A practice in the North Northamptonshire area

7. Mr B complains on behalf of his wife, Mrs B, about aspects of care and treatment Mrs B received from the Practice between July and September 2022. He specifically complains the Practice did not offer a face to face appointment at first contact and did not provide suitable pain relief when his wife presented with rib pain.

8. Mr B also complains the complaint process took a very long time.

9. Mr B explains his wife was in severe pain for more than two months.

10. Mr B also explains his wife passed away and was not able to consider the outcome of the complaint. Mr B explains this brings him a great deal of distress.

11. Mr B would like the Practice to apologise and to implement service improvements.

12. Mrs B was 71 had lung cancer and due to this one of her lungs was removed.

13. At the end of September 2021, she had a cancer lung review with her GP and no further concerns were raised until July 2022.

Face to face appointments

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

19. Mr B explains his wife phoned the Practice to obtain an appointment in July 2022. He details his wife was a cancer patient and as such, the Practice reassured them it had a process in place to ensure Mrs B received prompt treatment without unnecessary delay.

20. Sadly, in July 2022 the Practice did not act in line with the relevant process and this led to unnecessary distress and anxiety of obtaining a face to face appointment.

21. The Practice apologised for this during the local resolution stage and detailed it retrained all staff to ensure the relevant process is followed.

22. We recognise Mr and Mrs B felt disappointed the Practice was not able to offer a face to face appointment at the first point of contact. We are sorry to hear about the distress this has caused over the years.

23. Our Principles of Remedy say organisations should ‘try to offer a remedy that returns the complainant to the position they would have been in otherwise. An appropriate range of remedies will include: • an apology, explanation, and acknowledgement of responsibility • remedial action, which may include reviewing or changing a decision on the service given to an individual complainant; revising published material; revising procedures to prevent the same thing happening again; training or supervising staff; or any combination of these.’

24. We consider the action the Practice took following the complaint, along with the apology, are in line with our Principles for Remedy and put right the anxiety and distress Mrs and Mr B experienced. Furthermore, we consider the remedies the Practice proposed remedies are in line with Mr and Mrs B desired outcomes. For these reasons, we do not propose to take any further action on this part of the complaint.

Pain medication

25. Mr B complains the Practice did not provide suitable pain relief medication for his wife and her severe pain remained unmanaged for two months.

26. Medical records document Mrs B presented to the Practice with cough and left sided chest pain, at the end of July 2022. She had had a recent computed tomography (CT – a computer guided X-ray to take images of the inside of the body) scan of her lungs which the GP noted, and this showed some shadowing on the left side. The GP listened to Mrs B’s chest, and this examination revealed Mrs B had coarse crepitations (cracking breath sounds) on the left side. The GP prescribed antibiotics for a possible chest infection.

27. Records show there is no documented discussion during this appointment, about the pain Mrs B attended with or about pain relief.

28. Medical records document mid August 2022 Mrs B reattended with left sided chest pain. Sadly, again, there is no documented discussion about pain or pain relief.

29. Records show, in August 2022, the Practice asked Mrs B to contact her renal specialist herself regarding pain relief.

30. Medical records document specialists from secondary care prescribed Mrs B strong pain relief in September 2022.

31. GMC Good Medical Practice (2013) state clinicians: • ‘must promptly provide or arrange suitable advice, investigations or treatment where necessary • must take all possible steps to alleviate pain and distress whether or not a cure may be possible.’

32. Our adviser confirmed the Practice provided consultations and antibiotic treatment in line with established clinical practice, as listed above.

33. Our adviser explained general practitioners can prescribe strong pain medication and it is in their remit to seek support from other clinicians if there are doubts about the suitability of pain relief.

34. Based on medical records and independent clinical advice we have seen indications the Practice did not manage Mrs B’s pain in line with GMC’s Good Medical Practice (2013) guidance. We have also seen indications the Practice did not sought advice from colleagues on Mrs B’s behalf if it was not sure what it could prescribe.

35. As such, based on the pain Mrs B described and the Practice recorded in the medical notes, we are of the view she may have been in pain longer than she should have been.

36. We are sorry to hear Mrs B was in severe pain during these months. Based on the details Mr B provided we can see the excruciating pain Mrs B felt affected both her and her husband.

37. During this process, we approached the Practice and asked if it would be willing to consider a remedy to put right this part of the complaint. The Practice agreed to this.

38. Our NHS Complaints Standards say organisations should find ‘suitable and appropriate ways to put things right for people who raise a complaint’.

39. In this case, we are satisfied the Practice has acknowledged it can provide and apology and a financial remedy of £1,200 to remedy this part of the complaint. We found this proposal for remedy in line with our NHS Complaints Standards, therefore, we have decided not to take any further action.

Complaint Handling

40. Before we decide if we should conduct a detailed investigation of a complaint, we look at whether there are signs the event complained about had a negative effect which the organisation has not put right. Having done so we have found the Integrated Care Board has already done enough to put right the impact of these events.

41. Mrs B raised her original complaint in 2022, by contacting NHS England. As such, the complaint was passed to the local Integrated Care Board (ICB) for investigation. The local Integrated Care Board commissions private primary care practices, such as the Practice to deliver NHS funded care and treatment.

42. Sadly, there was an extensive delay in the local complaints’ procedures. The local IBC apologised for this, ‘unacceptable delay’, it its two responses and explained this was due to a backlog in complaints due to the pandemic and recruitment issues. The local ICB also experienced further delays due to post processing during relocation.

43. Mrs B raised his initial complaint in December 2022 and received the first reply from the local ICB in January 2024. Mr B then contacted us and, on our advice, Mrs B returned to the ICB to ask for a further response, in May 2024. The ICB provided a final response in February 2025.

44. We have no evidence Mr B chased a response to the complaint between December 2022 and January 2024.

45. We have evidence Mr B asked us to chase a final response to the complaint between May 2024 and February 2025.

46. We are sorry to see the complaints process took a very long time, we recognise it must have been very distressing to wait such a long time for a reply.

47. The Local Authority Social Services and National Health Service Complaints (England) Regulations state NHS organisations should aim to provide a response to a complaint within six months commencing on the day on which the complaint was received. The Regulations details if an organisation is not able to complete an investigation within six months, then it should notify the complainant of the reasons why and proceed to complete the investigation as soon as reasonably practicable after the six months period.

48. Coronavirus disease 2019 (COVID-19) is a contagious disease caused by the coronavirus SARS-CoV-2 (a breathing infection). In January 2020, the disease spread worldwide, resulting in the COVID-19 pandemic. During this time NHS services were reduced to prevent cross infection and to allow staff to be redeployed to cope with the pandemic.

49. We recognise a significant number of NHS organisations have been affected by the Covid-19 pandemic. We accept we were also affected by the pandemic and it took us longer then expected to consider complaints.

50. Taking into consideration the long-term impact the Covid-19 pandemic had on NHS’s ability to respond to complaints, we are of the view the apologies the local ICB offered in respect to this part of the complaint are in line with our NHS Complaint Standards. We are also pleased to see the local ICB detailed the reasons why it could not complete the investigation as soon as possible, we found this was in line with the Local Authority Social Services and National Health Service Complaints (England) Regulations. As such, we will not take any further action in respect to this part of the complaint.

51. We recognise the issues of this complaint weighted heavily on Mr B over a long period of time. We also know Mr B remains disappointed by the service his wife received from the Practice.

52. Complaints give us valuable insight into the organisations we investigate, and we recognise this has been an emotionally challenging process for Mr B. We would like to thank Mr B for sharing his experience with us.

1. We have carefully considered Mr B’s complaint about a primary care provider in North Northamptonshire (the Practice). We fully appreciate Mr B’s concerns that his wife’s health was deteriorating badly in 2022 and that he felt the Practice was not addressing his wife’s concerns. This was a very upsetting experience for both Mrs and Mr B. We understand how distressing this time was and remains for Mr B.

2. Ww offer our condolences to Mr B for the sad loss of his wife. It is clear from our investigation he cared for her very much.

3. We have found the Practice accepted it did not offer a face to face appointment at first point of contact as previously agreed with Mrs B. We are please to see the Practice accepted this was not in line with its commitments to Mrs B and apologised during the local resolution stage. We consider this is in line with our NHS Complaints Standards.

4. We recognise it must have been frustrating to wait a very long time for responses to the complaint. We acknowledge Covid-19 pandemic has put immense pressures on complaint handling at all levels within the NHS. We consider the apologies the local Integrated Care Board offered are in line with our NHS Complaints Standards.

5. We have seen the Practice examined Mrs B and offered treatment. However, we have not seen a full consideration of Mrs B’s main concern, severe pain.

6. The Practice acknowledged there is more it can do to resolve the above point of the complaint and confirmed it will pay Mr B a financial remedy of £1,200 and provide an apology.