Health

Summary

Mr C complained when his local medical practice decided to remove him from their patient list. His new medical practice is located some miles from his home and getting to it causes him inconvenience and expense. Mr C said that he did not understand why he had been removed from the practice list.

Our investigation found evidence that the practice had properly explained their decision, and the reasons for it, to Mr C and had then removed him from the list. However, we upheld the complaint because they had not issued Mr C with a warning about his behaviour in the twelve month period leading up to the decision, which they were contractually obliged to do.

Recommendations

We recommended that the Practice:
• revise their policy relating to the removal of patients from practice list; and
• apologise to Mr C for failing to issue a warning prior to removal from patient list.

Summary

Ms A requested that her first appointment with a new medical practice be longer than usual. Ms A was late for the appointment, and when the GP refused to see her she became upset. She wrote a letter about the situation while she was in the practice but this was not responded to. Within a few days she was informed that she had been removed from the practice list.

Ms A's representative (Ms C) complained to the practice on her behalf. They replied, saying that their views about the length of the scheduled appointment, how late Ms A had been and the behaviours she had displayed were different from those of Ms A. Ms A was dissatisfied with their response and raised her complaints with us.

We decided that the practice had reasonably fulfilled a request for a prescription and passed Ms A's records to her new practice. However, as they had not met the requirements of the relevant regulations for the immediate removal of a patient from a treatment list, we upheld Ms A's complaint that her removal had been inappropriate. We also upheld Ms A's complaint that the practice did not respond reasonably to complaints submitted about this matter.

Recommendations

We recommended that the practice:

• apologise to Ms A that her removal from their practice treatment list was not appropriate;
• review their procedure for the removal of patients from their treatment list to ensure that it complies with the relevant regulations, guidelines and guidance;
• apologise to Ms A that they did not respond reasonably to her letter; and
• review their complaints procedure to ensure that it is in line with the NHS Scotland complaints procedure.

Summary

Mr C complained that when his late father (Mr A) went to his medical practice in December 2011 they did not fully assess his condition and showed a lack of urgency in following up with his father. Mr A had a history of myeloma (cancer of the bone marrow) and had received treatment, including a stem cell transplant, between 2009 and 2011. In late 2010 and in November 2011 Mr A was told there was no trace of the disease left.

In late November and early December 2011 Mr A started to complain of breathlessness, weight loss, decreasing energy levels and back pain. His son and wife were concerned and persuaded him to speak to his GP on 6 December, as he was due to attend the practice that day for blood tests. Mrs A accompanied Mr A to the surgery and when she realised that Mr A was only due to see the practice nurse for the blood tests, asked that Mr A be seen by a GP.

One of the GPs (not Mr A's regular GP) saw Mr A as an emergency appointment. Although they examined him and made notes, our investigation found that there was no record of the presence or absence of anaemia (iron deficiency) or of the standard observations of pulse, temperature, respiration rate etc that would be expected for a patient reporting the symptoms that Mr A was suffering. The GP diagnosed a chest infection and prescribed an antibiotic. He told Mr A to make a follow-up appointment for seven days time, at which blood tests would be taken if there was no improvement in his symptoms.

Mr A forgot to make the follow-up appointment but six days later his son was so concerned that he tried to speak to Mr A's regular GP but was unable to do so. He did manage to speak to her the following day and she arranged urgent blood tests. The laboratory that conducted the tests were so concerned by the results that they contacted the local out-of-hours GP service that evening. A GP reviewed the results and notified the practice, but considered that a full GP review could wait until the next day. Mr A saw his regular GP, who immediately advised him to go to the local hospital and called ahead to make arrangements for him to be seen there. Mr A was admitted, but died in hospital the next day.

We upheld Mr C's complaint. Our medical adviser said that the GP should have had further blood tests done on 6 December, with a GP review on receipt of the results. The blood test that the practice nurse had taken was to check Mr A's cholesterol level and would not have told the GP anything about his condition or the cause of the symptoms Mr A complained of. The adviser also said that while it might have been reasonable for the GP to prescribe the antibiotic, the fact that he suspected an infective condition should have rung alarm bells in a patient with Mr A's history of myeloma. He thought that the symptoms Mr A was reporting should have triggered a more robust follow-up.

Recommendations

We recommended that the practice:

• issue a written apology to the family of the late Mr A;
• ensure that the GP conducts a significant event audit, to be discussed at his next appraisal; and
• conduct a review of a sample of clinical records to ensure that consultations are appropriate and accurately and fully recorded.

Summary

Mr C was dissatisfied after treatment from two dentists during 2010. He complained by telephone in January 2011. He also sent a complaint by email in June 2011 when the practice approached him for payment of an outstanding bill. Mr C's email was acknowledged by the practice by email three working days later, but as Mr C received no formal response to his complaint he telephoned several times between June and October 2011. He sent a further email in October 2011 which was acknowledged six working days later. Again he received no formal response to the complaints and approached us in January 2012. He complained that the practice had failed to respond appropriately to his complaints.

We upheld Mr C's complaint. Our investigation found that the practice's complaints policy and procedure did not comply with relevant NHS legislation and guidance at the time. The guidance said that complaints to family health service providers should be acknowledged within three working days and a full response provided within ten working days. The practice complaints policy said that they would acknowledge complaints within seven working days and respond within 20 working days.

Our investigation also showed that the practice did not comply with their own timescales. Although the two emails Mr C sent were acknowledged, there is no evidence that any of his calls were recorded, acknowledged or responded to. In addition, when we made enquiries to the practice these were either not responded to or the responses were very delayed.

Recommendations

We recommended that the practice:

• issue a written apology to Mr C; and
• review and amend the practice complaints procedure to comply with the requirements of the NHS legislation and guidance.

Summary

Ms C complained about treatment received after she fractured her wrist. She said that nurses within the hospital's plaster room had incorrectly applied a cast on two dates in January 2011.

She complained in particular that on one visit, the treatment was inappropriate and resulted in permanent damage to her hand and wrist. However, we found no evidence that the treatment was unreasonable – reviews of the positioning of the casts during the board's investigation had established they had been positioned appropriately, and after taking advice from our medical adviser, we accepted this. There was also no evidence Ms C had sustained permanent damage because of the positioning or fitting of the casts. We did not uphold any of her complaints.

Ms C also complained that following her review appointment she had received inappropriate advice from a registrar that she had suffered permanent damage to her wrist, had lost the use of three fingers, and would require obtaining the services of a carer. We found no evidence that this advice had been given, and the written records reflected that she had been given different information.

We also found that the board's investigation into Ms C's complaints was thorough and reasonable, with all issues raised addressed. We noted Ms C had been in frequent communication with the board via letter, email and telephone, and the board had acknowledged all correspondence. We found that the board had generally addressed follow-up queries well, although Ms C had frequently requested two particular members of staff be removed from the investigation, and the board had not addressed this concern. Although we found it was reasonable for the board to maintain those staff members' involvement in the investigation, we found the board could have clearly told Ms C about this decision, and drew this to their attention.

Summary

When Ms C attended for a psychiatric assessment, the board had concerns about her mental heath and the risks she presented to herself and others. They notified the police about an aspect of this. Ms C complained that the board failed to tell her about the action taken. We reviewed the records, and found that it was clearly documented that the police contact had been discussed with Ms C in advance. Although Ms C did not agree with this, in the absence of any specific evidence to the contrary we did not uphold the complaint.

Summary

Ms C's late father (Mr A) was admitted to hospital with circulation problems in his legs. He was diagnosed as having compressed arteries causing reduced blood supply, and emergency surgery was arranged for that afternoon. This was carried out but there was no improvement and his condition deteriorated. Two days later, medical staff concluded that the outlook for Mr A was poor and agreed with his family to provide only palliative care (care to prevent or relieve suffering). Mr A passed away later that day.

Ms C said that the day after Mr A's operation her mother (Mrs A) tried unsuccessfully to discuss his condition with a doctor. Ms C also told staff that she was going on holiday the next day, but said that nobody told her how serious her father's condition was. The next day, Mrs A went to hospital expecting an update and so did not bring any family members with her. Staff there told her that Mr A’s condition was terminal. Ms C was informed of this when she arrived at her holiday destination but could not get a flight back until the following day and so did not see her father before he died.

We took advice from one of our medical advisers, and found that while Mr A was critically ill, he was stable on the day after his operation. We found no evidence that his death so soon afterwards could have been predicted, as his condition did not deteriorate significantly until shortly before his death. We also found that staff acted reasonably when they asked Mrs A to come into the hospital quickly and told her of her husband's terminal condition, as at that point Mr A was deteriorating rapidly.

Summary

Mr C is 76 years old and has a disability. He complained about the board's toenail cutting service. He said he needed his nails cut every eight to ten weeks, but the board only provided the service every 12 to 14 weeks. Mr C also said that because they recently told him that it would be 16 weeks until his next appointment, he had to pay for private treatment in between times. He felt that the service he received was inadequate.

When we investigated, the board explained that their view of Mr C's requirements was based on an assessment that they make of each patient to decide how often appointments were needed. This assessed Mr C as requiring appointments every 12 weeks. They said that they had obtained a detailed second opinion from a senior specialist at another of their clinics, which supported this view. The board also said that they try to meet the required timescale for the next appointment but there were times when this was not possible, for example when there were staff absences. At such times, patients such as Mr C who need only routine attention may find that their appointment is after the end of the recommended return period.

As part of our investigation, we obtained advice from our nursing adviser. She said that the board's assessments appeared to have been carried out appropriately. There was no clinical evidence to suggest that Mr C needed appointments more often than every 12 weeks. Our adviser noted that although Mr C would like to have his nails cut more often, the board had to make difficult decisions about managing resources. We found that they had managed Mr C's case appropriately and provided an adequate service.

Summary

Mr C said that an NHS 24 nurse practitioner failed to respond appropriately to a call made to NHS 24 when his mother fell ill. The nurse practitioner explained during the call that she would arrange for an out-of-hours GP to attend within two hours. Following the GP's visit, Mr C's mother was admitted to hospital where she later died. Mr C complained that the nurse practitioner failed to take into account his mother's recent admission to hospital, following the fracture of her hip, and failed to give the case sufficient priority.

Our nursing adviser considered the evidence, including a recording of the call, and reached the conclusion that the nurse practitioner's actions were reasonable. She noted that the nurse practitioner had in fact upgraded the response time from 'two hours' to an 'urgent' response after the telephone call but that, unfortunately, the family were not informed of this. As the nurse practitioner's actions were, however, reasonable in terms of the priority given to the call, we did not uphold the complaint.

Summary

Mrs C complained about the orthodontic treatment that her son (Mr A) received. (Orthodontics is the branch of dentistry dealing with the prevention and correction of irregular teeth.) Mr A attended an appointment with the orthodontist and Mrs C completed an NHS form so he could be considered for NHS treatment. The orthodontist found that Mr A's teeth were not misaligned enough to qualify for NHS funding but carried out work privately on his front teeth. Mrs C complained that she was not told that Mr A would be treated privately. She said that she did not agree to this and that she only became aware of the decision when she relocated to England and found that the orthodontist had withheld Mr A's clinical records because the bills were unpaid.

We found that Mr A should not have been considered eligible for NHS treatment. However, the orthodontist should in that case have obtained written consent from Mrs C for private treatment to be carried out. The decision to provide the treatment was confirmed in writing to Mr A's dentist, and the orthodontist said that it was discussed with Mrs C during the appointment, along with the associated costs. However, we found no evidence in the records to show that this was discussed with Mrs C. Neither did we find evidence that consent was obtained, or that any payment was taken once treatment commenced. We also found that it was inappropriate for the orthodontist to withhold Mr A's clinical records. We made recommendations to address thse failings.

Recommendations

We recommended that the dentist:

• arrange for copies of Mr A's clinical records to be provided to his new dentist and/or orthodontist on request;
• waive any outstanding fees associated with Mr A's treatment; and
• apologise to Mrs C for the issues highlighted by our investigation.