SPSO Individual Decisions

C complained about the standard of medical care and treatment provided by the practice and about the way that they handled C's complaint. C attended the practice with symptoms of rectal bleeding, a change in bowel habit and abdominal pain. The practice made a routine referral to hospital but did not carry out a rectal examination. C was later diagnosed with bowel cancer. C felt that there was an unreasonable delay in diagnosing and treating their cancer. We took independent advice from a GP. We found that C's referral to hospital should have been marked as urgent given their symptoms and a rectal examination undertaken. We also found that information about C’s family history was not recorded correctly. Therefore, we upheld this part of C's complaint. However, we noted that it was unlikely that these failings would have had any impact on the treatment options or outcome for C. C also complained that the practice failed to handle their complaint reasonably. We found that the practice failed to reflect on the failings in their response to C. We upheld this part of C's complaint.

C complained that the practice failed to handle their telephone call reasonably. C called the practice while being discharged from hospital to speak to a GP about an urgent review of their GP prescribed medication. In particular, regarding the safe discontinuation of pregabalin (an anti-epileptic drug that can also be used to treat nerve pain and anxiety) following surgery. We found that the call did not address C’s concern that C needed advice about how to safely discontinue GP prescribed medication. C was also not told that further fit notes could be accessed by requesting one through the practice website or that they needed to wait until they had received a discharge letter so that the pharmacy team and the GP had the correct information. C was not informed that they could call for a same day triage appointment on their discharge from hospital. Although C was offered a routine appointment which is consistent with the practice’s policy on GP access, C was not given the chance to say whether they wanted to accept this before the call was terminated by the practice. We found that no offer was made to send a message to a GP informing them of the problem, to be actioned by the GP as and when appropriate. No explanation was provided to C about why their request to speak to the Practice Manager was refused and no consideration was given to requesting someone else (such as the Team Leader) to call C back. Therefore, we upheld this part of C’s complaint. C also complained that the practice failed to handle their complaint reasonably. We found that the complaint response did not address all the issues that C raised. The response also made statements about what C was told that were not supported by the recording of the telephone call to the reception team. We upheld this part of C’s complaint.

C complained that the practice failed to provide them with reasonable care and treatment. C suffered from inflammatory conditions of the skin and joints and was under the care of rheumatology (specialists in the diagnosis and management of chronic inflammatory conditions such as rheumatoid arthritis), dermatology (specialists in the in the diagnosis and treatment of skin disorders) and the practice. C was being prescribed an immunosuppressant and the practice was in a shared care agreement with the NHS board for monitoring bloods in regards to the prescription. C required a liver transplant due to liver cirrhosis induced by the treatment. C complained that the practice had not properly monitored their bloods, had not picked up on warning signs and had not communicated appropriately with the relevant specialists or with C. C noted that they had also been incorrectly prescribed an antibiotic containing penicillin. We took independent advice from a GP. We found that the practice had monitored bloods appropriately, and where there were gaps in monitoring, C's attendance had been requested. We also found that the practice had sought specialist advice and followed NICE guidelines appropriately. We noted that the practice had verbally apologised for the penicillin mistake. Therefore, we did not uphold this part of C's complaint but fed back to the practice that it would be appropriate to apologise in writing. C also complained that they were immediately removed from the practice register after making a comment on social media expressing concerns about their treatment. C noted that they were given no warning and that their poor health, vulnerability and their requirement for continuity of care were not taken into account. We found that the practice had not followed guidelines in respect of removing the patient from the register, without warning. Therefore, we upheld this part of C's complaint.

C complained to the practice about the lack of treatment when they attended two consultations reporting a breast lump. C felt that the GPs they saw gave them false reassurance that there was nothing to worry about. C then attended the hospital specialists for an ultrasound scan (a scan that uses sound waves to create images of organs and structures inside the body), biopsy (tissue sample) and mammogram (an x-ray of the breast) and received results which showed evidence of a cancerous lump which required chemotherapy (a treatment where medicine is used to kill cancerous cells) and surgery. We took independent advice from a GP. We found that the GPs involved carried out appropriate examinations and that it was appropriate to refer C to the hospital specialists for further examination. We did not uphold the complaint although some feedback was provided to the practice in an effort to improve learning. Related reading View Decision Report 202009052 as a PDF (24.2 KB) Updated: April 20, 2022

C complained that the practice failed to provide appropriate care and treatment to their late child (A). A had a lump removed from their eye lid which was subsequently diagnosed to be cancerous. A went to see their doctor with severe pain in their left arm, which moved to their right arm and neck. A was prescribed painkillers and referred to physiotherapy. A returned from a family holiday and, still suffering from severe pain which had worsened, saw another doctor. A's painkillers were changed and they were referred to physiotherapy. After a further consultation, A was referred for an x-ray which identified that A's C6 vertebrae had collapsed and that there was a cancerous tumour. A died a few months later. C complained that doctors at the practice failed to respond to A's symptoms in a reasonable manner given A's history of cancer. C complained that it took A to attend the practice on a number of occasions before appropriate treatment/investigations were undertaken. C believed that had doctors taken account of A's previous history, A would have received appropriate treatment sooner. A considered that the practice failed to investigate and respond to their complaint appropriately. We took independent advice from a medical adviser. We found that the practice's consultations with C were reasonable. There was no unreasonable delay in the decision to refer C for an x-ray. We did not uphold this aspect of the complaint. With respect to the complaints handling, we found that there was a misapprehension on the practice's part about the handling of the complaint which resulted in a failure to communicate with C in accordance with their complaints handling procedure. However, the practice had investigated the complaint and provided an accurate and detailed response within a reasonable timeframe and, on balance we did not uphold this aspect of the complaint. We provided feedback to the practice on their obligations with respect to complaints handling. Related re

C complained that the practice did not take reasonable action in response to their late spouse (A)'s symptoms and condition. A had a long history of degenerative disc disease affecting their spine (when normal changes that take place in the discs of your spine cause pain) and a history of stomach cancer. A visited or contacted the practice several times over three months regarding pain in the neck and shoulder, numbness in the right hand and jerking of the right leg. Tests were undertaken, medication and therapies prescribed and a referral to an orthopaedic specialist (a specialist in the treatment of diseases and injuries of the musculoskeletal system) was made. Following a fall at home, A was admitted to hospital where a spread of cancer to A's spine was diagnosed. A died shortly after C submitted a complaint to the practice about their response to A's symptoms and condition over the previous few months. In response, the practice recounted the actions they had taken in response to A's visits and contacts in their final months, highlighted blood tests whose results did not indicate any significant abnormality or spread of cancer and explained that A's symptoms were relatable to their ongoing diagnosis of degenerative cervical disc and spinal stenosis (a condition where the space around the spinal cord narrows, compressing a section of nerve tissue). The practice advised that a significant case review had been carried out. This had highlighted that A's orthopaedic referral could have been upgraded to urgent when it was clear A's symptoms were not being controlled, but stated that it was doubtful this would have had any impact on the outcome. C was unhappy with this response and brought their complaint to this office. We took independent advice from a GP. We found that the practice took reasonable action in response to A's symptoms and condition until a point. However, when it was clear that A's symptoms were not being controlled and began to worsen, the pr

C complained that the practice had unfairly accused them of being threatening and aggressive, resulting in their removal from the practice list and that C had been unreasonably placed on an opiate reduction programme. C said that they had been targeted because they had successfully complained about the services provided by the practice in the past. C said that the practice had misrepresented the opiate reduction as mandatory, when in fact they were only required to review opiate use. C said that the practice had not taken into account the impact of the opiate reduction on them. The practice said that they had a zero tolerance for aggressive or inappropriate behaviour. C had abused the prescription request service and had entered the practice and refused to leave unless they were provided with an additional prescription. The practice had, after review, reinstated C to the practice, but C had continued to request medication early, breaching their agreements with the practice. This had resulted in their removal from the practice lists. The practice had reviewed and reduced C's medication in line with best practice and health board guidance. C had previously sought medication early and was considered by the practice to meet the criteria for opiate reduction. We took advice from an independent medical adviser. We found that the practice had acted reasonably in seeking to reduce C's opiate use. We also found that arguably the practice should have provided C with a written warning prior to the first decision to remove them from the practice list. When C had appealed against this decision, however, the practice had reviewed it and agreed to reinstate C subject to commitments about their behaviour. C's second removal had been due to the practice's view that the agreements reached with C had been breached. The practice were entitled to reach this decision and had acted reasonably. Therefore, we did not uphold the complaint. Related reading View Decision Report 2

C complained about the care and treatment their late spouse (A) received from the practice. C had arranged a same-day appointment at the practice as A had been sick over the weekend. When the time approached; A was too ill to attend, therefore, C called the practice to request a house visit. A triage phone call took place that morning. A's symptoms were noted, advice provided and medication prescribed for sickness and diarrhoea. The following day, C requested a house visit as they felt that A's condition had worsened. Arrangements were made for a house visit to take place. C was concerned that A's condition was further deteriorating, so they contacted the practice to check when the doctor would arrive. The practice subsequently arranged for an emergency ambulance. A was taken to hospital but died shortly thereafter. The primary cause of death was found to be diabetic ketoacidosis (a complication of diabetes mellitus) and respiratory tract infection. In responding to the complaint, the practice said that they could not always judge the severity of the symptoms over the phone; however, from the symptoms provided to the doctor, the appropriate action was taken in A's case. C remained dissatisfied with the care and treatment A had received and raised the matter with us. C was also unhappy that the practice's response to the complaint did not adequately cover all of their concerns. We took independent advice from a GP. We found that, at the time of the triage phone call, there was an unreasonable failure to take an adequate history and further assess A (by way of an examination either by a house visit or hospital admission). We, therefore, upheld this aspect of the complaint. During our investigation, the practice provided us with some evidence of reflection and learning that had taken place. In terms of C's concerns about the practice's response to their complaint, we found that they had appropriately contacted C in a timely manner in an attempt to obtain

Mrs C complained to us that the practice had failed to provide appropriate care and treatment to her late daughter (Miss A). Miss A had attended the practice with her partner and had reported symptoms of severe headaches, tiredness and constantly dropping items from her left hand. The GP took Miss A's blood pressure and gave her a vitamin injection. Miss A died at home the following day. We took independent advice from a GP adviser. We found that the doctor should have arranged further investigations of Miss A's weakness and dropping items with her left hand as this was a new symptom. The doctor should have arranged for an urgent review by a stroke specialist to establish if there were signs of a Transient Ischaemic Attack (a mini stroke) which was a risk factor for subsequent stroke or myocardial infarction (heart attack). However, we found that the doctor had carried out a reasonable assessment and examination which was in line with national guidance. There was no indication at that time that Miss A required an urgent hospital admission. Miss A had a complex medical history and her symptoms of high blood pressure, headache and tiredness were longstanding. On balance, we took the view that the doctor provided reasonable treatment and we did not uphold the complaint. Whilst we did not uphold the complaint we provided feedback to the doctor that they should review the standard of their record-keeping and refresh their knowledge about the presenting symptoms of a Transient Ischaemic Attack. Related reading View Decision Report 201800568 as a PDF (11.35 KB) Updated: December 2, 2018

Mrs C complained about the care and treatment provided to her husband (Mr A) by the practice. Mr A attended the practice feeling unwell, having had a history of heart problems. In the following weeks Mr A was admitted to hospital where he was diagnosed with a condition in his heart. Mr A suffered an injury in the brain as a result of a bleed, and his short term memory has been impacted by this. Mrs C considered that if the heart condition had been diagnosed earlier, then Mr A's eventual outcome may have been different. We took independent advice from a GP adviser. We found that the symptoms described and noted were not indicative of a particular illness. We also found that the classic symptoms of Mr A's condition were not seen until the day Mr A was admitted to hospital. We found that the GP took reasonable steps to establish the reason for Mr A being unwell and carried out appropriate tests. We also considered that the GP made an appropriate referral to a cardiologist (a  doctor who specialises in finding, treating and preventing diseases of the heart and blood vessels). The referral to the cardiologist was not sent as a matter of urgency. The GP surgery acknowledged this error and took steps to ensure that this did not happen again. We found that, even if the referral had been sent urgently, this would not have had an impact on the outcome. We did not uphold the complaint. Related reading View Decision Report 201702591 as a PDF (11.3 KB) Updated: December 2, 2018

Mrs C attended two consultations with the practice who had recently taken over from her previous practice. She had attended her previous practice five years earlier after she had experienced an increase in epileptic seizures. Mrs C complained that, during these two consultations, the practice unreasonably focussed on the events of five years previously. She raised concerns that the practice placed undue focus on the reporting requirements of the Driver and Vehicle Licencing Agency (DVLA) and she found it difficult to get her health concerns across. Mrs C also complained that, during the first consultation, she was unreasonably prescribed the wrong dosage of epilepsy medication. We found that the first of the two consultations was Mrs C's first with the practice altogether, following them taking over the running of her local practice. Her prior consultation with her previous practice noted concerns about the management of her epilepsy and an intention to notify the DVLA. We took independent medical advice from a GP, who confirmed that DVLA guidance requires patients with epilepsy to notify them. We considered that it was reasonable for the practice to discuss Mrs C's epilepsy and DVLA reporting requirements during her consultations. Therefore, we did not uphold this aspect of Mrs C's complaint. Mrs C also complained that she was prescribed the wrong dosage of her epilepsy medication. We found that there had been a prescribing error and that the practice did not address this when responding to Mrs C's complaint. Therefore, we upheld this aspect of Mrs C's complaint. However, we noted that the practice acknowledged that the error was their fault and that this was fixed before any medication was actually issued.

Ms C complained to us that the practice had failed to provide appropriate care and treatment to her late mother (Mrs A). She said that her mother had attended the practice on a number of occasions and was given a diagnosis of a chest infection, whereas she was in the final stages of lung cancer. Ms C was concerned that the practice had concentrated on a chest infection being the cause of her mother's symptoms. In addition, a chest x-ray which was taken showed signs of a cavity in her lung which was not followed up or mentioned to Mrs A or her family. We took independent advice from a GP adviser and concluded that there were some failings in the level of care provided. During the initial consultations it was appropriate for the GP to arrive at a potential diagnosis of a chest infection and we found that appropriate investigations including an x-ray and blood tests were performed. However, we considered that once the chest x-ray result had been received which showed a cavity on the lung, then further action should have been taken. This would either have been to repeat the chest x-ray within a defined time frame with a view to onward referral to a chest specialist, or to make a direct referral at that time to a chest specialist. Further action should also have been taken as Mrs A's blood results revealed that she was anaemic. We also concluded that, although the final outcome would not have altered, the diagnosis would have been reached sooner and this would have allowed Mrs A and her family to make decisions regarding future care and support which would be required. We upheld the complaint.

Mrs C complained that the practice had not provided her with reasonable care and treatment when she raised concerns about her skin condition. We took independent advice from a GP adviser. We found that the GPs at the practice had taken Mrs C's concerns seriously and that they had made reasonable and appropriate referrals to several specialists. We found that they had sent samples to a microbiology laboratory to be tested and that they had communicated thoroughly with the specialists regarding Mrs C's symptoms. We also found that the practice staff had communicated appropriately with Mrs C during consultations and when advising her of her diagnosis, and that the prescribed medications were appropriate. We did not uphold Mrs C's complaint. Related reading View Decision Report 201607617 as a PDF (10.92 KB) Updated: December 2, 2018

Miss C complained about the care and treatment provided to her mother (Mrs A) at her GP practice. Miss C was concerned that the practice were not addressing Mrs A's health problems or taking into account her fear of medical situations. Miss C had power of attorney for Mrs A and complained that the practice provided Mrs A with unreasonable treatment and that they were not keeping her informed of Mrs A's health care. We took independent advice from a GP. We found that the practice had completed a full assessment of Mrs A and a full advanced care plan was done. Mrs A was seen on a house call, as requested, and appropriate treatment was provided. There had also been communication between the practice and other professionals regarding Mrs A's healthcare. We considered that the practice provided Mrs A with appropriate care and treatment, and therefore, did not uphold this aspect of Miss C's complaint. In relation to Miss C's complaint about the practice failing to keep her informed, we found that at the time of Miss C's complaint, the practice held a letter confirming that Mrs A did have capacity. A subsequent assessment confirmed she lacked capacity, but the practice had not been aware of that at the time of the complaint, nor had they been aware of the power of attorney. We found that the practice acted appropriately in maintaining Mrs A's confidentiality until such time as it was brought to their attention that she no longer had capacity and Miss C had power of attorney. We did not uphold this aspect of Miss C's complaint. Related reading View Decision Report 201703571 as a PDF (11.26 KB) Updated: December 2, 2018

Mrs C complained about the medical practice with regards to the care and treatment provided to her husband (Mr A). Mrs C said that the GP failed to ensure that Mr A's diagnosis of a rare type of cancer was followed up and that had the GP acted differently, Mr A would have been offered earlier treatment. We took independent medical advice from a GP. We found that the practice had not been told that the diagnosis of cancer was definitive, but rather that it had been communicated as a 'suspicion of diagnosis'. We found that there was no obligation for the practice to record this if it was not definitive. Additionally, we found that it was not the practice's responsibility to ensure that further tests and reviews were being carried out as this was the responsibility of secondary care. Therefore we did not uphold Mrs C's complaint. Related reading View Decision Report 201604204 as a PDF (10.99 KB) Updated: March 13, 2018

Mr C complained about the medical practice on behalf of his mother (Mrs A). Mrs A was discharged from hospital and given three new medications. On learning of these new medications, the practice decided to carry out a review of Mrs A's prescriptions, as this would result in her being prescribed 18 different medications a day. Mrs A's GP phoned Mrs A's daughter (Mrs B) to discuss the medications as they considered that these new medications were not necessary and may cause side effects that would exacerbate Mrs A's existing conditions. Mrs B felt that the GP's manner was callous and uncaring and that the content of the call was inappropriate. Following the call, the practice decided to prescribe the medications in line with the request from Mrs A's respiratory consultant. However, this call led Mrs A's family to decide that they would change GP practices. Mrs A died before the new practice was able to arrange Mrs A's medications. On investigation we found that there was some discrepancy in the information available to the practice, caused by a delay in the hospital sending them Mrs A's full discharge letter. This meant that they were not in possession of the consultant's rationale for providing the new medication and had to carry out the review based on the medical history they were aware of. Our adviser considered the relevant medical records and concluded that it was reasonable for the practice to carry out a review of Mrs A's medications in the circumstances. They also considered the conclusions reached in the review to be reasonable, based on the information available to them at that time. On reviewing the records we were unable to see any evidence that the content or manner of the call in question was unreasonable. For these reasons, we did not uphold Mr C's complaint. Related reading View Decision Report 201603200 as a PDF (11.44 KB) Updated: March 13, 2018

Mrs C complained to us that the medical practice failed to provide her mother (Mrs A) with appropriate clinical treatment for her reported symptoms. Mrs C said that by the time Mrs A had been referred to hospital, she was found to have severe sepsis (blood infection). Mrs C said the GPs did not examine Mrs A fully and failed to admit her to hospital sooner. We obtained independent GP advice. We found that the GPs who visited Mrs A had on a number of occasions said to Mrs A that her blood tests and presentation were concerning and that hospital admission or further investigation was advised. However, we found that Mrs A declined the offer of a hospital admission on three occasions. Related reading View Decision Report 201605172 as a PDF (10.93 KB) Updated: March 13, 2018

Mr C complained to us that his GP had not provided him with appropriate medication in view of his symptoms and medical history. Mr C had on-going high blood pressure and this was complicated by low sodium levels. He felt that the medications his GP had prescribed him were the cause of him being hospitalised due to low sodium and dehydration. We took independent medical advice and found that whilst it had been difficult to balance Mr C's blood pressure and sodium levels, his GP had prescribed him appropriate mediation. We found that when he was hospitalised, he was suffering from a very rare side effect of one of his medications. The adviser said that they would not have expected Mr C's GP to have been alert to the possibility of this side effect. We found that there was one occasion on which Mr C's GP could have given Mr C a blood test and failed to. However, we noted that the practice had already apologised for this. Therefore, we did not uphold Mr C's complaint. Related reading View Decision Report 201602674 as a PDF (11.08 KB) Updated: March 13, 2018

Mr C complained about the care and treatment he received from his medical practice. He was concerned that the GP inappropriately prescribed him steroid medication for asthma which caused his heart rate to increase, requiring hospital treatment. Mr C felt that his GP dismissed his ongoing concerns about his heart rate and breathlessness. We took independent advice from a GP adviser and considered that it was appropriate that Mr C's GP diagnosed worsening asthma and prescribed steroid medication in accordance with national guidance. In addition, whilst Mr C had been diagnosed previously with atrial fibrillation (where the heart beats irregularly and faster than normal), the type of steroid prescribed was not specifically associated with this condition. Therefore we considered that it was reasonable practice to prescribe this treatment and did not uphold Mr C's complaint. Related reading View Decision Report 201508103 as a PDF (11.03 KB) Updated: March 13, 2018

Miss C complained about care provided by her GP practice. She attended the practice a number of times over a period of six months with various symptoms which were ascribed to depression and treated as such. When Miss C began displaying slurred speech, her GP urgently referred her to hospital where she was diagnosed with a brain tumour. We sought independent advice from a medical adviser. Their view was that Miss C's symptoms were reasonably ascribed to other causes and it was not until the symptom of slurred speech occurred that it became clear there might be another cause for Miss C's condition. The adviser said the GP then took appropriate action by urgently referring Miss C. For this reason we did not uphold this complaint. We did however uphold the complaint about post-operative care as the practice had acknowledged that their normal practice is to contact patients once they have been discharged from hospital and this did not happen in this case. The practice said they intended to carry out an Enhanced Significant Adverse Event (ESAE), and we made a recommendation in relation to this.

Mr C complained that he was not prescribed medication to treat high blood pressure and that during a home visit a GP did not diagnose a deep vein thrombosis (DVT) in his leg. Mr C had a knee replacement operation in December 2014 and requested a home visit in January 2015 as he was suffering from pain and swelling in his leg. A GP attended and examined Mr C's leg but did not find any obvious signs of DVT. A week later, Mr C had a post-operative check on his leg and the DVT was discovered and he was admitted to hospital for treatment. Our investigation included taking independent advice from a medical adviser who was of the view that the examination carried out by the GP was appropriate and that there were no recorded signs that would have suggested DVT. The adviser stated that DVTs can develop over time and that the signs are difficult to identify in the early stages. We did not uphold this aspect of the complaint. Following his treatment for the DVT Mr C was referred to the anti-coagulation clinic to monitor his blood, and he was prescribed Warfarin (an anti-coagulation medication) to reduce the risk of further clots for six months. During this time Mr C stopped taking the medication to treat his high blood pressure. When he was advised by the clinic to stop taking the Warfarin, Mr C requested a prescription for his blood pressure medication from the GP which he stated was not provided for seven days. The records showed that the prescription was issued on the day it was requested and we did not uphold this aspect of the complaint. Related reading View Decision Report 201508030 as a PDF (11.36 KB) Updated: March 13, 2018

Mrs C complained about the care and treatment provided by the practice. Mrs C raised concerns that the practice did not provide a reasonable standard of care when she presented with symptoms of bowel discomfort and diarrhoea over a period of several months. In particular, she was concerned the practice failed to diagnose her colonic cancer at an early stage. Mrs C also raised concerns about timeliness of blood tests, the antibiotics prescribed, and her concerns that the practice was dismissive of her symptoms. She also complained the practice unreasonably failed to provide a letter of referral she asked for in order to arrange a private scan. The practice said that Mrs C's treatment had been reasonable. In particular, they noted that Mrs C had attended a colonoscopy (an examination of the bowel with a camera on a flexible tube) two months prior to the period in question, which had shown no signs of cancer, but provided an alternative explanation, which was consistent with her symptoms. The practice said that the GP in question understood Mrs C had requested a scan, and had arranged appropriate investigations. After receiving independent advice from a GP, we did not uphold Mrs C's complaint. We found that the practice had acted reasonably in the circumstances, based on the result of the colonoscopy, the alternative diagnosis, and the nature of the symptoms Mrs C experienced. We also considered that the practice provided appropriate care and treatment in relation to blood tests, prescription of antibiotics, and was responsive to her symptoms. We also considered the actions of the practice in relation to the scan were reasonable in the circumstances. During the course of our investigation, we noted aspects of the practice's complaints procedure did not comply with the Scottish Government's 'Can I help you?' guidance, so although we did not uphold the complaint, we made a recommendation about this.

Ms C complained about the treatment her father (Mr A) received from the practice over a five month period in 2013. Mr A had been diagnosed with bladder cancer in 2012 and attended the practice on a number of occasions complaining of back pain. Ms C did not feel that his condition was taken seriously or that adequate treatment was provided by the practice. We sought independent medical advice on this case. Whilst we generally found that the practice provided good treatment in line with national guidance during the period in question, we found that the GPs could have been more proactive in arranging specialist investigations when Mr A's pain failed to reduce. Our investigation also highlighted significant concerns about the management of Mr A's pain some months later on the day he died. We were critical of the practice for failing to react to the urgency of the situation when family members contacted them, and for failing to have important palliative care drugs available to alleviate Mr A's pain.

Mrs C complained that her late husband (Mr C)'s GP practice did not properly investigate his underlying heart condition, which was diagnosed at a post-mortem examination. The practice were apologetic about Mr and Mrs C's experience but did not find any failings in the care given to Mr C. We took independent advice from a medical adviser who is a GP. The adviser said that Mr C's symptoms were not consistent with possible angina (chest pain caused by an inadequate blood supply to the heart) or a heart attack. Therefore, we considered that the assessments, treatment and referrals to specialists were reasonable and appropriate. We did not uphold the complaint. Related reading View Decision Report 201405654 as a PDF (10.96 KB) Updated: March 13, 2018

Mrs C complained about the way the medical practice handled two phone calls when she became ill while on holiday. During the first call, which was made by her son, Mrs C felt that the receptionist concentrated too much on the fact that she was currently outside the practice area and that she should seek an appointment with a local GP practice. Mrs C did so and the GP diagnosed quinsy on her tonsil (a complication of tonsillitis where an abscess forms between a tonsil and the throat). Mrs C phoned the practice the following day to arrange an appointment for when she returned home. She was informed that there were no pre-bookable appointments available for the next two days. Mrs C felt that the reception staff should have sought advice from a doctor rather than make decisions about whether her medical condition could wait until an appointment was available. We sought independent clinical advice from a GP adviser who felt that the practice had handled both calls appropriately. During the first call, her son was advised that Mrs C should seek a medical opinion from a local GP in order that her condition could be assessed. During the second call we found that the receptionist had accurately explained the process for making appointments. We did not uphold the complaint. Related reading View Decision Report 201501996 as a PDF (11.21 KB) Updated: March 13, 2018