A practice in the Somerset area

3. Miss O complains about several aspects of the treatment she has received from the Practice.

4. Miss O says the Practice:

• gave mixed messages about what to do during her asthma review • did not listen to her concerns about her eczema, and • did not look at a lump on her neck but instead just told her it was a swollen lymph node.

5. Miss O also complains about the difficulty she had in contacting the Practice by phone and being told not to use the online booking system as it was not working.

6. Miss O says as a result, her eczema spread to every limb of her body and she got a fungal infection. She says overall this situation has caused her stress and she has had to move to a new practice.

7. As an outcome, Miss O is looking for an acceptance of what has gone wrong and for the Practice to take responsibility. She also wants the Practice to improve its appointment and phone system.

8. Miss O, who is in her late twenties and was diagnosed with eczema and asthma as a child. The Practice contacted Miss O on 7 December 2021, inviting her for her annual asthma review. Following this, Miss O contacted the Practice on 24 January 2022 because she was having a bad eczema flare-up.

12. Before we decide if we should conduct a detailed investigation of 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. If it appears something may have gone wrong, we look at if the organisation has already done enough to put it right.

Communication about peak flow readings

13. Miss O complains that during her asthma review in December 2021, a nurse at the Practice told her she only needed to give the highest and lowest readings after recording her peak flow for two weeks. After she gave these, she was told she needed to give the full set of readings. Miss O feels this shows mixed communication within the Practice and the mixed messages given to patients could cause concern.

14. In response, the Practice has said the nurse asked Miss O to record her peak flow readings for two weeks and give these to the Practice, but if that was not possible, the highest and lowest readings would be enough. The Practice explained that when the doctor came to review the highest and lowest readings, they decided they needed the full set of readings. The Practice explained it was not suggesting Miss O had done anything wrong. The doctor just needed more information from her.

15. Miss O’s medical records, which were completed at the time of her appointment, support what the Practice has said in its response. We cannot say for certain what the nurse said to Miss O during this appointment, but it is clear from what Miss O has said that she came away from it believing she only needed to give the highest and lowest readings, and we appreciate that.

16. Miss O recorded her peak flow readings every day to determine which were the highest and lowest to give these to the Practice. When Miss O received a text from the Practice asking for the further readings, she did not reply, as she felt frustrated the Practice had failed to ask for them initially. No matter what the nurse said during Miss O’s appointment, Miss O would have had the readings available if she had wanted to give them to the Practice. Miss O chose not to, and that is her choice.

17. We cannot determine for certain what was said during Miss O’s appointment. Even if the nurse was not clear the full set of readings needed to be given, this is not so far away from what should have happened to be considered a failing.

Treatment for eczema

18. Miss O complains the Practice did not listen to her and dismissed her concerns about her eczema, including not looking at her skin when she attended with infected eczema on 21 February 2022. Miss O says when she first went to the Practice, the eczema was only on her back and arm, but it then spread to every limb of her body.

19. In response, the Practice detailed what happened at each appointment, including saying Miss O was examined on 21 February. It confirmed it believes the care and treatment given at each point were appropriate.

20. Our adviser explained there is no NICE guideline for the treatment of atopic eczema in adults, so we used the GMC guidelines (points 15 and 16) to evaluate the care. We also considered the NHS website’s information on treatment for atopic eczema.

21. Point 15 of the GMC guidance says, ‘You must provide a good standard of practice and care. If you assess, diagnose or treat patients, you must adequately assess the patient’s conditions, taking account of their history (including the symptoms and psychological, spiritual, social and cultural factors), their views and values; where necessary, examine the patient [and] promptly provide or arrange suitable advice, investigations or treatment where necessary’.

22. Point 16 says, ‘In providing clinical care you must prescribe drugs or treatment, including repeat prescriptions, only when you have adequate knowledge of the patient’s health and are satisfied that the drugs or treatment serve the patient’s needs [and] provide effective treatments based on the best available evidence [and] take all possible steps to alleviate pain and distress whether or not a cure may be possible’.

23. The NHS website says, ‘The main treatments for atopic eczema are emollients (moisturisers) – used every day to stop the skin becoming dry [and] topical corticosteroids – creams and ointments used to reduce swelling and redness during flare-ups’.

24. Miss O’s medical records show during her consultation on 26 January, the Practice took her history, examined her, diagnosed her with eczema and advised her to increase her use of moisturiser.

25. Our adviser explained the correct treatment plan for eczema comes down to how the symptoms appear upon examination, which we are unable to determine. However, Miss O’s consultation is well documented. Based on the recorded details, the consultation was in line with the GMC’s guidelines, and the treatment given was in line with the NHS website.

26. Miss O’s medical records from 21 February show the Practice examined at least her back and arms during her consultation. Our adviser explained there were no documented signs of infection, such as crusting and weeping. The Practice prescribed Miss O a moisturiser and topical steroids. Our adviser told us that, again, this consultation was appropriate based on the recorded details.

27. We appreciate Miss O’s recollection of this appointment differs from what is documented in her medical record. The Practice’s record would have been completed at the time of her appointment. In contrast, Miss O did not mention this specific aspect of her complaint until her second complaint letter, dated 19 May. In the absence of any other evidence, we cannot say the Practice did anything wrong during this consultation.

28. Miss O returned to the Practice on 25 February. Her records say she did now show signs her eczema was infected, so the Practice prescribed her antibiotics. This is in line with the NICE guideline.

Treatment for a lump

29. Miss O complains the Practice did not look at a lump on her neck and just told her it was a swollen lymph node. Miss O says this was not in her notes which confirms her complaint about the Practice dismissing her concerns.

30. In response, the Practice has confirmed there is no mention of the lump on her neck in her records, and, as such, it cannot comment on this aspect of her complaint.

31. Again, the Practice will have completed the notes on Miss O’s record at the time of the appointment, and from what we have seen, the notes are thorough. This is not to say Miss O did not mention the lump to the Practice, but without any mention of it in her records, we are unable to form a view on what the Practice should have done.

Difficulty contacting the Practice

32. Miss O complains about the difficulty she had in contacting the Practice by phone. Miss O told us she had to call the Practice 288 times to be able to get through on 14 March 2022, and when she did, she had to wait at position one in the queue for 20 minutes.

33. In response, the Practice explained there had been an issue with its phone line. It was telling people in the queue they were first in line when they were not. This has now been rectified. The Practice also advised there can be a delay in answering calls due to the number of people trying to get through. It apologised for Miss O’s experience.

34. Our Principles of Good Complaint Handling say that to put things right, organisations should: ‘give an apology, explanation, and an acknowledgement of responsibility, and remedial action, which may include reviewing or changing a decision on the service given to an individual complainant; revising published material; revising procedures, policies or guidance to prevent the same thing happening again; training or supervising staff; or any combination of these’. We have seen the Practice has acted in line with this in apologising for Miss O’s experience and explaining the error with its phone line. The Practice has also said this is now rectified. We would not expect the Practice to do anything more than it already has done to address this aspect of the complaint.

35. Miss O also complains about being told not to use the online booking system as it does not work. The Practice has not directly addressed this in its responses and instead responded to explain more about how the online booking system works and how it has not identified any errors in this.

36. We do not feel it would be proportionate to seek a direct response to this point even though it the Practice has not addressed it. If staff at the Practice did say this to Miss O, we realise it would potentially have been wrong to do so, as the Practice has explained in its response the system was working at the time.

37. We appreciate the frustration Miss O would have felt that day considering the difficulties she had in trying to contact the Practice. If the Practice did give Miss O incorrect information about the system, we do not consider that serious enough to be a failing.

Conclusion

38. We have found no signs anything went wrong with the treatment the Practice gave to Miss O. We have also seen the Practice has taken sufficient action to put right anything we can see may have gone wrong with Miss O booking an appointment.

39. We recognise the stress that led Miss O to leave the Practice. We hope she now has a more satisfactory relationship with her new practice.

1. The Parliamentary and Health Service Ombudsman has carefully considered Miss O’s complaint about her treatment from, and her communication issues with a practice in the Somerset area (the Practice). We appreciate how frustrated Miss O has felt at not getting the level of care or service she expected when she was unwell.

2. After careful consideration, we have decided not to consider the complaint further. This is because we have seen no signs anything went wrong with the treatment the Practice gave to Miss O.