A practice in the City of Leicester area

5. Mrs C complains about several aspects of care and treatment provided by the Practice between February 2020 and November 2023. She says:

Between February 2020 and January 2022 • doctors failed to diagnose her leg pain as fibromyalgia • the Practice failed to respond to her verbal complaint in 2021

Between November 2022 and August 2023 • doctors failed to identify her stomach symptoms as gastritis

In November 2023 • doctors refused to provide further antibiotics for a chest infection after her symptoms became worse

6. Mrs C says the treatments the GPs gave her for her leg pain were not helpful and did not relieve her symptoms. Mrs C says she suffered for several months before her gastritis was diagnosed and she started to receive appropriate treatment. Mrs C says her chest infection developed into sepsis (a life-threatening reaction to an infection) and pneumonia (inflammation of the lungs) for which she required inpatient treatment in hospital. She says she nearly died from the sepsis due to the GPs failing to prescribe additional antibiotics.

7. Mrs C seeks an apology from the Practice for failings and a financial payment in recognition of the failings and the impact they had on her.

8. In February 2020 Mrs C started complaining to GPs at the Practice about pain in her legs. She was referred to the chronic pain clinic in August 2021 and was eventually diagnosed with fibromyalgia (a long-term condition that causes widespread pain and other symptoms) by her rheumatologist, who treated her for another condition.

9. Mrs C says she started having problems with her stomach in November 2022. In April 2023 she visited the GP, complaining of weight loss and reduced appetite. In May 2023 Mrs C had an endoscopy and was diagnosed with gastritis (when the lining of the stomach becomes irritated and causes pain) and candida (a fungal infection, also known as thrush) in her oesophagus. She returned to the GP in July with continuing symptoms and was prescribed further medication to treat thrush and gastritis. In August, due to ongoing symptoms, the GP referred Mrs C to gastroenterology.

10. On 7 November 2023 Mrs C was prescribed antibiotics and steroids by the GP for a chest infection. On 11 November she contacted the Practice to ask for more antibiotics as the infection had not cleared. The Practice advised her to call NHS 111. On 17 November, Mrs C called NHS 111 and was advised to attend Accident and Emergency. She did so and was diagnosed with pneumonia and sepsis.

11. Mrs C complained to the Practice on 16 January 2024 about the three separate issues set out above.

Leg pain

15. The law says a person needs to make their complaint to us within a year of becoming aware of the problem. We cannot investigate complaints brought to us after one year, unless we consider there is a good reason to do so. We have discussed this with Mrs C to understand the reasons why she could not do so. We have also considered the time the organisation has taken to respond to Mrs C.

16. Mrs C says she first approached the Practice to discuss symptoms of pain in her legs in February 2020. We can see Mrs C was advised by the GP to discuss her symptoms of leg pain with her rheumatologist, who she saw for a pre-existing condition. In June 2021, a GP referred Mrs C to a chronic pain clinic as her symptoms of pain in her legs continued, and treatment provided by the Practice was not helping. Mrs C was then diagnosed with fibromyalgia.

17. Mrs C says she then made a verbal complaint to the practice manager at the time she was diagnosed with fibromyalgia but heard nothing further. The Practice says the practice manager was then absent from work on sick leave, but that Mrs C could have approached the covering practice managers to continue discussing her concerns. The Practice apologised this had not been made clear to her at the time.

18. Mrs C complained to the Practice in writing about this issue alongside the other two episodes of care in January 2024. The Practice responded to Mrs C on 12 March 2024, providing explanations relating to all three episodes of care. It explained NHS complaints regulations state complaints should be made within 12 months of the incident or the person becoming aware of the issues complained about. Despite this the Practice investigated her concerns about the leg pain, based on what it could see in her healthcare records.

19. The NHS complaints regulations state a complaint about the NHS in England must be made not later than 12 months after the date on which an incident occurred or, if later, the date on which a person became aware of the issues complained about. The time limit can be put aside if the organisation is satisfied the person had good reasons for not making a complaint within the time limit and if it is still possible to investigate the complaint effectively or fairly.

20. Mrs C was unable to specify the date when she was diagnosed with fibromyalgia, although she confirms this was after she was seen in the chronic pain clinic in 2021. The earliest reference to a diagnosis of fibromyalgia we could see in her GP records was on 17 May 2022, although we think the diagnosis was made earlier than this. Mrs C did not make a formal complaint about her concerns about leg pain until 16 January 2024, 20 months after the first reference to fibromyalgia in her GP records.

21. We can see Mrs C was advised initially to discuss her symptoms of leg pain with her rheumatologist in 2020, and she says the diagnosis of fibromyalgia was confirmed by her rheumatologist after she was seen in the chronic pain clinic in 2021. We note Mrs C then raised her concerns about a delay in diagnosis of fibromyalgia with the practice manager at the time, but did not follow this up further until she made her formal complaint to the Practice on 16 January 2024.

22. We asked Mrs C why she did not make her complaint about leg pain earlier, and she told us she did not know she could make a complaint about NHS care and treatment until after she had sepsis in November 2023. We can see Mrs C approached a charity, the Patient’s Association, to support her complaint to the Practice in January 2024. We cannot see any good reason Mrs C could not have explored her options to make a complaint about this earlier.

23. For this reason, we have decided not to put aside our time limit to investigate her concerns about leg pain and the time it took for her to be diagnosed with fibromyalgia.

Gastritis

24. Mrs C says she started to have symptoms of her stomach problem in November 2022, but we could not find any evidence she had raised this with her GPs until April 2023.

25. 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. We have done this and have not found any indications that something has gone wrong.

26. On 3 April 2023, Mrs C visited the GP with symptoms of weight loss. At the time, the GP thought the weight loss could be due to a worsening of her depression. On 19 April 2023, the GP ordered a number of investigations to check for other reasons for the weight loss, including blood tests, a chest X-ray and a faecal immunochemical test (FIT) which checks for small amounts of blood in stools as this can be a sign of cancer. These tests are in line with NICE guidelines for suspected cancer, which recommends a number of tests to screen out cancer as a cause of unexplained weight loss.

27. The tests came back normal, and the GP then referred Mrs C under the urgent two week wait suspected cancer pathway to investigate her weight loss further. This was appropriate as NICE guidelines for suspected cancer recommends urgent investigation or a suspected cancer pathway referral if the cause of weight loss cannot be identified. Mrs C then had a CT scan of her chest, abdomen and pelvis, which did not show any signs of cancer.

28. With the previous tests being normal, Mrs C returned to her GP on 10 May 2023 with symptoms of early satiety (feeling full after eating a small amount), dyspepsia (indigestion or reflux) and dysphagia (food getting stuck in the oesophagus when swallowing). The GP immediately referred Mrs C under the two week wait suspected cancer pathway for investigation of these symptoms. Again, this is in line with NICE guidelines on suspected cancer, which says an urgent endoscopy should be arranged within two weeks of these symptoms being reported.

29. Mrs C had an endoscopy which showed she had gastritis and candida in her oesophagus. This was treated with fluconazole, an antifungal treatment, and the GP changed her antacid (medicines that neutralise the acid in the stomach) from lansoprazole to esomeprazole to treat the symptoms of gastritis. This was in line with NICE guidelines on candida and gastro-oesophageal reflux disease and dyspepsia.

30. Mrs C reported to the GP on 31 May her symptoms were a lot better on esomeprazole. She was prescribed anti-sickness tablets for symptoms of nausea.

31. On 11 July Mrs C returned to the GP, saying her symptoms of gastritis and candida had returned. The GP prescribed another antacid and Mrs C was advised to return in a month if her symptoms continued.

32. On 23 August the GP referred Mrs C to gastroenterology due to ongoing symptoms with gastritis and candida infection. This is in line with NICE guidance on gastro-oesophageal reflux disease and dyspepsia, which says doctors should consider referral to a specialist service for people with gastro-oesophageal symptoms which do not respond to treatment, or which are unexplained.

33. We consider the GPs at the Practice acted in line with NICE guidance in relation to Mrs C’s symptoms of gastritis and candida. We acknowledge Mrs C has concerns about the time it took to identify the cause of her symptoms and the discomfort and pain she experienced. We hope our explanations provide her with reassurance the GPs acted in line with guidance and standards in dealing with her symptoms of stomach issues.

Pneumonia and sepsis

34. Mrs C saw a GP on 7 November 2023 with a worsening of her existing chronic obstructive pulmonary disease (COPD - the name for a group of lung conditions that cause breathing difficulties). She had symptoms of infection including coughing up green phlegm and was prescribed a course of antibiotics and steroids.

35. Mrs C says GPs at the Practice refused to provide her with additional antibiotics on 10 November 2023. She says as a result of this, her symptoms became worse, and she was admitted to hospital on 17 November with pneumonia and sepsis.

36. Again, we looked into whether there were any signs GPs at the Practice had got something wrong. Our adviser says Mrs C’s observations taken on 7 November 2023 did not show any suggestion a hospital admission was needed. She had a mild wheeze which is common in COPD flare ups.

37. When Mrs C contacted the Practice on 10 November 2023, the Practice clinic was full. Mrs C was still on the course of antibiotics which had been prescribed for her. Mrs C was advised to contact NHS 111 if her symptoms were getting worse. Our adviser says the Practice provided appropriate treatment and safety-netting advice to Mrs C on 11 November 2023, with the treatment provided (antibiotics and steroids) in line with NICE guidance on managing patients with COPD.

38. Mrs C did not contact the Practice again or call NHS 111 until 17 November 2023, by which time her symptoms had become worse, with chest pains and coughing up blood. She was diagnosed with pneumonia and says she had sepsis and required treatment in hospital for this.

39. We think Mrs C was given appropriate advice by the Practice to contact NHS 111 or seek urgent care or treatment, as it had no appointments available. She was still part-way through the course of antibiotics, which were appropriately provided by the GPs in line with NICE guidance on managing COPD. We think the actions taken by the Practice on

10 November 2023 were appropriate and have not seen any indications there was anything wrong with the advice provided to Mrs C. For this reason, we will not be taking any further action on her complaint.

40. We are sorry Mrs C’s condition continued to worsen and that she was later admitted to hospital with pneumonia on 17 November 2023. We appreciate this would have been a very difficult and frightening experience for her. We thank Mrs C for bringing her complaint to us and hope the explanations provided in this statement provide her with reassurance on her concerns.

1. We have carefully considered Mrs C’s complaint about a Practice in the Leicester area. We were sorry to hear about Mrs C’s experiences and illnesses and how they have affected her.

2. Mrs C complained about three separate episodes of care from the Practice. We have decided her complaint about how the GPs managed her complaints of leg pain falls outside of our time limit, and we have seen no good reason to put our time limit aside to consider it further.

3. We have also looked into her concerns about symptoms of stomach problems and about treatment of a chest infection and seen no indication of anything wrong with the care and treatment provided.

4. It is for these reasons that we do not propose to investigate this complaint further.