SPSO Individual Decisions

Ms C had been on Depo-Provera contraceptive injections for a number of years, from 1994-2002, then from around 2005-2010. In May 2010 she developed back pain and other symptoms which she reported to the GPs at her local surgery. She was given various possible causes but after referral to a dermatologist, rheumatologist and an MRI scan she was eventually diagnosed in February 2011 with a probable chronic syndrome. Ms C considers that had her contraceptive medication been appropriately monitored she would not have developed the condition ‘SAPHO syndrome’. She also considers that the GPs failed to diagnose her syndrome. Our medical adviser considered the case and found that the monitoring of Ms C's contraceptive use, particularly in the earlier years had lacked detail. He found that blood pressure monitoring had been sporadic and there was no evidence of systematic review of the method of contraception. The adviser noted guidelines regarding review periods had not been issued until 2004, and that the notes had improved significantly from 2010 onwards – nonetheless the complaint regarding monitoring was upheld. In relation to investigation and diagnosis, the adviser found the GPs’ actions to be a demonstration of good practice, in that appropriate and detailed referrals to specialist departments were made timeously. The adviser also found the probable syndrome was extremely rare and would not have expected a GP to diagnose it. Finally, no causative link between the contraceptive and SAPHO syndrome has been established. We did not uphold this complaint. Recommendation We recommended that the practice: • apologise to Ms C for failing to monitor her appropriately whilst she was on Depo-Provera. Related reading View Decision Report 201100691 as a PDF (19.92 KB) Updated: March 13, 2018

Mrs C told us that she accompanied her daughter to the medical centre to see a doctor, as her daughter had suffered an allergic reaction to silicone. An incident occurred within the premises. Mrs C's daughter was subsequently removed from the practice list for inappropriate violence and abuse towards staff. Differing accounts of what happened have been given by Mrs C and her daughter compared with those of the practice nurse and practice manager. Mrs C wrote to one of the doctors saying that her daughter had not been abusive towards staff and asked that she be allowed to re-register. After the medical centre cancelled a meeting to discuss Mrs C's concerns, she made a formal complaint to the board as she was concerned that the medical centre were not interested in resolving the issues she had raised. The board explained to Mrs C the complaints process for family health services and acted as an intermediary between her and the medical centre. The complaint we investigated was about the way that staff treated Mrs C's daughter on the day she attended the practice, and the way in which the medical centre handled the complaint. We found that there was insufficient evidence to support the complaint that staff had mistreated her daughter. However, we established that the medical centre did not respond to the complaint in full in good time, and we concluded that there was evidence of poor complaints handling.

Mr C complained about the care and treatment that his late mother (Mrs A) received from her medical practice prior to her death. He alleged that the practice either failed to diagnose her or diagnosed her incorrectly and that, as a consequence, she did not receive appropriate and timely treatment. Mr C also complained that despite the fact that Mrs A had recently undergone chemotherapy for the treatment of cancer, and was in remission, she was given the 'flu vaccine’. He considered that this was inappropriate and led to her unexpected death. Our investigation found that on the basis of the information available to them, the practice treated and cared for Mrs A appropriately. Our medical adviser also confirmed that the 'flu vaccine’ was not contra-indicated, and was in fact recommended for patients like Mrs A who had lowered immunity as a consequence of her illness and treatment. Related reading View Decision Report 201100468 as a PDF (13.88 KB) Updated: March 13, 2018

Mrs C complained about the actions of a GP who attended her father (Mr A) at home. She was unhappy that the GP did not arrange for Mr A to be admitted to hospital, despite having low blood pressure; not eating or drinking; and not thinking straight. Mr A had told the GP he did not want to go to hospital. Mr A was seen at home the following day by an out-of-hours doctor who arranged for him to be admitted. Mr A died in hospital less than two weeks later. Mrs C felt that the GP who first attended should have ignored Mr A’s wishes, and arranged for him to be admitted. She felt that the delay had contributed to her father’s death. Our investigation established that the GP had recommended that Mr A should go to hospital, but he had refused this, and was competent to do so. We also found that the GP had carried out an appropriate examination and that although she spent some time with Mr A, she could not persuade him to agree to admission. Related reading View Decision Report 201100796 as a PDF (16.79 KB) Updated: March 13, 2018

Mr C was a new patient at the practice and his medical records had not yet arrived. While the practice was waiting for them, Mr C asked for additional medication. When he did not receive this, he complained about how the practice had dealt with his request. We found that they had not in fact properly actioned it. We recommended that the practice apologise to Mr C and carry out a significant event analysis to identify the problem and prevent a recurrence.

Mr C raised concerns about a telephone consultation that he had with his GP. He was suffering from severe lower back pain. He told us that he believed that he should have had a home visit as he was admitted to hospital later that evening with Cauda Equina Syndrome (a disabling condition caused by compression of the nerves of the spine). Although our investigation found that the GP's management plan was reasonable, we found that her notes of the consultation were limited. Our medical adviser told us that in the circumstances a physical examination of Mr C was required. As this should have been carried out at his home, we upheld Mr C's complaint that the GP's telephone assessment of his condition was inadequate. We did, however, recognise that it was possible that the outcome would have been the same, even had the physical examination taken place. Related reading View Decision Report 201002571 as a PDF (13.99 KB) Updated: March 13, 2018

Mr C was unhappy because when he tried to register with a new medical practice, they declined his application. He said he had not been given a true and satisfactory explanation of why this happened. The National Health Service (General Medical Service Contracts) (Scotland) Regulations 2004 say that 'a contractor which refuses an application ... shall, within 14 days of its decision, notify the applicant in writing of the refusal and the reasons for it'. We spoke with the practice and found that they had written to him within the required timescales to explain their reasons for refusing his application. In doing this, they fulfilled the requirements of the Regulations. The practice is entitled to refuse an application, and it was not for us to question their reasons for doing so. Related reading View Decision Report 201005167 as a PDF () Updated: March 13, 2018

Mrs C complained that her medical practice removed her and her baby from the practice list without prior discussion, warning or reasonable explanation. In the course of the investigation, we found that the practice removed Mrs C because they believed that she had missed an appointment. This was in line with the practice’s protocol for new patients missing appointments. We found, however, that their protocol did not adhere to the General Medical Council Regulations on this issue (Section 20 of Schedule 5, Part 2, of The National Health Service (General Medical Services Contracts) (Scotland) Regulations 2004).

Ms C made a GP appointment for her daughter, who was unwell. When, however, her daughter became more unwell Ms C phoned to request a GP home visit on an earlier date. She did not specifically cancel the booked appointment. As their records showed that she had not kept an appointment on an earlier occasion, the practice wrote to her saying that if she continued to miss appointments, they would remove her from their register. She complained that it was unreasonable for them to have done this, and said that she was also unhappy with the practice's attitude when she phoned them about the letter.  We explained that although we could look at the first part of her complaint, we would be unable to prove what happened during the phone call.  Although she was disappointed that we would not be looking at this, she withdrew her complaint. Related reading View Decision Report 201004170 as a PDF (13.7 KB) Updated: March 13, 2018