A practice in the Fareham area

3. Ms S complains that the Practice failed to diagnose her son, C, had a middle ear infection on two occasions in July 2024. She thinks the Practice should have arranged for him to see a GP rather than a nurse on the second occasion to give him the best chance of being correctly diagnosed.

4. Ms S says this meant C’s illness got worse than it should have done, resulting him in having a burst ear drum and developing facial palsy. She says the local hospital may not have needed to operate on him, or could have operated sooner, had the Practice diagnosed C correctly. She says Joshua has not recovered as quickly as he should have done because of this.

5. She would like the Practice to acknowledge what it got wrong and apologise for the impact of that on C. She would also like the Practice to make service improvements to its triage system for child patients.

6. In mid-July 2024 Ms S took her son to her GP practice because he had a throat infection, temperature and sore ears. C was 11 at the time. The GP diagnosed he had a virus.

7. Two days later she took C to a pharmacist, who gave him Otigo for the pain. This is ear drops for pain relief.

8. The next day Ms S went back to the Practice. She asked to see a doctor, but a nurse saw him. The Practice prescribed an ear spray for C. Later that day she took him to the local hospital emergency department (ED) as C was still in pain. It prescribed oral antibiotics.

9. Three days after this, Ms S contacted NHS111. It advised her to go back to the ED. It diagnosed an ear infection and referred C to its ear, nose and throat (ENT) department. The hospital operated on C. It said he had a burst ear drum and fitted grommets. He also developed face palsy.

13. Ms S says the Practice failed to diagnose C correctly on two occasions in July 2024. She also says the Practice should have made sure he was seen by a GP rather than a nurse on the second occasion. She says, because of this, C’s ear infection became worse than it should. She thinks he may not have needed an operation, or he would have had the operation sooner if the Practice had acted differently

14. The Practice says it reviewed C’s symptoms on both occasions. It says on the first occasion his symptoms indicated a viral throat infection. It says it explained to Ms S what to do if C’s symptoms got worse. It does not think it got his diagnosis wrong at either visit. The Practice says it has a doctor-led triage system to make sure its resources are used as effectively as possible. It says it has not identified any issues with its triage system and its decision for a nurse to see C at the second appointment. But it also said her feedback had helped it to review and improve further its triage service.

15. Ms S also complained to the local ICB about what the Practice did. The ICB investigated and said it did not think the Practice had got something wrong.

16. The relevant standards for this complaint are ‘Good medical practice’, the NHS Choice Framework and NICE quality standard 91 (NG91). C was eventually diagnosed with otitis media, which is an infection of the middle ear.

17. ‘Good medical practice’ says medical practitioners should provide a good standard of care and take account of a patient’s medical condition, history and symptoms when diagnosing them. Practitioners should give the patient advice on what to do if their condition gets worse too. The NHS Choice Framework says Practices should try to make sure a patient sees the particular healthcare professional they have asked for, where that is possible. NG91 says what to do if a medical practitioner diagnoses a child with otitis media.

18. We asked our adviser about the first visit to the Practice in July 2024. They said the GP did a good assessment of C’s symptoms and they did not indicate he had a middle ear infection. We can see the Practice provided guidance on what to do if his symptoms got worse. This was in line with ‘Good medical practice’.

19. We can see how worrying and upsetting this was for Ms S. We understand why she is worried the GP made a mistake at this appointment. When we weigh up the evidence, It appears the GP acted in line with ‘Good medical practice’. We have seen no indication the Practice got something wrong here.

20. When Ms S and C went back to the Practice on the second occasion, the nurse diagnosed him with otitis externa (an infection of the skin leading down to the ear) but did not prescribe him antibiotics. She prescribed Otomize ear spray.

21. The notes show C had ear pain and a red, inflamed ear drum on this occasion, which had not been present at the first appointment. Our adviser said C’s symptoms at the second appointment did indicate he had an ear infection (otitis media). They said the nurse’s diagnosis was not in line with the symptoms.

22. Our adviser said the Practice should have diagnosed C in line with NG91. However, NG91 does not recommend giving antibiotics to a child of C’s age who has been diagnosed with otitis media. Although the nurse did not make the right diagnosis, even if she had, in line with what NG91 says, she would not have prescribed antibiotics.

23. The NHS Choice Framework says patients should be able to choose if they see a doctor. The Practice has not explained why it feels its nurse was sufficiently qualified to assess C, or if its GPs were not available. It did not make sure C was seen by the person Ms S wanted, or tell her why this was not possible.

24. We can only speculate about whether a GP would have been available to see C on the day, and whether they would have made the right diagnosis. However, we can see that if they had, in line with NG91, they would also not have prescribed antibiotics.

25. We can also see from the records that C’s condition later got worse even after the ED had prescribed him antibiotics and he had taken them. Our adviser said this indicates C’s condition would not have improved if the Practice had prescribed him with antibiotics on the second visit. NG91 says acute complications can happen with or without antibiotics. Our adviser said this is rare but unfortunately is what happened to C. It appears he was very unlucky to develop unpleasant complications.

26. We understand why Ms S remains concerned about what happened when she took C to the Practice on these two occasions. We hope our decision gives Ms S some reassurance and closure about what happened. We would like to thank her for bringing this complaint to us and wish her and C well for the future.

1. We have carefully considered Ms S’s complaint about the Practice. We do not think it got something wrong at her son, C’s first appointment in July 2024. We think it did get some things wrong when he had another appointment three days later. We do not think what it got wrong made C’s condition worse or meant he needed an operation he could have avoided, which Ms S was concerned about.

2. We appreciate how upsetting and distressing this time was for Ms S and for C. We hope our decision will bring her some reassurance the Practice’s actions did not have a clinical impact on C. We wish them both well for the future.