A medical practice in the Peterborough area

4. Ms E complains about poor care and communication she received from the Practice in relation to a condition recorded in her medical records, she says:

· in December 2019, during a GP appointment to discuss a separate issue, she tried to explain to the doctor that she was bleeding from her bowels and that ‘over the counter’ medication was not working but she was abruptly told to make another appointment. The doctor made no attempt to listen to her concerns and she was unable to get an appointment for several weeks

· in December 2019, receptionists were rude and unhelpful when she called to arrange an urgent appointment

· the Practice failed to tell her about a diagnosis of Hereditary Haemorrhagic Telangiectasia (HHT) (an inherited genetic condition affecting the blood vessels), inaccurately recorded in her medical records by her previous GP surgery, when she transferred there in 2017.

5. Ms E feels needing a separate appointment to discuss bleeding from her bowels caused a delay in accessing treatment and achieving an accurate diagnosis. Ms E also believes the receptionist’s attitude may have delayed her access to appropriate treatment.

6. Ms E says that she was denied the opportunity to adapt her work and lifestyle choices to take account of the diagnosis. Ms E says thinking she had HHT caused her anxiety, and she was signed off work as a result.

7. Ms E is looking for service improvements in treating rectal bleeding, in communication, and reviewing new patients. She would also like the Practice to confirm her records are now accurate and do not show she has HHT, and to apologise for the delays in treating her rectal bleeding.

8. In 2003, a HHT diagnosis was recorded at Ms E’s previous GP surgery. The Practice included this condition in a referral to the colorectal team in February 2020, and Ms E was told HHT was recorded on her records at the colorectal appointment in February 2020. In March 2020 the Practice requested advice from the Genetics Clinic at a local hospital to determine whether Ms E had HHT. In November 2020 the Genetics Clinic confirmed Ms E did not have HHT and she was discharged from the clinic.

Ms E being advised to book another appointment

11. Before we decide if we should investigate a complaint in more detail, 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. The Practice explained it allows 10 minutes per appointment, including for Ms E’s appointment relating to her ear. The appointment lasted 16 minutes and the doctor explained they would not be able to give Ms E the necessary time needed to fully discuss and examine her bleeding problem.

12. Information ‘GP Surgery Appointments’ on NHS.UK says a standard GP appointment currently lasts 10 minutes. This information says you may be able to book a longer appointment depending on the type of appointment you need. There is nothing to indicate Ms E booked a longer appointment. This is also supported by information on Myhealth.nhs.uk, which says should you need to book more than one issue you should consider booking a ‘double’ appointment. We have seen no evidence Ms E tried to book a double appointment.

13. We appreciate Ms E’s frustration at being asked to book another appointment and her unhappiness with the way the GP spoke to her.

14. We cannot know for sure what the tone and manner of the GP was in that appointment but can say that the information provided was correct. The time allowed for appointments at the Practice was in line with nationally published NHS information.

15. The GP suggested Ms E make a separate appointment for the separate issue she wished to discuss, and Ms E did not make another appointment until January 2020. We have seen no indication of maladministration (fault) leading to a delay in treatment, as the GP’s advice was in line with published NHS information about appointment lengths.

Receptionists were rude and unhelpful

16. Before we decide if we should investigate a complaint in more detail, we look at whether there are signs the events complained about had a negative effect which the organisation has not put right. We have done this, and we have found the Practice has already done enough to address Ms E’s experience of its reception staff. The response letter from the Practice apologises for the attitude and helpfulness of its receptionists.

17. The Practice explained it holds regular staff meetings where both compliments and complaints are discussed. This allows it to address any issues identified and learn from them. The response also confirms that following these meetings, they will offer any additional support and training to any of the team if required.

18. Our Principles for Good Complaint Handling say organisations should take responsibility for the actions of their staff. We can see the Practice offers its apologies and says it accepts Ms E was upset as a result of her interaction with the receptionists. We consider this response appropriately takes responsibility for the actions of its staff and the impact this had of Ms E and apologised for the distress it caused her. The Practice has explained how feedback is used to seek continuous improvement by explaining that feedback and potentially training could be administered. This again is in line with our Principles for Good Complaint Handling which say to address complaints organisations should take action, which includes ‘training or supervising staff’.

19. It is clear Ms E found the interaction with the reception staff distressing and we consider the Practice has taken appropriate action to acknowledge that and to explain steps it takes in response to feedback, including complaints.

Told there would be a four week wait for an urgent appointment

20. For this issue we considered the impact on Ms E and what the Practice has done to address it. We have not seen any indication that these issues had a negative impact on Ms E.

21. The Practice has explained that due to various reasons, such as COVID-19, and doctors leaving the Practice, there was limited access to appointments. It has acknowledged this and explained that if the doctor’s advance booked appointments are booked up then there is very little their receptionists can do.

22. We can see Ms E saw a GP towards the end of January 2020 and her test results were returned four days later. Ms E has told us they were not sent to her, so she went to collect them herself shortly after that date. She had a telephone appointment with a GP at the beginning of February 2020 and was referred to a specialist on the two week referral pathway the following day.

23. Ms E says she was told throughout December and January she would have to wait four weeks for an appointment. We appreciate how distressing this would have been. We can see once she did make an appointment for January, it took only 11 days for her to be referred on an urgent pathway for specialist treatment. We have seen no evidence of other contact with the Practice prior to this, but appreciate an unsuccessful attempt to book an appointment may not have been recorded.

24. The Practice has apologised and explained the pressure it was under due to staffing issues and has said that they will look to review their future allocations. This is in line with our Principles of Good Complaint Handling as the Practice has been accountable and acknowledged the delays and apologised for them. We consider this is an appropriate response given the evidence we have seen suggests Ms E was able to get an appointment in good time, despite initially being told she would need to wait four weeks.

Not told about HHT diagnosis upon transfer to Practice in 2017

25. Having considered what happened, in relation to the HHT diagnosis, we have not seen indications the Practice has got something wrong.

26. Ms E tells us she was not told about the diagnosis of HHT at any point since this was recorded on her records in 2003. This was incorrectly recorded by her previous GP surgery. She believes the Practice should have informed her of the diagnosis when she joined as a patient in 2017.

27. In its response, the Practice explains the HHT diagnosis was added in 2003, 14 years prior to Ms E joining the Practice. It says it cannot source any further information to explain how the HHT diagnosis was added to her records. We now know Ms E did not have HHT and it appears her previous GP surgery added it to her records in error.

28. We have considered the GMC guidance for doctors, and it focuses on doctors ensuring the treatment they provide is professional and in the patient’s best interests. Under ‘continuity and coordination of care’ the Guidance says doctors must share information with colleagues involved in a patient’s care including outside the team, including when you refer patients to other health providers.

29. We appreciate Ms E’s concern that a condition she was not aware of was recorded in her records, albeit in error. We have not seen evidence the Practice got things wrong. As the condition was recorded on her records some 14 years before she registered, it is reasonable that the Practice assumed she was aware of her medical history.

30. When the Practice referred Ms E to the specialist for further tests, it correctly shared the information about her previous conditions, including HHT. It also followed up with a genetics specialist team once it became aware Ms E had no knowledge of the condition, to establish whether she did have HHT, and the referral confirmed she did not.

31. Ms E complained that the Practice did not listen to her concerns regarding her bleeding, despite her having a history of HHT and this made her symptoms more concerning. Ms E was not aware of the HHT record until March 2020. During further consultations, no signs of Ms E having HHT were present. In November 2020 the Genetics Clinic at a local hospital confirmed Ms E did not have HHT and that this was a coding error which should be removed from her records.

32. The Practice has explained in their response they have referred the issue of incorrect information being on Ms E’s medical records to the genetics team at a local hospital for advice. They then contacted Ms E directly. The Practice explain that once she had seen the Genetics team, it would be happy to discuss findings and offer support to Ms E.

33. We have seen no indication of failings in the action the GP took before and after Ms E became aware of HHT recorded on her records as it correctly took steps to share information and make appropriate referrals at each stage, in line with the GMC guidance.

34. For the reasons above, we will not be investigating Ms E’s complaint further. We recognise the worry and distress Ms E suffered and hope that our consideration of the Practice’s actions has given her some reassurance.

1. We have carefully considered Ms E’s complaint about a medical practice in the Peterborough area (the Practice). We are very sorry to hear about Ms E’s experience and the impact that this had on her.

2. For one aspect of Ms E’s complaint, we found no indication the Practice did anything wrong. For other aspects of the complaint, we consider the Practice took appropriate actions to address them.

3. Ms E told us how worrying it was to think she had a genetic disorder she had not previously been aware of, and to not receive appropriate treatment for the bleeding she was experiencing. We appreciate the distress and worry she went through.