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3. Mr B complains about the care provided to his son, C, when he attended the Urgent Care Centre on 9 October 2023 after cutting his finger at school. Specifically, Mr B says inadequate functionality tests were performed and the clinician treating C failed to identify that his injury had cut through a tendon.

4. Mr B complains about the care provided to his son, C, when he attended the GP Practice on 15 November 2023 with restricted movement in a finger he had injured a few weeks earlier. Specifically, Mr B says the GP’s decision to refer C to the Hand Clinic for physiotherapy was incorrect.

5. Mr B complains about the care provided to his son, C, when he attended the NHS Trust on 13 December 2023 after being referred to hospital through the 111-service due to a hand injury. Specifically, after C and his mother decided that surgery on C’s finger was their preferred option, the consultant decided that an opinion from another clinician at a different Trust was required. The clinician had the same opinion as the consultant at the NHS Trust, so Mr B feels this just delayed the surgical process for C.

6. Mr B says C is in so much pain in his finger and palm that he is unable to write with his right hand. This has affected him academically and he has had to learn to write with his left hand. It is suspected that C now suffers from a condition called ‘trigger finger’ which involves his finger popping out of place and C having to manually rectify it. This is exceptionally painful for C, and he has had to leave lessons and go home at times, but it can affect him at any time of day sometimes impacting on his sleep. Apart from school, C has had to stop playing sport due to the pain and all these restrictions are impacting on his mental health. Mr B is concerned that the Urgent Care Centre’s initial failure to carry out appropriate tests to identify the problem may lead to C never regaining the full use of his hand.

7. As a set of outcomes, Mr B wants acknowledgement from the Urgent Care Centre that it failed to identify the full extent of C’s injury. Mr B also wants a financial remedy.

8. C is 12 years old. On 9 October 2023, C cut his finger at school on a knife in cookery. The cut was on his little finger, palm side, right hand at the first joint up from the knuckle. The school advised C's mother to take him to A&E due to the depth of the cut and as he had momentarily lost consciousness.

9. C’s mother took him to the Urgent Care Centre where the depth of the cut was assessed and steri strips were applied. Mr B says inadequate functionality tests were performed which failed to identify that C had cut through a tendon. C said the functionality test was a resistance test where he had to push upwards and downwards with his injured finger against the finger of the nurse. C said he was not able to fully perform these tests, but this was not noted by the clinician. The clinician appeared more to focus on the depth of the cut rather than any other additional checks.

10. Over the course of two weeks the cut healed. Following this, C found he was unable to move his little finger at the second joint. On learning this, an appointment was made to visit C's GP. C saw a GP on the 15 November 2023 who said he would be referred to physiotherapy. This was the earliest appointment via the GP that C’s mother was able to make through the booking system. Due to the fact C could not move his finger, Mr B was doubtful whether a referral to NHS physiotherapy was the right decision. Therefore, he contacted a physiotherapist friend who watched a video of the movement in C’s finger. The physiotherapist said therapy would not remedy his finger and C should return to the hospital as they suspected his flexor digitorum profundus had been severed.

11. An appointment was made via 111 for C to see a doctor on the 18 November 2023. On this occasion, the doctor examined his finger for infection, but no infection was present. He agreed physiotherapy was not an appropriate option and referred C to a paediatrician hand specialist.

12. On 13 December 2023, C attended hospital where he was seen by a consultant. He said C had cut through his tendon which is why he had lost the movement in his finger. The consultant explained due to the length of time since the injury, the tendon end had retracted into his palm so surgery would need to be performed on his finger and palm to locate the tendon to reattach. He also explained this should have been picked up when C originally attended the Urgent Care Centre and that operating closer to the time of injury would have meant a greater chance of success. The consultant and C's mother agreed to proceed with an operation planned for 6 weeks from that date.

13. On the 28 December 2023, Mr B received correspondence from the consultant stating he would like the opinion of a hand specialist before operating and that he would hear in due course. Mr B was concerned about the delay this would cause in C having surgery.

Urgent Care Centre

15. The law says we cannot investigate a complaint where a person has (or had) the option to take legal action, unless we consider this is (or was) unreasonable in the circumstances. We have discussed this with Mr B to understand his circumstances and the outcomes he wants for his complaint about the Urgent Care Centre. We do not consider whether legal action would succeed but whether it would be a reasonable option to look in to.

16. The Urgent Care Centre said in its complaint response that some functionality tests were completed, but there is no indication that the extension of C’s finger was tested, which uses a different tendon. It is therefore possible that an extensor tendon rupture may have been missed. As such, the Urgent Care Centre partly upheld Mr B’s complaint, but it has already taken some remedial action by contacting the clinician involved for a statement and circulating learning to remind staff to test for both flexor and extensor tendon rupture.

17. Nevertheless, we can see the potential injustice for C if further surgery is unsuccessful and he never regains full use of his hand. This is deeply concerning for C and his family. Given this, and with Mr B’s main desired outcome being financial compensation, we have explored with him the possibility of taking legal action against the Urgent Care Centre.

18. Mr B acknowledged that he had sought legal advice before coming to the Ombudsman and was told that he had to complete our process before contemplating legal action. This is incorrect. Legal action can be commenced at any time, but not alongside our process. It must be one or the other.

19. Therefore, Mr B confirmed that if the previous advice he had been given was incorrect, he would start searching for solicitors to take on his case against the Urgent Care Centre. We advised Mr B that we are not here to replace other forms of resolution, such as the courts. As such, where that route exists for complainants like Mr B, we need to consider if it is reasonable for him to pursue that first. Mr B must consider legal routes first. We are not a ‘stepping stone’ in pursuing legal action.

20. Mr B has a potential cause of action (clinical negligence), and he should be in time to take such action. Mr B has not said how much compensation he is seeking but given the circumstances of his complaint and the potential injustice for C, it could be a significant amount beyond what we can realistically achieve.

21. Mr B subsequently confirmed that he had contacted solicitors and was waiting to hear if they will take on his case. He has asked us to wait for the solicitors to decide before we take any further action, but we do not know how long their decision will take. Furthermore, we would expect Mr B to contact several firms of solicitors if this approach is unsuccessful and exhaust this process as part of his attempt to proceed with a legal claim.

22. Overall, we consider that Mr B is willing to engage with the legal route (and has shown he has done so) and to that end, we are satisfied that he should (and is) exploring his legal options. We do not know how long legal firms will take to come back and note that Mr B may not need Ombudsman intervention if a solicitor agrees to take this case. Ombudsman consideration of a complaint can take time and there are strict time limits on making clinical negligence claims. Therefore, given the time that has already elapsed, our consideration of Mr B’s complaint now could prejudice his ability to pursue a legal claim.

23. We do remain an option for considering Mr B’s complaint against the Urgent Care Centre, but only if the legal route is unavailable to him or it does not cover some parts of his complaint that we can realistically consider. Therefore, in accordance with our processes, we must close Mr B’s complaint for now. We hope Mr B can find suitable legal representation to pursue legal action. He can come back to us at the end of the legal process if he remains dissatisfied.

GP Practice

24. Before we decide if we should conduct a detailed investigation of a complaint, we look at whether there are signs the events complained about had a negative effect which the organisation has not put right. Having done so we have found that the GP Practice and the NHS Trust has already done enough to put right the impact of these events.

25. The GP Practice said in its complaint response that after the GP took some advice (from a Senior House Officer) when C and his mother came to the surgery on 15 November 2023, he was referred to the paediatric orthopaedic service. This resulted in C being seen at the NHS Trust by an appropriate consultant.

26. On 18 November 2023, C was seen at the extended hours service. During this consultation, it was noted by the doctor that his parents had mentioned C had been referred to physiotherapy which they thought was unhelpful. After examination, the doctor commented that he could see C had in fact been referred to paediatric orthopaedics, not physiotherapy. Therefore, this was an appropriate referral, and no further action was required.

27. The GP Practice felt there had been a misunderstanding by C’s parents in that they thought the doctor seen on 18 November 2023 had referred him, when in fact the doctor on 15 November 2023 had referred him to the NHS Trust appropriately at the first opportunity.

28. Given this explanation by the GP Practice, we are satisfied this was a misunderstanding. C was appropriately referred when he saw the doctor on 15 November 2023 and there was nothing further the Practice should have done. We put this to Mr B, and he acknowledged that this explanation had rectified this part of his complaint. As such, there is no further action for us to take regarding this part of Mr B’s complaint.

NHS Trust

29. The NHS Trust said in its complaint response that C saw the consultant on 13 December 2023 with his mother present. After discussing the pros and cons of treatment options, C and his mother decided that they wanted hand surgery. After the consultation, the consultant discussed the case with some colleagues and decided to request the opinion of a surgeon based at another NHS Trust. The referral letter was sent on 21 December 2023 and the consultant wrote to Mr B on the same day about the change of plan.

30. The NHS Trust apologised about the delay in seeking a further opinion, but said it felt this was the most appropriate course of action in the circumstances to get C the best care. After Mr B raised initial concerns about this, the NHS Trust tried to expediate C’s appointment with the surgeon, but this was at the discretion of the other NHS Trust. We note that C was seen by the surgeon at the other NHS Trust on 24 January 2024.

31. The consultant had a change of heart about C’s treatment after seeing him on 13 December 2023. Although, unfortunately, the consultant did not inform C and his family about this on the day, we consider it was in C’s best clinical interests as the NHS Trust has said. Furthermore, the consultant did let C, and his family know in a letter sent on 21 December 2023.

32. We appreciate that C did not see the surgeon until over one month later on 24 January 2024, and this was a frustrating and worrying time for him and his family. While it is acknowledged that this was inconvenient, there is no indication it made any difference to C’s care or outcome. Any delay is due to the other NHS Trust which is not part of this complaint.

33. In summary, while it may have been possible for the NHS Trust to complete this process more promptly, it is unclear by how much as C would still have been on a waiting list with other patients. The NHS Trust apologised to Mr B and his family for the change of plan and informed them about the new arrangements promptly by letter. We put this to Mr B, and he acknowledged that this explanation had rectified this part of his complaint. As such, there is no further action for us to take regarding this part of Mr B’s complaint.

34. We recognise that C’s day-to-day life has been affected since his hand injury in October 2023, and this is difficult for him, and for his family to witness. Mr B has informed us that after an initial procedure earlier this year, C is due to have a second procedure on his hand during December 2024. We hope this goes well and resolves any movement restrictions in C’s hand.

1. We have carefully considered Mr B’s complaints about Urgent Care Centre, GP Practice and NHS Trust.

-We consider Mr B could take legal action on the matter he has brought to us about Urgent Care Centre.

-We have decided the GP Practice and the NHS Trust have already done enough to put right the impact of these events on C and his family.

2. We recognise that C has had a difficult experience with his hand injury which is ongoing, and this has affected everyone in Mr B’s family. Nevertheless, the GP Practice and the NHS Trust have both appropriately explained their roles in this matter and we consider Mr B has a reasonable alternative legal remedy to resolve his complaint about the Urgent Care Centre.