrote to the practice to complain about her medical records. She thought there were a number of inconsistencies between the two copies of the records she had, which she said showed that her notes appeared to have been rewritten or that information had been re-entered by the practice at some point. Mrs C also referred to the coded acronym 'DNR' which she believed related to not resuscitating her and meant that she had at some point been identified for palliative care (care provided solely to prevent or relieve suffering). The practice responded explaining that Mrs C's medical notes had not been altered and a resuscitation-related code had never been entered into her records. Mrs C complained to us that the practice unreasonably failed to respond to her complaint about information held in her medical notes, particularly the use of the abbreviation DNR. After taking independent advice from one of our medical advisers on the clinical aspects of Mrs C's complaint, we found that the practice's explanations were reasonable. We also found no evidence that Mrs C's medical notes were purposely altered, and we did not uphold Mrs C's complaint. Related reading View Decision Report 201401247 as a PDF (11.16 KB) Updated: March 13, 2018

Mrs C said that when she was a patient at the practice, the acronym DNR appeared in her medical records. She said she was told by a medical professional this meant 'do not resuscitate'. She was extremely upset about this and wrote to the practice asking for an explanation. The practice said that the acronym referred to 'diabetic nurse review' and that they used the abbreviation DNAR for 'do not attempt resuscitation', rather than DNR. Mrs C complained that this explanation did not make sense in the context of her medical records. After taking independent advice from one of our medical advisers, we found that the practice's explanation was accurate and that they had responded to Mrs C's complaint in a reasonable way. Related reading View Decision Report 201401248 as a PDF (10.93 KB) Updated: March 13, 2018