A practice in the East Suffolk area

5. Mrs L complains on behalf of her daughter, B, about the care and treatment she received from a GP Practice in Suffolk (the Practice) on 20 June 2025. Specifically, she complains the Practice:

• did not triage or treat her daughter properly at her appointment on 20 June 2025 • failed to diagnose her daughter’s ear infection • recorded her daughter’s symptoms incorrectly in her records and • responded to her complaint without meaningful reflection or accountability.

6. As a result of these failings, Mrs L says the delays left her daughter experiencing avoidable pain and discomfort and caused her ongoing worry and distress. She says the lack of response to the information provided and the handling of the referral led her to lose confidence in the Practice’s ability to identify and act on clinical risk. Mrs L says this created additional strain for the family at an already difficult time and she was forced to travel unnecessarily with a unwell child. She says the response from the Practice further affected her trust in the Practice and she feels her concerns have not been properly considered.

7. As an outcome to her complaint, Mrs L seeks an apology, an acknowledgement of failings, service improvements and a financial remedy to recognise the emotional distress experienced by her and her daughter.

8. Mrs L complained about the care and treatment her daughter, B, received from the Practice in June 2025. B has a history of ear, nose and throat (ENT) problems and recurrent ear infections.

9. On 20 June 2025 Mrs L contacted the Practice via its online system (PATCHS) about a rash B had developed. An hour later Mrs L reported to the Practice B had pain in her right ear.

10. Mrs L could not get an appointment for B so they visited the pharmacy.

11. Mrs L and B returned to the Practice and B had an appointment with a GP. The GP found B’s ears to be normal and provided safety netting advice to Mrs L.

12. Mrs L told us she took B to an ENT specialist who diagnosed B with an ear infection and prescribed medication.

13. Mrs L complained to the Practice in June 2025, and the Practice responded to her complaint in July 2025. Mrs L complained to us in July 2025.

17. Before we decide if we should investigate a complaint in more detail we look at whether there are signs the organisation concerned has got something wrong. We do this by comparing what should have happened with what did happen. If what happened fell far short of what should have happened, we call this a failing. When we see indications of a failing, we next look at whether that failing had a negative impact on the person in question. If we think it did, we will go on to consider what, if anything, the organisation has done to try and put things right.

18. B has a history of ear, nose and throat (ENT) problems and suffers with recurrent ear infections.

19. Mrs L submitted a PATCHS request to the Practice at 8:49am on 20 June 2025 for a rash B had developed. She wanted advice about whether it was chicken pox.

20. Around an hour later, Mrs L called the Practice to report B was experiencing right ear pain. This information was added to the existing PATCHS submission.

21. Around five hours later, at 2:21pm, Mrs L called the Practice for an update. The Practice told her it had no appointment capacity available that day and offered an appointment for Monday, three days later. Mrs L was unhappy with this as B has a history of recurrent ear infections and was under the ENT specialist.

22. Mrs L said she disputed the Practice’s decision to offer an appointment within a few days. The Practice suggested Mrs L could try a pharmacy, and Mrs L confirmed she would attend the pharmacy for support.

23. Mrs L visited the pharmacy. She says it told her due to B’s medical history it would be unable to assist.

24. Mrs L said the pharmacy looked in B’s ears and noted they were red, however due to E’s medical history they were be unable to provide the antibiotics. She says the pharmacy told her it would send an emergency referral back to the GP Practice.

25. From the records, we can see the pharmacy gave Mrs L a consultation form which said, due to patient history of referral to ENT and pinkness to ears B was signposted urgently back to GP Practice. It recorded the consultation outcome as ‘urgent escalation to another service’.

26. Mrs L said on the way back from the pharmacy, she called the ENT department and explained B’s situation. Mrs L says ENT advised her to go to the GP and tell them she has spoken to ENT who advised B needs to be seen by the GP. We have not seen any evidence of this call.

27. Mrs L then attended the Practice in person to speak with the staff face-to-face. Mrs L told staff the pharmacy had referred them back to the Practice, as they were unable to help B.

28. Mrs L said when she arrived at the Practice, staff told her it had no capacity for appointments. When she told them she had spoken to ENT, who recommended B should be seen, staff went to speak to the GP and B had an appointment with the GP at 3.22pm.

29. B’s medical records of the appointment with the GP document her having a history of ear infections and being under the ENT specialists. The symptoms noted in the records include itchy ears. The records also show Mrs L had previously submitted PATCHS requests for B’s ear pain in January and April 2025, and these resulted in face-to-face appointments the same day.

30. As part of the assessment the GP completed an otoscopy examination. The records show B’s ear showed some wax, but her eardrums were normal and showed no sign of infection. Mrs L was informed the examination was normal and she was also advised to seek further medical advice if B’s condition worsened.

31. Mrs L did not agree with the GP’s assessment and arranged for her daughter to be seen by the ENT specialist. B had an appointment with the ENT specialist at 4.26pm on 20 June 2025. The ENT specialist letter noted B’s symptoms as ear pain, reduced appetite and reduced hearing. It also noted B didn’t have fever, discharge, vertigo, tinnitus, hearing loss or mastoid pain. B was given oral antibiotics and ear drops.

Triage and treatment

32. Mrs L says the Practice did not triage or treat her daughter properly at her appointment in June 2025, which led to a delay in her receiving care. She says the Practice did not respond to her online PATCHS submission and did not consider her daughter’s ENT history or presenting symptom when triaging the PATCHS submission. Mrs L says the submission was wrongly marked as non-urgent, and the Practice failed to action the pharmacist’s referral. She says the treatment was not done properly, and she had to take her daughter to the ENT specialist to get her checked out.

33. Mrs L said this caused distress and inconvenience to her and her daughter, as B was left without treatment for longer than she needed to be.

34. NHS guidance states earache and ear pain are common, particularly in young children. It also says most earaches get better on their own but to get medical help if symptoms do not improve between two to three days.

35. The guidance also contains information about symptoms which may require an urgent GP appointment, and these include having earache and:

• have had it for more than 2 to 3 days • become generally unwell • have a very high temperature, or feel hot, cold or shivery • have swelling around the ear • have fluid coming from the ear • have hearing loss or a change in hearing • have something stuck in the ear • the child is under 2 and has earache in both ears

36. The NHS modern general practice model requires consistent structured information to be collected at the point of contact, to let the Practice know about symptoms, make a request or follow up about something, with patients either providing this information via an online form or to reception staff who capture the information about their needs. Patient needs can then be consistently assessed and prioritised allowing Practices to provide patients with the most appropriate care or other response from the right member of the Practice team, including signposting and referring patients to other appropriate services.

37. Our adviser says this allows the Practice to assess PATCHS and use their clinical judgement to prioritise cases according or refer the patient to the appropriate service.

38. When a Practice receives a referral or escalation by the community pharmacy, it usually relies on its own policies and procedures. There is no standard guidance available on what the Practice should do when it receives a referral from the pharmacy. Our adviser confirms this view. Our adviser included, if reception staff receive a referral, it should be escalated to the clinicians in the Practice to be assessed and prioritised as a clinical need.

39. Point 7 of the GMC Good medical practice also says in providing clinical care, you must adequately assess a patient’s condition(s), taking account of their history, including • symptoms • relevant psychological, spiritual, social, economic, and cultural factors • the patient’s views, needs, and values and carry out a physical examination where necessary

40. We understand seeing her child in pain must have been distressing and frustrating for Mrs L.

41. While Mrs L was understandably concerned about her daughter’s symptoms, the records do not show Mrs L reported symptoms which would normally require urgent clinical assessment, such as fever, discharge from the ear or signs of becoming generally unwell.

42. We asked our adviser to review the information available to the Practice at the time. Our adviser said, based on the symptoms recorded, there were no clear red flag symptoms which would normally require urgent same-day clinical assessment.

43. Our adviser explained in these circumstances it would be reasonable for the Practice to initially triage the request as non-urgent and to suggest seeking advice from a local pharmacy.

44. When Mrs L returned to the Practice from the pharmacy, the Practice arranged for B to be seen by a GP later that afternoon.

45. Based on the evidence we have seen the Practice acted in line with the expected standards when triaging and responding to Mrs L’s contact about B’s symptoms.

46. For these reasons, we will not be looking into this part of the complaint further.

Diagnosis

47. Mrs L said when B was seen by the GP, the GP said her ears looked normal and there were no signs of infection. Mrs L did not agree with this assessment and later arranged for B to be seen by an ENT specialist. Mrs L said when the ENT examined B, they said B had a red, swollen eardrum and provided her with oral antibiotics and antibiotic ear drop medication.

48. Mrs L believes the GP failed to correctly diagnose the ear infection.

49. B’s medical records show the GP assessed B. They conducted an otoscopy examination and recorded the ear drums appeared normal with no signs of infection. Mrs L was informed the examination was normal and was advised if E’s condition worsened, she should seek further medical advice.

50. NICE Ear Infection guidance says to diagnose a middle ear infection if there is an earache, and upon examination of the ear, a red, yellow or cloudy tympanic membrane (eardrum), bulging or perforation of the eardrum.

51. GMC Good medical practice refers to providing good clinical care. Point 6 says clinicians must provide a good standard of practice and care. It says if you assess, diagnose or treat patients, you must work in partnership with them to assess their needs and priorities, the investigation or treatment you propose, provide or arrange must be based on this assessment, and on your clinical judgement about the likely effectiveness of the treatment options.

52. We asked our clinical adviser to review the medical records and the GP’s assessment. Our adviser explained the diagnosis of a middle ear infection is usually based on symptoms such as ear pain together with clinical signs seen during examination of the ear.

53. Our adviser says the records show the GP carried out an appropriate examination and documented the findings. The notes indicate the ear drums appeared normal and there were no signs of infection at the time of the examination.

54. While Mrs L says an ENT specialist later diagnosed B with an ear infection, symptoms and clinical signs can develop over time. The fact an infection was identified later does not necessarily mean it would have been visible or identifiable during the earlier GP consultation.

55. We understand Mrs L’s frustration and distress as she was informed by the GP her daughter’s ears were normal and a short while later, she was informed by the ENT specialist that B had an ear infection.

56. Taking this into account, and based on the evidence provided, we have not seen evidence the GP’s assessment and diagnosis fell below the expected clinical standard.

57. For these reasons, we will not be looking at this part of the complaint further.

Medical records

58. Mrs L said the GP recorded B’s symptoms incorrectly in the medical notes. She says the record note symptoms of itchy ears; however, she says this is not what she said. Mrs L says she told the GP that B was experiencing ear pain.

59. B’s records say from the appointment on 20 June 2025 state, her ‘ears have been a bit itchy the past couple days.’

60. It is important to explain our role is to make independent final decisions about NHS complaints in England. We make decisions by weighing up and considering all the available evidence. We then consider the likelihood that something has gone wrong with the service provided. As we are impartial, we must make robust decisions based on facts and evidence.

61. Unfortunately, Mrs L believes the notes from her daughter’s appointment are not factual and we are not able to prove or disprove this. Regrettably, without further evidence we are not able to reach a view on whether something likely went wrong at this appointment.

Complaint handling

62. Mrs L says the Practice did not respond to her complaint in a meaningful way, and she does not think it has reflected or taken any accountability for the distress it caused her and B.

63. The Practice has apologised and acknowledged the distress and worry Mrs L felt. It confirmed even though it does not believe there was a clinical oversight, it understands how worrying the experience was. It confirmed the complaint would be reviewed at the next clinical meeting and it would encourage the use of the specific online questionnaires to help ensure accurate triage. It also confirmed the care navigation team would remain available during working hours to support access to appropriate care.

64. Our Principles of Good Complaint Handling say organisations should try and resolve matters informally whenever possible.

65. Our Complaint Standards say NHS organisations must look into what happened and find out if they did something wrong and see complaints as an opportunity to develop and improve its services and people. It must give an open and honest answer as quickly as possible, and give a clear, balanced account of what happened based on established facts. Staff recognise what learning can be taken from a complaint and are clear about how the learning will be used to improve services and support staff.

66. In providing the response, the Practice confirmed it would review the complaint at the next clinical meeting and would also ensure use of questionnaires for specific triage. This took place in October 2024, and the Practice confirmed it would emphasise patient-centred care and highlighted the importance of clear documentation between hospital and primary care, as well as recognition of system and human errors and the need for continuous process improvement.

67. Taking this into account, we consider the Practice’s response was in line with expected complaint handling standards.

68. For these reasons, we will not be looking into this part of the complaint further.

69. We thank Mrs L for taking the time to bring her complaint to our attention. We hope our explanation brings some reassurance about the care and treatment her daughter received.

1. We have carefully considered Mrs L’s complaint about the care and treatment her daughter, B, received from a GP practice in Suffolk (the Practice).

2. We are very sorry to hear of the distress caused to B and Mrs L following the appointment at the Practice. We are grateful for Mrs L’s time in bringing this complaint to our attention.

3. We would like to reassure Mrs L we have not seen indications Practice staff missed an opportunity to diagnose B’s ear infection. Additionally, it appears it made appropriate clinical decisions at the time of the incident.

4. In regard to the way the Practice handled Mrs L’s complaint, we find the Practice acted in line with our complaint handling standards. We hope our explanation below reassures Mrs L we have looked into her complaint carefully.