An independent provider in the Tower Hamlets area

3. Mrs S complains that when she went to the Treatment Centre on 10 February 2021:

• staff did not X-ray her foot • the management plan did not include immobilising her foot • staff failed to diagnose an osteochondral lesion of the talus (an injury to the bone and cartilage in the ankle).

4. She complains the Practice:

• failed to refer her to an orthopaedic specialist on 18 March 2021 • recommended physiotherapy that was not appropriate for the injury she had • failed to identify and act on the injury when her X-rays were returned • ignored the recommendation from a private orthopaedic surgeon to refer her to their service under the NHS for an MRI scan and ongoing care.

5. Mrs S complains the Trust: • started a treatment plan that was not suitable for her injury • failed to appropriately transfer her care from a private provider to the Trust’s musculoskeletal (MSK) service • did not consider her osteochondral lesion injury during an appointment on 22 March 2021 • gave her physiotherapy exercises to do that were not appropriate.

6. She says these errors caused her pain and distress. She says she has been unable to work in the fitness industry, had to pay for private treatment in the UK and had to travel abroad for treatment. She says she would not have had these costs if she was given the right care.

7. Mrs S would like the organisations to reimburse her for the costs of her private treatment and travelling abroad for treatment. She would also like a financial payment to recognise the distress caused and her loss of earnings due to being unable to work.

8. Mrs S injured her ankle on 18 January 2021. On 25 January she called NHS 111 and spoke to a GP at the Practice. The GP offered an X-ray at a local hospital on 4 February but Mrs S was unable to attend due to poor weather.

9. On 10 February Mrs S called NHS 111 again and was advised to attend the Treatment Centre. She attended the same day and was unhappy with the appointment.

10. On 1 March, Mrs S had an X-ray. The results were sent to her GP on 4 March and showed she had an osteochondral lesion. The GP called Mrs S on 18 March to tell her this.

11. Mrs S had a video consultation with a physiotherapist on 22 March. Mrs S says she was given physical exercises to complete.

12. On 25 March Mrs S booked a consultation with a private orthopaedic consultant. The consultant wrote a letter to her GP asking for a referral to their NHS clinic.

13. Mrs S continued to struggle with pain in her ankle. She had an MRI scan on 16 June, which supported the findings of the X-ray.

14. She attended an appointment with Trust’s MSK service on 23 September to discuss surgery and possible injections for inflammation.

15. At the same time, Mrs S complained to the services that had given care for her ankle injury. She complained to all three organisations involved in her care in September 2021. She received final responses from them all by March 2022.

16. Mrs S came to us on 12 March 2022. On 21 December we decided to close the case because we thought it was reasonable for Mrs S to explore the legal options available to her first. Mrs S spoke to a solicitor in February 2023 and got a response in March. She then came to us again in May.

18. The Health Service Commissioners Act 1993 is the law that gives us our power to investigate complaints about the NHS. It says we cannot look into a complaint that comes to us more than 12 months after the issues happened, unless it was unreasonable for the person to come to us sooner.

19. Mrs S became aware of the issues she complains about between February and March 2021. This was when she experienced a poor service from the organisations she has complained about.

20. She complained to them in September 2021. We are satisfied that because she had 12 months to make a complaint and she did this within that time period, the seven months it took to do this was not unreasonable.

21. Between September 2021 and March 2022, Mrs S was involved in the complaints process for these organisations, and we are satisfied that this fully explains the time between September 2021 and when she came to us in March 2022.

22. In December 2022 we decided it was reasonable for Mrs S to explore her legal options and try to make a claim for medical negligence. Section 4 of the law states that we cannot do an investigation if a person has a legal route to resolve their complaint and it is not unreasonable to expect the person to do this.

23. When we wrote to Mrs S in December 2022, we advised her that she should speak to solicitors and explore the legal option available to her. We also advised her that if she was unable to get a solicitor to take on her case she should return to us without delay. We advised that there is a time limit to bringing complaints to our service and she should explore these options and return to us at the earliest opportunity.

24. Mrs S approached a solicitor’s firm in February, which advised her it could not represent her but that she should contact other firms who may be able to help. She did not approach another firm but instead returned to our service two months later.

25. If a person comes to us when their complaint is not ready for us, such as in Mrs S’s case, and the complaint comes back to us outside our time limit, we must consider whether there were any unreasonable delays in returning to our service.

26. We note there are two reasons why we cannot take further action at this time. The first is that we are not satisfied she has fully explored the legal options available to her. The second is that due to the time that has passed since these events happened, the complaint is now outside our time limit.

27. We considered whether it would be right or fair to ask Mrs S to explore her legal options and return to us, knowing there is a chance we may not be able to look at the complaint at a later date due to the time limit. We decided that the fairest approach would be to consider whether we would be able to put the time limit to one side now and if not, give Mrs S this decision now. This was to stop her from experiencing the inconvenience of a delay.

28. For the reasons already explained, we are satisfied that if Mrs S had fully explored her legal options before coming to us, we would more likely than not have decided the complaint was within our time limit, or that the small delay of one month was because of the time the organisations took to handle her complaint. But, after we asked her to explore these options, it was five months before she returned to our service and this is longer than we would expect.

29. The email from the solicitors firm shows that Mrs S approached them on 22 March 2023. But, her account is that she approached them in February 2023 and got a response in March. We have seen no reason why we should not accept her account of what happened. This means that she took no action for two months after our decision and then after getting the response, waited another seven weeks to come back to us. The month between when she contacted the solicitor and when it responded to her, is a period of delay that is reasonably explained. We asked Mrs S whether there were any personal circumstances that explained the delay in returning to our service.

30. When we spoke with Mrs S in October 2023, we explained the time limit again and asked about the time between when we sent our decision in December 2022 and her coming back to us in May 2023. She said she travelled abroad for surgery and was recovering until May 2023. According to many patient information sources published by the NHS, the recovery time for returning to work after this surgery is two weeks. These sources say there will be swelling/discomfort for up to three months, but this would not stop someone from working or doing everyday tasks.

31. Mrs S sent her complaints to us online and has been able to communicate by email. This tells us that being abroad was not a barrier to her contacting us sooner. While we appreciate that she would have needed time to recover from surgery, the recovery time is two weeks so we are not persuaded that this explains the five months it took to speak to a solicitor and then return to us. Had we seen evidence of attempts at contacting different firms, or serious delays in the firm getting back to her this may have explained the delay. But in this case, the solicitor replied within one month.

32. Only part of this delay is explained. She did not take action to approach any solicitors until two months after our decision in December 2022 and we have not seen a good enough explanation of why she could not have acted sooner.

33. Because we sent our first decision just before Christmas, we would not expect Mrs S to reach out to firms for legal advice until the new year. From the first week in January there was still a delay of six weeks in her taking any action to explore her legal options. We can also accept that her surgery abroad explains around three weeks of the delay, a week to plan and travel and two weeks to recover. We do not consider that such minor surgery would stop her from approaching us again for some months or delay her from approaching solicitors. We consider that most of this delay is not well explained by her personal circumstances, or the time taken to approach the solicitor’s firm.

34. For these reasons we are not taking further action on her complaint.

1. We have carefully considered Mrs S’s complaint about a GP practice in the Islington area (the Practice), an independent provider in the Tower Hamlets area (the Treatment Centre) and Whittington Health NHS Trust (the Trust). We have decided not to take further action on her complaint because it came to us outside of our time limit and we have not seen good reasons to put our time limit to one side.

2. We recognise that Mrs S’s experience caused her ongoing pain and distress and she has paid for private treatment. She also returned abroad to get the surgery she needed and we understand this involved costs. Our decision does not take away from how these events affected Mrs S.