A practice in the Camden area

3. Ms J complains about the following aspects of her care and treatment at the Practice on 24 June 2024 in relation to a cervical examination. She complains that:

• a person was present in the room without consent • the examination was painful and there was no informed consent for it • the doctors at the Practice were not authorised to carry out the examination.

4. As a result of this procedure Ms J says she has lost trust in healthcare professionals and suffers emotional and physical distress.

5. Ms J wants an apology and service improvements.

Third party in consultation

8. Ms J says that when she attended her appointment there was a third-party present in the room. She said that she was not given advance warning of this, and it made her uncomfortable.

9. The Practice explained this person was a paramedic, and it asked Ms J if they could remain present for the appointment. After Ms J declined the paramedic left the room in line with her wishes. The Practice said that as a teaching Practice it offers opportunities for clinicians to learn.

10. Section 13 of the GMC’s Decision making and consent guidelines say doctors should let patients know of their right to refuse to take part in teaching or research.

11. Ms J confirmed the Practice told her who the person was and was asked if they could remain. She has confirmed that when she refused the person left the room and did not return as per her wishes.

12. There is no indication the Practice did not follow the GMC guidelines. It respected her wishes that she did not want that person in the room. We will not consider this aspect of the complaint further.

Painful procedure and consent

13. Ms J says that she has had a similar procedure in the past which was not uncomfortable or painful. However, in this instance she found it was painful. She also says that the Practice did not gain consent for this.

14. GMC guidelines on consent say:

‘Obtaining a patient’s consent needn’t always be a formal, time-consuming process. While some interventions require a patient’s signature on a form, for most healthcare decisions you can rely on a patient’s verbal consent, as long as you are satisfied, they’ve had the opportunity to consider any relevant information and decided to go ahead.

‘Although a patient can give consent verbally (or non-verbally) you should make sure this is recorded in their notes.’

15. Ms J’s notes say she gave verbal consent prior to the cervical examination. This would be in line with GMC guidelines on consent.

16. The Practice acknowledged that the procedure was uncomfortable for Ms J, it explained that the examination is not always the same as a person may sit differently or a full bladder or bowel may cause the examination to be more difficult. The clinical notes do not record anything remarkable about the examination or that Ms J complained of pain at the time. We do recognise that she did experience discomfort and that the experience was not very pleasant for her.

17. NHS guidelines around cervical screening appointments says that discomfort is not an unusual part of an examination. It says:

‘Cervical screening does not usually hurt, but some people may find it uncomfortable or painful. You can ask to stop the test at any point if you need to.

‘You may have some light bleeding or spotting after cervical screening. This should stop within a few hours’.

18. We can see that the Practice did ask Ms J for consent before the procedure took place and Ms J has acknowledged that the Practice recognised her discomfort, and it asked her if she was okay to continue. We can see no indication that the Practice failed to act in line with guidelines during the examination and will not proceed further with this aspect of her complaint.

GP not able to carry out cervical examination

19. Mrs J says that at the Practice cervical examinations are only carried out by a nurse and that the doctors are not allowed to do this. She says this was confirmed to her by the Practice.

20. Ms J had previously been seen due to postmenopausal bleeding. Ms J had recently been examined by a gynaecologist for an examination, but she felt that a patch on cervix had not been looked at. The GP at the Practice offered to examine her due to her ongoing concerns.

21. The NHS website on booking cervical screening says screening is ‘usually done by a female nurse or doctor’. GMC professional standards also say doctors must recognise and work within the limits of their competence.

22. We have seen no evidence to suggest the GP was not competent to carry out this examination. It might be the case that nurses at the Practice often or usually perform cervical examinations, and we believe that is what Ms J may have been told. But that does not mean GPs are not able to perform such examinations. We can see no indication the Practice did anything wrong, we will therefore not proceed further with this aspect of the complaint.

23. We know this issue has caused Ms A distress and will not be the decision she was hoping for. We are sorry to hear about the effects these events have had on her. We are grateful to her for bringing her complaint to us.

1. We have carefully considered Ms J’s complaint about the Practice. We have decided to take no further action on Ms J’s complaint. This is because we can see no indication the Practice failed to follow suitable guidelines in her care and treatment.

2. We recognise this has been a difficult time for Ms J due to her ongoing health concerns.