A practice in the Barnet area

6. Miss M complains the Trust failed to manage her spinal referral correctly and discharged her without treatment in error.

7. Miss M says the mismanagement of her back pain referrals led to a delay in a diagnosis of severe lumbar spine stenosis with crowding of the cauda equina nerve roots due to multiple-level disc prolapses alongside facet joint arthritis and foraminal stenosis. She says the delay resulted in her being in extreme pain for a long period of time which has impacted the quality of her life and affected her opportunities with work. She says she is also fearful of cauda equina syndrome developing due to the delays.

8. She wants an acknowledgement of failings, an apology, service improvements and a financial remedy.

9. Following an appointment in mid-November 2021, Miss M’s GP made a referral to the Trust for it to see her for symptoms relating to her spine.

10. Her GP then referred her to the same service due to an ankle injury in February 2022. The Trust recommended she have a physiotherapy appointment for her ankle issue. She refused this so the Trust discharged her from its service. This discharge also included her spinal referral.

11. Miss M had an MRI on her whole spine in June 2023, and the results indicated she had severe lumbar spinal stenosis (narrowing of the spinal cord) with compression of the nerve roots due to multiple-level disc prolapse (degenerative disc disease) and facet joint (small joints at the back of the spine) arthritis.

14. Miss M complains the Trust failed to manage the referral her GP sent to its MSK service in November 2021. She says her GP sent a spinal referral for her back pain symptoms, but it did not action this referral. She says the Trust then discharged her from its service in February 2022 without providing her with an appointment for her back pain.

15. The Trust’s MSK triage SOP says that when the MSK physiotherapy service receives a referral it will register it on its system and following this, clinical staff will triage, and it will be place on the relevant waiting list or caseload.

16. The records show the Trust received a referral for Miss M from her GP in early December. The referral from the GP gave details of her ongoing back pain due to an historical fall. It also requested the Trust see her for further imaging.

17. The Trust triaged the referral as suitable for physiotherapy as there was no bowel or bladder dysfunction reported. We can see it then placed Miss M on a waiting list for an appointment. We have not seen any evidence that the Trust offered her an appointment following triage.

18. In March 2022, the Trust saw Miss M for another issue relating to her ankle in the physiotherapy service. We can see during her appointment, Miss M advised she had a fracture clinic appointment the following week, so the Trust told her to book a follow up with its service if she required it and dependent on the outcome of her upcoming appointment. In June, it discharged her from its MSK service as she had not booked a follow up. At this time the Trust also discharged her spinal referral.

19. There is no evidence that the Trust sent a letter to Miss M or her GP to advise of the discharge. In its final response, the Trust acknowledged its error in discharging Miss M from its service without her being seen for her spinal symptoms.

20. We therefore consider the Trust did not act in line with its MSK guidelines when it managed Miss M’s MSK referral for her spine and symptoms relating to this as it did not provide treatment following its triage of her symptoms.

21. As we have identified a failing in this and her discharge from the service in June, we have gone on to consider the impact this had on her.

22. Miss M says the mismanagement of her back pain led to a delay in a diagnosis of severe lumbar spine stenosis which is the narrowing of the spinal canal with crowding of the cauda equina nerve roots (when the bundle of nerves at the lower spinal cord are compressed) due to multiple level disc prolapses alongside small joint arthritis which she received in June 2023, 14 months after her discharge.

23. She says the delay resulted in her being in extreme pain for a long period of time which has impacted the quality of her life and affected her opportunities with work. She says she is also fearful of cauda equina syndrome developing due to the delays.

24. Due to the nature of the complaint, we sought impact advice from an experienced spinal consultant who has explained Miss M’s discharge without treatment led to a delay in the Trust reviewing her for her management options. They go on to explain the options for treatment would have been routine elective surgery or injections for the pain and neuropathic medications.

25. We would not be able to say which of these options would have been beneficial for Miss M as she had other health conditions which may have impacted her treatment options. We also cannot say what the outcome would have been had these treatments options been offered to her earlier.

26. We cannot discount however the amount of pain Miss M was in during the 14-month delay and how this affected her daily life and work options which she says has impacted her financially. From what she told us, she also worries that that her symptoms will develop further due to the delay. It is important to note she had other health related issues during the same period which would have added to her pain and mobility issues. We also consider that there would have been opportunity during the 14 months for Miss M to contact the Trust about her referral.

27. In its final response, the Trust has acknowledged the shortfalls in the management of Miss M’s back pain and has provided the actions it has taken from her complaint to show learning. We consider however, it has not fully recognised the impact the failings had on her during the 14-month delay and how this affected her day-to-day life and impacted her financially.

28. She wants an acknowledgement of failings, an apology, service improvements and a financial remedy.

29. We consider the Trust has not fully addressed the impact on Miss M or put things right. We will therefore uphold the complaint and make recommendations in our final report.

1. Miss M is understandably concerned that Central London Community Healthcare NHS Trust (the Trust) failed to manage the referral her GP sent to its musculoskeletal (MSK) service in November 2021 and discharged her without providing treatment.

2. We were sorry to hear about what happened and how she explained a lack of treatment for her back pain has affected her physical and mental wellbeing due to her diagnosis and unmanaged pain which she told us has affected the quality of her life and affected work opportunities.

3. After carefully considering all the evidence we have found the Trust did not act in line with guidance in its management of her referral to the MSK service for back symptoms which was causing her ongoing pain.

4. We consider the identified failing to have led to the impact Miss M has told us about as she says her pain was unmanaged for a long period of time and she explained how this affected her daily life. She has also told us about her worry that she will develop a syndrome due to the delay in diagnosis.

5. Although in its final response the Trust apologised to Miss M and has taken actions to learn from the complaint, it has not fully recognised the impact the failings had on her during the 14-month delay and how this affected her day-to-day life and impacted her financially. We will therefore uphold this complaint and make recommendations at the end of this report.