A practice in the Cheshire East area

4. Mr A complains about the following aspects of the care a GP practice provided for his bad back.

5. He says: • its GPs wrongly told him he had a slipped disc in January 2024 and a back fracture in September and November 2024 • the Practice lost his March 2024 self-referral for a physiotherapy appointment • the Practice wrongly referred him to a musculoskeletal specialist in August • its physiotherapist recommended inappropriate exercises between September and November.

6. Mr A says his back did not recover as he should have done because of what the Practice got wrong. He says he can no longer walk properly and this has affected his mental health.

7. He would like the Practice to acknowledge what it got wrong, and apologise and offer him compensation for the impact. He also wants it to improve its service.

8. In January 2024 Mr A saw a GP at the Practice about his bad back. The GP said he should complete an online self-referral for a physiotherapy appointment at the Practice. He did this on 25 March. Mr Erskine also visited a private chiropractor. He had not heard anything about his self-referral by July and so contacted the Practice again. It said it did not have a record of his self-referral and asked him to re-send it, which he did.

9. The Practice also made him a new appointment with a GP in August 2024.

10. The Practice referred Mr A to a musculoskeletal specialist (MSK) and to the local hospital for an MRI scan of his back. He had this in September. The Practice also booked him for sessions with its physiotherapist starting in late September. The physiotherapist gave Mr A exercises for his back between September and November.

11. In September and November 2024 the Practice told Mr A it had the results of his MRI scan. It said these indicated he had broken a bone in his back.

12. Mr A complained to the Practice. He received responses from it but was not satisfied with these. He complained to us in 2025. He says the problem with his back has not been resolved. In September 2025 the local Trust told Mr A and his GP that he had a psoas muscle issue (pain in the lower back often due to tightness in the muscle).

Diagnosis

16. Mr A says the Practice misdiagnosed what was wrong with his back in both January and the autumn of 2024. He says it wrongly told him he had a slipped disc in January and a fracture in September 2024. He says this means he did not get the right treatment for his back and so he was not able to get better as he should have done.

17. Mr A’s GP notes showed he had an appointment about his back pain on 29 January. There is nothing documented in the notes of that consultation about a diagnosis or suspected diagnosis, of a slipped disc or anything else. We can see the GP documented Mr A’s symptoms and history and advised him to self-refer for physiotherapy.

18. NICE NG59 sets out that a doctor should refer someone with lower back pain for exercise programmes in the first instance if they think self-management by the patient is not enough. It says they should not usually offer a scan. Our GP adviser said the Practice’s suggestion that Mr A complete a self-referral for physiotherapy was in line with NG59.

19. The evidence we have does not indicate the Practice misdiagnosed Mr A in January 2024. It does indicate it acted in line with the relevant standard in response to his back symptoms.

20. The records show the Practice told Mr A in October and November 2024 that he had an L5 pars defect, which is a small fracture in the lower back. This was what the report of his September MRI scan had shown. The Practice did not produce the report – it was only passing on the results. The GMC’s ‘Good medical practice’ says doctors should give patients information based on the best evidence they have available to them. We think this is what the Practice did here. So we cannot say it misdiagnosed him on this occasion.

21. We understand this was frustrating when a scan in 2025 showed something different. When we weigh up the evidence, we cannot say the Practice got anything wrong when it told him about the report of the MRI scan.

Referrals

22. Mr A says the Practice caused delays which meant his back did not get better as quickly as it should.

23. Mr A self-referred for a physiotherapist appointment at the Practice on 25 March 2024. He was on a waiting list. On 19 August, the Practice texted him to ask if he still wanted to remain on the waiting list, and to reply if he did. He did not reply, so the Practice cancelled the self-referral.

24. However, in July Mr A had contacted the Practice as he had heard nothing about his self-referral. He was told – wrongly – that the Practice did not have this. He thought this meant it had lost his self-referral. The Practice made him a GP appointment in mid-August, at which he confirmed he still wanted a physiotherapist appointment and an MRI scan. The Practice referred him for an MRI and organised an appointment with an MSK specialist for 27 August. The MSK specialist reviewed Mr A and advised he needed to see a physiotherapist.

25. Mr A contacted the Practice again and it then organised a physiotherapist appointment for him for the end of September.

26. ‘Good Medical Practice’ says doctors should communicate clearly with patients. Our Principles say organisations should do what they say they are going to do and deal with people promptly (‘Being customer focused’). As we set out earlier, NG59 says doctors should refer patients with lower back pain for exercise programmes in the first instance.

27. The Practice has told us the waiting time for physiotherapy at the time Mr A self-referred was 22 weeks. So it is not surprising that he had not had an appointment for this when he contacted the Practice in July. But there is no indication the Practice had communicated with him about this, before he self-referred or while he was on the waiting list, in line with Good medical practice. The GP who saw Mr A in January documented ‘Advised self ref to physio initially and review in 1-2 months if not settling’. This does not indicate the Practice made Mr A aware of the long waiting time for physiotherapy. There is no indication it contacted him before he contacted the Practice in July. Then it said it did not have his self-referral. We know this was incorrect because he remained on the waiting list, leading to the text on 19 August.

28. Our GP adviser said the Practice was not wrong to give Mr A an appointment with an MSK specialist in August 2024. But this only provided another opinion about what to do next. There is no indication the Practice needed a further opinion. The GP in January had decided he should be referred to the physiotherapist for an exercise programme, in line with NG59. Our GP adviser says the Practice would have known the MSK specialist would not be able to resolve Mr A’s concerns. So this appointment was unnecessary.

29. The Practice cancelled Mr A’s physiotherapy referral because he did not reply to the 19 August text asking him if he wished to remain on the waiting list. We can understand why Mr A did not reply. He had told the GP only days before that he still wanted physiotherapy and the Practice had made him an appointment. So as far as he was concerned, the matter was resolved. It was only when he got to that appointment that he realised it was not physiotherapy, it was with an MSK specialist.

30. The Practice did not communicate with him properly about what it had referred him for. So it did not act in line with our Principles or Good medical practice. We have therefore seen indications the Practice got something wrong here. We next thought about what impact this had.

31. The Practice organised a physiotherapy assessment for the end of September. This was six months after Mr A had sent his self-referral. So we have thought about what would have happened if the Practice had communicated with him better.

32. If the Practice has told Mr A it had a waiting time of 22 weeks for physiotherapy appointments, and if it had not wrongly told him it did not have his self-referral in July, he would have known there was a long wait for an appointment, but that he remained on its waiting list. Mr A could have then avoided the frustration of not knowing what was happening when he was in pain and discomfort. He would likely have avoided having the further appointments with the GP and MSK specialist that got him no further towards getting physiotherapy. He would have known to reply to the Practice’s 19 August text to say he still wanted physiotherapy.

33. Mr A self-referred on 25 March and 22 weeks from then was 26 August. However, the 19 August text suggested there would still be a wait at that point. It is more likely than not Mr A would have waited a bit longer than the 22 weeks. On the basis of the available information we cannot say whether he would have got a physiotherapy appointment sooner than 30 September. If he had, this may only have been a couple of weeks sooner. We cannot criticise the Practice for having a waiting list. He would always have had to wait for a physiotherapy appointment.

34. We can see Mr A was in pain while he was waiting and this was very unpleasant for him. The records show Mr A had had a bad back for at least two months before he went to the Practice about it in January 2024. This means his condition would likely already have been considered chronic (pain which has lasted over 12 weeks) before he had his first appointment, even if the Practice had communicated better with him. We cannot say a potential further short delay would have had a significant impact on the effectiveness of the physiotherapy once he had it or that it made his back worse.

35. But we can see this was very frustrating and upsetting for Mr A. He had to chase up something about which the Practice should have communicated with him more clearly. And, when he had done that, its actions meant he had unnecessary appointments with the GP and MSK specialist, and then had to ask to be put back on the physiotherapy waiting list again. This compounded the frustration Mr A was feeling.

Physiotherapy

36. Mr A says the Practice’s physiotherapist gave him exercises to do between September and November 2024 which were not appropriate for his condition. He thinks these exercises did not help him get better and may have actually made his condition worse.

37. The relevant standard for this is NICE CKS ‘Back pain – low (without radiculopathy)’. This says how to assess lower back pain and how to decide what exercises to offer to a patient.

38. We can see from the records Mr A told the Practice in January 2024 he had had lower back pain since November 2023. When he saw the physiotherapist at the end of September 2024 he had therefore been suffering with this for nearly 11 months. The NICE CKS defines pain that has lasted for over 12 weeks as chronic pain and sets out how practitioners should assess and treat this.

39. Our physiotherapist adviser said the notes show the physiotherapist did a thorough assessment at the September 2024 appointment. This included the history of the onset of this pain, Mr A’s past medical history, a measure of his symptoms, his sleeping pattern and the treatment and investigations he had already had on his back, and his other work and hobbies. They said Mr A had a chronic condition. It appears the physiotherapist assessed Mr A in line with the NICE CKS.

40. The records show that at the September 2024 appointment, the physiotherapist recommended a set of exercises for Mr A to do at home. They also advised him to continue with strengthening exercises the MSK specialist had recommended and to continue attending the gym. Our physiotherapist adviser said these exercises were in line with the NICE CKS. They also commented that the exercises were appropriate for a psoas muscle issue, which Mr A was later diagnosed with.

41. Mr A has told us going to the gym has helped improve his back. And an entry in his GP notes in May 2025 show he was playing football at that time. (He had unfortunately fallen while playing and sustained an injury.) These things indicate his back condition did improve after September 2024.

42. When we weigh up the evidence, we think the physiotherapist acted in line with the relevant standards. We do not think the Practice got something wrong here.

What the Practice has done to put things right

43. We can see the Practice apologised to Mr A for the miscommunication that led to it removing him from the physiotherapy waiting list and that the MSK appointment was not what he was expecting. It said it would take steps to improve the waiting time for the physiotherapy service and how it communicates with patients on the waiting list, and in the information it gives patients about the difference between MSK and physiotherapy services.

44. The NHS Complaint Standards says NHS organisations should give open and honest responses to complaints. They should acknowledge where they make mistakes and reflect the impact those had. They should apologise and take action to put things right, including learning from complaints.

45. We think the Practice has taken the poor communication seriously. It has apologised to Mr A for its mistakes and it has committed to improving its service, in line with the NHS Complaint Standards.

46. We have thought about whether the Practice needs to do anything more to put things right for Mr A. However, he has been clear that his main concern is that the Practice misdiagnosed him and he only wants us to investigate further if we will ask the Practice to do more to put that right. As we have set out earlier, we cannot say the Practice misdiagnosed him. So we can do nothing more to achieve what Mr A wants.

47. We would like to thank Mr A for bringing this to us. We can see this was a frustrating and worrying time for him, especially as he continues to be a patient at the Practice. We wish him well for the future.

1. We have carefully considered Mr A’s complaint about the Practice. There is no indication the Practice misdiagnosed his back problem. We think its physiotherapist recommended appropriate exercises for him. We do think the Practice got things wrong in its communication with him about his self-referral to a physiotherapist, including how long the waiting list was and that it did not have his referral when it did. This led to it removing him from the waiting list and having unnecessary other appointments.

2. We can see what we think the Practice got wrong was frustrating and upsetting for Mr A, at a time when he was suffering with back problems. We can see he had to do more than he should have to get his physiotherapy and this affected his faith in how the Practice was treating him. We think it has put these things right for him and there is nothing more we can do to achieve the outcomes Mr A is looking for.

3. We are sorry to hear about Mr A’s experience. We hope our decision offers him some reassurance about what happened to him.