A practice in the Kingston upon Thames area

4. Mrs A complains about the care and treatment she has received from a GP Practice in Surrey (the Practice), between July 2023 and April 2024. She states: • it did not send her for Magnetic Resonance Imaging (MRI) which would have identified her condition • the findings of her private MRI were minimised and not forwarded to the correct department at the hospital.

5. Mrs A complains about the manner she was spoken to on 20 March 2024 by her General Practitioner (GP). She complains the GP was unprofessional and sought to minimise a serious condition.

6. Mrs A says the Practice has prolonged her discomfort and distress by its actions.

7. By bringing the complaint to us, Mrs A would like service improvements; for the Practice to review the process of referral for an MRI and the GP to reflect on the decision-making process for deciding on an MRI referral. Mrs A asks to be reimbursed for the cost of the private MRI examination.

8. Mrs A has had ongoing symptoms on the left side of her face from April 2022. She had a biopsy on lesions on the left side of her face. The results in June 2022 showed these were benign.

9. Mrs A experienced on-going sensory symptoms to the left side of her face throughout 2022 and 2023. She was referred by the Practice to a number of hospital specialists for investigations. Ear Nose and Throat Surgery (ENT), Maxillofacial Surgery, Ophthalmology, and Dermatology were all unable to diagnose a cause.

10. Mrs A first asked the Practice whether an MRI referral would be beneficial to investigate her symptoms in July 2023. In January 2024 she indicated to the Practice she would be seeking a private MRI scan and in February 2024 she asked for a private MRI referral letter from the Practice. The Practice provided this, and Mrs A had a private MRI in March 2024.

11. The results of the scan were provided in a radiologist report to the Practice on 8 March 2024. The Practice reviewed the report on 13 March and Mrs A attended an appointment on 20 March 2024.

12. At the appointment the findings on the report were discussed with Mrs A. There were no indications which gave a diagnosis for Mrs A’s symptoms, but there was an incidental finding of a possible 7mm aneurysm, and the report indicated additional investigations should be considered. The report stated consideration should be given to further evaluation with Computed Tomography Angiography (CTA) and Magnetic Resonance Angiography (MRA), and review by neurosurgical and neurovascular MDT (multidisciplinary team meeting).

13. Mrs A had a Neurology appointment on 27 March 2024, and the Practice provided a printout of the radiologist report for her to take with her to the appointment. Unfortunately, the appointment was cancelled by the Trust and a new appointment date provided for September 2024.

14. Mrs A rang the hospital on 2 April, to seek an earlier date for her Neurology appointment and asked whether a referral to Neurosurgery could be made as indicated on the radiologist report. Mrs A was informed only the Practice could make the referral. Mrs A contacted the Practice, and a referral was made on 5 April 2024 and marked as urgent.

15. Mrs A had her appointment with Neurology on 8 May 2024. She had a Neuroradiology appointment in July 2024 and had surgery to resolve the aneurysm in September 2024.

Not referring for an MRI

19. 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.

20. Mrs A tells us between 14 July 2023 and 30 January 2024 the Practice did not refer her for an MRI scan, despite her asking for one on multiple occasions. On 6 March 2024 Mrs A paid for a private MRI scan and was upset to learn she had an aneurysm. Mrs A feels the aneurysm was the cause of her symptoms and had the Practice referred her for an MRI earlier, this would have been diagnosed sooner.

21. Our clinical adviser told us there are no specific guidelines for a patient presenting with the sensory facial symptoms which Mrs A described. GMP explains clinicians have a duty to ‘promptly provide or arrange suitable advice, investigations or treatment where necessary’.

22. From Mrs A’s medical records, we can see the Practice referred Mrs A to several different specialists in an effort to diagnose the cause of her symptoms. Our adviser said these referrals were clinically appropriate.

23. Our adviser told us MRI scans are available for certain cancer investigations. Mrs A’s symptoms did not indicate cancer and so it was not clinically appropriate for the GP to arrange one for her. Our adviser said it would be for the specialists to arrange an MRI if it was a necessary investigation for them to diagnose the cause of her symptoms.

24. We can see no evidence the Practice fell below the standard expected by not requesting an MRI. For this reason, we will take no further action on this part of Mrs A’s complaint. We hope to reassure Mrs A the Practice acted appropriately in referring her to specialists.

Results from private MRI minimised and not referred correctly

25. The Mrs A tells us the results of the MRI indicated the presence of an aneurysm, and she feels this should have been dealt with more urgently. She says the Practice should have provided the information contained in the report more quickly and referred her to the specialist recommended in the report with an urgent referral.

26. Our adviser confirmed there are no guidelines on the timeliness of referrals. GMP states clinicians ‘must provide a good standard of practice and care’ and the clinician must ‘promptly provide or arrange suitable advice, investigations or treatment where necessary’. Additionally, the GMP guidelines advise clinicians must communicate relevant information to colleagues in other services. GMP also says clinicians must promptly provide or arrange suitable advice, investigations or treatment where necessary.

27. We would expect the Practice to review any clinical information available to them (private or not) and act accordingly. This involves communicating relevant information to the patient as well as to other colleagues who the patient might be referred to.

28. The results of the MRI (in a radiologist report) were sent to the Practice on 8 March. We can see from the medical records the Practice reviewed the report on 13 March. The Practice stipulated a face-to-face appointment was required within seven days. Mrs A was given an appointment for 20 March.

29. In the appointment the results were discussed, and Mrs A was provided with a printed copy of the report. The Practice say they were aware Mrs A had an appointment with Neurology on 27 March. The Practice say they did not want to risk inadvertently knocking Mrs A off the Neurology waiting list with a new referral to Neurosurgery.  They also thought the Neurologist would likely have faster access to the specialist scans and a Neurosurgical MDT (multi-disciplinary team) than a new referral to Neurosurgery would create.  They say the aim was to get Mrs A seen quickly by the specialist and her next tests arranged, rather than create any confusion or delay.

30. We can see the Practice advised her to attend her pre-booked Neurology appointment. The records show the Practice sent an email to Neurology on 26 March 2024 This is in line with the GMC guidelines as the Practice discussed the information with Mrs A and made appropriate referrals (albeit a pre-existing appointment in this case) as well as forwarding the relevant information to the specialist before the appointment date.

31. We note, when the Trust cancelled the Neurology appointment for 27 March 2024 Mrs A was given another appointment later in the year. When Mrs A called the Practice and asked for an urgent referral to Neurosurgery the Practice did this.

32. We have not seen any indication of failings in relation to a need for a specific referral to Neurosurgery. The Practice acted in line with GMC guidance in passing Mrs A’s information to Neurology for her pre-booked appointment. When the pre-booked appointment was cancelled, it made an urgent referral for her.

33. We are glad to hear that she has successfully resolved the aneurysm issue in September 2024. We hope to reassure Mrs A the Practice has reflected on her complaint and are taking learning from her experience. Mrs A may find it helpful to know our adviser noted that as the finding of the aneurysm was incidental to other investigations, the process from discovery to surgical resolution in September 2024 moved through the system as expected.

Unprofessional manner from GP

34. Mrs A says she felt the way in which she was spoken to about the results of her MRI in the appointment on 20 March 2024 was unprofessional. In Mrs A’s complaint to the Practice on 22 January 2025, she uses the specific phrase ‘so it wasn’t what you thought it was’ as being used by the GP. Mrs A felt this minimised the seriousness of the results and made her feel her concerns were being dismissed.

35. We are not able to comment on what was said in the consultation and we have seen no evidence to confirm what was communicated. We do recognise Mrs A’s recollection of the event does carry weight. Mrs A was provided with information about a serious finding, and this would have been a distressing time for her.

36. Whilst we cannot come to a finding on how she was spoken to, Mrs A may be reassured by how the Practice dealt with her complaint about this matter.

37. The NHS Complaint Standards state organisations should ‘welcome complaints in a positive way’, and ‘are thorough and fair when looking into complaints’, and ‘give fair and accountable responses’.

38. In the response to Mrs A’s complaint, the Practice said it reflected on the manner in which Mrs A was given and received the findings on the MRI. Whilst it was unable to recall the exact words used in the consultation it offered an explanation as to what they were attempting to achieve.

39. We can see in their complaint response the Practice acted in line with the Complaint Standards.

40. We thank Mrs A for taking the time in bringing her complaint to our attention. We hope our explanation brings some reassurance about the care and treatment she has received.

1. We have carefully considered Mrs A’s complaint about the Practice.

2. We are very sorry to hear Mrs A has endured numerous investigations into her symptoms over a two-year period. We understand how difficult this has been and how the incidental finding of an aneurysm in March 2024 must have increased her distress.

3. We would like to reassure Mrs A we have not seen any indications the Practice missed an opportunity to diagnose her aneurysm sooner. Additionally, the appropriate decisions about her treatment were made. We hope the explanation below provides Mrs A with answers to her concerns and reassurance.