Not upheld, no recommendations

Summary

Ms C complained about the care and treatment that her father (Mr A) received from the medical practice during the weeks leading up to his admission to hospital with a chest infection and kidney failure. Mr A saw doctors from the practice several times in the four weeks before he was admitted. Ms C was concerned that an earlier diagnosis of chest infection could have improved his care at home, and reduced the need for hospital intervention. Mr A died three days after he was admitted to hospital.

Mr A had seen doctors from the practice five times - in relation to fluid on his lungs, an ongoing urine infection and unsteadiness with walking. In addition, he saw a physiotherapist twice, had a chest x-ray and a chest scan. The final consultation was during a home visit, when signs of a chest infection were apparent. At first, the GP had assessed that Mr A could stay at home, and take antibiotics. However, when blood tests showed that his kidney function was poor, she decided that he needed admission to hospital for closer monitoring.

We obtained independent advice on this complaint from one of our medical advisers, but did not uphold the complaint. The advice indicated that the chest infection was not apparent until the day Mr A was admitted to hospital, and was not evident on the chest scan. Our adviser considered that the care and treatment provided by the practice were of a good standard and that there was no delay in diagnosing the chest infection. We also found that the practice had acted promptly to secure Mr A's admission to hospital when the infection was identified.

Summary

Ms C was undergoing private treatment, including hormone therapy, as a transgender individual suffering from gender dysphoria (a condition in which a person feels that there is a mismatch between their biological sex and their gender identity). Her private medical provider was treating her with Zoladex (a hormonal therapy) but her NHS medical practice was not prepared to prescribe this for her, as it is only licensed in the UK for prostate cancer treatment. Ms C felt that she was being discriminated against.

After taking independent advice from one of our medical advisers, who is a GP, we did not uphold the complaint. We found that that the practice had acted appropriately and in line with General Medical Council guidelines in refusing to prescribe a drug they were not familiar with and that they did not feel competent to administer or monitor.

Summary

Mrs A, who was 91 years old, became ill and was admitted to hospital, where she deteriorated and died. Her son (Mr C) complained to the board that it was inappropriate for them to have placed his late mother on the Liverpool Care Pathway (LCP - a care planning system for dying patients). Mrs A was on the LCP for more than two weeks before she died, which Mr C felt was too long. He felt that staff should instead have provided her with treatment, for example an operation. He said that although it might have ended her life sooner, he felt that at least she would not have suffered for so long.

The board maintained that it was appropriate to have placed Mrs A on the LCP. Due to Mrs A's age and her other medical conditions, the board said the risks of surgery would have outweighed any potential benefit. They confirmed that communication was maintained with appropriate family members. Our investigation found that it was not unreasonable for staff to have placed Mrs A on the LCP, as it is used by health care staff to ensure high quality personal care is delivered in the last days of life. We also noted that the decision was discussed with family members who were the hospital's first point of contact.

Summary

In 2007, Ms C had her right breast removed because of cancer. In 2012, her left breast was also removed as a preventative measure and at the same time, she underwent reconstructive surgery (breast implants). She was discharged from hospital but was re-admitted about a week later, and had to have necrotic (dead) skin removed, as well as her breast implants. She was discharged on the day that the presence of a bacterial infection was identified. Ms C's recovery has been slow and she complained that, in the circumstances of her case, she was discharged inappropriately.

The complaint was investigated, taking into account all the relevant information, including the complaints correspondence, and Ms C's medical records. We also obtained independent medical advice. We did not uphold Ms C's complaint as our investigation found that on both occasions it had been appropriate to discharge her. On the day of her first discharge, she was noted to be doing well and her wound was satisfactory. On the next occasion, there was no suggestion in the records that she had infection. She had already completed a course of antibiotics and was discharged with more. While it was noted that the circumstances experienced by Ms C were distressing in that she did suffer infection, lost her implants and suffered the trauma of poor wound healing, the advice received was that it had been appropriate to discharge her.

Summary

Mrs C complained that her former GP did not investigate the symptoms she was reporting, and that this led to a delay in a spinal problem being diagnosed and treated. Mrs C had a complex medical history with various symptoms which she reported at various consultations at the medical practice, as well as during home visits and phone consultations. She was being treated for various medical conditions, some of which had symptoms that related to her spinal problem.

Our investigation, which included taking independent advice from one of our medical advisers, found that it was reasonable that the practice did not specifically investigate the possibility of a spinal problem. The adviser was of the view that many NHS GPs would have had difficulty in identifying or suspecting a spinal problem in the midst of the many and complex conditions from which Mrs C suffered. The adviser also noted that the first mention of a symptom that could specifically have related to a spinal problem, and which could have been followed-up, took place at a consultation at the practice in April 2012, which lasted for an hour. During the consultation, Mrs C had taken exception to a suggestion by the GP for a referral to another specialist, unrelated to the spinal problem. She had left the consultation and four days later made a formal complaint to the practice. In her letter she indicated that she and her husband no longer wished to be patients there.

The practice had reviewed Mrs C's complaint letter, and as they felt that the doctor/patient relationship had broken down, had applied to the local health board to have Mr and Mrs C allocated to another practice, which happened in early May. By the middle of June, Mrs C's new GP had ordered a MRI (a specialist type of imaging) scan, which revealed the spinal problem. Our investigation found that, in the circumstances, it was not unreasonable that the original practice did not follow up the specific symptom reported in April 2012.

Summary

Following a review of treatment room services, the board consulted on proposed changes to these. The changes included introducing a new full-time treatment room service at a new site. Mr C complained that the board failed to carry out a meaningful consultation about the changes and said that many GPs and elected officials were concerned about the consultation and the impact of the changes.

Our investigation considered whether there was any administrative fault in the way the board consulted about the changes, particularly in relation to Scottish guidance about consultation. This says that consultations should be proportionate, clear and meaningful. In reaching our decision on the complaint, we took into account advice explaining why the changes do not constitute a major service change. We also noted that key stakeholder groups, including a patient representative group and the democratically elected representative general practitioner body, were involved in the consultation process. After carrying out an equality impact assessment, the board also engaged with public transport services. We were, therefore, satisfied that the board undertook a thorough, transparent and proportionate consultation process seeking input from, amongst others, general practitioners, patients and elected officials and, in doing so, complied with the guidance.

Summary

Mr C complained about his former medical practice. He said that he worked as a self-employed plasterer and for some time had suffered from tennis elbow which affected his ability to work. He said that after he had physiotherapy he returned to the practice as requested, but was refused a further sick line. Mr C complained that the doctor concerned would not listen to him and, despite the fact that he was not fit to work, would not give him a sick line.

To investigate the complaint, we looked at all the available information, including the complaints correspondence and Mr C's medical records. After also obtaining independent advice from one of our medical advisers, we did not uphold Mr C's complaint. The adviser said that the responsibility for sickness notification was a statutory one. GPs issue sick notes after assessing the patient, which includes taking an occupational history and conducting an examination. In Mr C's case, the examination showed no abnormality and the GP recommended that he go back to work but should return to the practice if the problem recurred. As the GP did not think Mr C was unfit for work, she did not provide a sick line. The adviser said that in all the circumstances, this was in order.

Summary

Mr C's son (Mr A) attended his then medical practice in June 2011 complaining of left hand rib pain and pain in his elbows, right hip and shoulder, left wrist and lower back. He was examined by the GP, blood tests were taken and he was prescribed pain medication. Mr A's pain worsened and he had a further phone consultation with his GP. Advice was given, and Mr A was encouraged to join a different practice closer to home, as he no longer lived in his current GP's area.

Mr A transferred to a new medical practice. Before his first consultation there, Mr A's pain worsened again and he attended a hospital accident and emergency department (A&E) where x-rays were taken, showing evidence of possible cancer. He was referred to the hospital chest clinic, but the chest physician reviewed the information and decided that he did not need to see Mr A. When Mr A attended his first consultation at the new medical practice, his health records had not yet arrived from the previous practice. Because of the time it took to add Mr A's information to the computer system, important results from A&E were not available at his next appointment. Before Mr A had his second consultation at the practice, the chest physician from the hospital contacted them and advised that Mr A had nothing to be concerned about. Mr A was treated with pain killers on the understanding that he had a cracked rib.

Mr C complained that the new practice did not ensure they had all of Mr A's records and test results to hand when examining him, and that the GPs who examined him did not conduct thorough examinations, preferring to prescribe stronger pain medication to alleviate his symptoms. Having taken independent advice from one of our medical advisers, our investigation found that the initial lack of records during the first consultation was outwith the practice's control. The call from the chest physician then reassured them that there was nothing sinister in Mr A's chest x-ray. We considered that, once the records arrived, they could have been made available to the GPs before they were added to the computer system. Given, however, the advice provided by the chest physician, we took the view that it was very unlikely that the treatment offered to Mr A would have been any different had his x-ray results and other records been available. We noted that the practice have since changed their procedures to ensure that GPs are made aware of any patient information that has not yet been added to the computer system.

Summary

Mr C, who is a prisoner, was told by a prison officer that he was to attend an appointment at the prison health centre. The doctor wanted to review Mr C's 'medically unfit' status. Mr C said that he was not well enough to go to the appointment and asked the prison officer to tell the health centre. After this, Mr C complained that he had to pass information about his health to the prison officer, which he felt was inappropriate.

During our investigation, the health board explained to us that prison staff are responsible for the movement of prisoners around the different areas of the prison. That includes taking prisoners to the health centre for appointments. In addition, the board confirmed that prisoners are required to let prison staff know when they feel unwell. They advised that prisoners do not need to explain to staff why they are unwell.

In light of the information provided, we were satisfied that what happened in Mr C's case was appropriate and we did not uphold his complaint.

Summary

Mr C complained that his medication for anxiety had been stopped as it was no longer on the list of approved medication compiled by the Scottish Medicines Consortium. He said that when he went to his medical practice for assistance, a GP told him to return home and arranged for an ambulance to call at Mr C's home and take him to hospital for an assessment by mental health services. Mr C said that he did not receive appropriate and timely medical treatment, and believed that he should have been allowed to wait at the practice for the ambulance. He was also concerned at the time it took to arrive.

We took independent advice about this complaint from a medical adviser, who is a GP. The adviser said that it was appropriate for the GP to have arranged for the mental health assessment and that the assessment result confirmed there was no clinical need for an urgent referral to hospital by emergency ambulance. We did not uphold the complaint as there was no evidence that the GP acted incorrectly.