A medical practice in the Bath and North East Somerset area

3. Mrs A complains her GP at the Practice wrongly attributed her symptoms of Deep Vein Thrombosis (DVT) to an existing diagnosis of varicose veins, when they assessed her on 7 January. DVT is a condition of blood clots forming deep in the body. Varicose veins are swollen or enlarged veins. Both conditions usually occur in the legs.

4. Mrs A says the GP did not explore alternative causes of symptoms, beyond varicose veins. She says the GP failed to diagnose the cause of her pain and therefore offered inappropriate treatment for DVT.

5. Mrs A says what happened caused her physical and emotional trauma. She says she felt shocked and angry, as well as frightened about what could have happened. She also says she had to pay more than £6000 for private treatment.

6. Mrs A wants recognition and acceptance that the outcome of her assessment on 7 January was unsatisfactory and did not address the cause of her pain. She also wants acknowledgement the GP did not carry out further investigation to establish the cause of her symptoms. Mrs A would also like a review of the GP’s practice, and a refund of all costs she incurred.

7. Mrs A has a history of varicose veins. On 7 January, Mrs A attended the Practice due to pain in her calf. Mrs A told us the GP prescribed pain relief and told her there was nothing that could be done.

8. On 24 January, Mrs A obtained a private diagnosis following a doppler scan (an ultrasound scan used to estimate the blood flow through blood vessels).

9. The scan revealed 'extensive superficial thrombophlebitis’ (inflammation in the tissue surrounding the vein caused by a blood clot). The scan showed this was affecting the entire length of some of Mrs A’s blood vessels, extending into the femoral vein, meaning the scan showed femoral DVT as well.

13. Before we decide if we should carry out a detailed investigation into a complaint, we look at whether there are signs the organisation has got something wrong. We do this by comparing what should have happened with what did happen. We have done this, and we have not found any indications that something has gone wrong.

14. Mrs A complained to us her GP wrongly attributed her symptoms of DVT to an existing diagnosis of varicose veins. Mrs A says the GP did not explore alternative causes of her symptoms, beyond varicose veins. She says the GP failed to diagnose and therefore offer appropriate treatment for DVT. She said this resulted in her paying for private treatment.

15. During our primary investigation into Mrs A's complaint, we reviewed her medical records. We discussed the case with a clinical adviser to help us understand the correct process the Practice should have followed at the time. This allowed us to consider if the Practice acted in line with the process.

16. GMC guidance says for doctors to provide good clinical care, they should assess patients' conditions and consider their history. It also states that they should examine the patient, promptly provide, or arrange suitable advice, and refer to another practitioner when this serves the patients' needs.

17. We also used NICE guidance Clinical Knowledge Summary to help us understand what would be good clinical care for the appointment Mrs A is unhappy about. This guidance says to use the two level DVT Wells score to assess the likelihood of DVT. A DVT Wells score is a checklist that gives a score depending on the symptoms a patient has. A Wells score of two shows that DVT is likely, and a score of one shows DVT is unlikely.

18. NICE guidance Clinical knowledge Summary says, for people who are unlikely to have DVT (Wells score below two), the recommendation is to offer D-dimer test with the results available within four hours. A D-dimer is a blood test used to check for evidence of blood clotting problems.

19. We have also reviewed the specific NICE guideline for thrombosis conditions, like DVT. That guidance tells us what clinicians should do if both the Wells and D-dimer tests do not indicate DVT. It says clinicians should think about alternative diagnoses and tell the person it is not likely they have DVT.

20. It is documented in Mrs A’s medical records that the GP did a Wells score assessment and a D-dimer test in order to exclude DVT. The medical records show the GP completed the Wells test, taking into account the symptoms Mrs A had, including significant calf pain. The result of the Wells score was one. The D-dimer test was negative for signs of clotting. These two results indicated DVT was unlikely.

21. The evidence we have seen indicates the Practice did the tests the guidance on diagnosing DVT recommends. This indicates the Practice suspected DVT and investigated it in line with the guidance. The evidence indicates the Practice thought about an alternative diagnosis to varicose veins, after exploring possible DVT.

22. This indicates the Practice acted in line with GMC and NICE guidance. This is because the medical records indicate the Practice promptly provided and arranged suitable advice and investigations in the D-dimer test and Wells score.

23. This indicates the Practice acted in line with the guidance when it diagnosed Mrs A with varicose veins and ruled out DVT. We recognise Mrs A had private investigations which found DVT. The evidence indicates there were no indications of DVT at the time, in the appropriate tests the Practice carried out. For the reasons we have explained, we have seen no indications of failings for this complaint.

24. We understand that Mrs A has experienced painful symptoms, and the issues have had a significant impact on her emotional wellbeing. We appreciate why she brought her concerns to us.

1. We have carefully considered Mrs A’s complaint about a medical practice in the Bath and North East Somerset area (the Practice). We have seen no indication that anything went seriously wrong. We have reviewed all the relevant evidence that indicates the Practice assessed Mrs A’s symptoms and considered alternative causes, in line with relevant standards.

2. We are sorry to hear Mrs A’s concerns about the care she received. We recognise she has suffered difficult symptoms and this has been a distressing experience for her.