A practice in the Cornwall area

5. Mrs R is unhappy with the care and treatment which she received from the Practice regarding her Chronic Obstructive Pulmonary Disease (COPD) and Asthma between January 2023 and April 2024. Specifically, Mrs R says the Practice:

• did not carry out a health check when she joined in January 2023 • did not carry out appropriate tests to confirm if she had asthma or COPD • prescribed her an inappropriate inhaler • failed to refer her to secondary care, and • ignored symptoms of fatigue and tiredness.

6. As a result of the Practice’s failings, Mrs R says she cannot exercise as she used to be able to and her family and friends are surprised by her health decline. Mrs R says she has to sleep in a reclining chair and cannot do any housework, now having to employ a cleaner and gardener. Mrs R says that she is now mainly housebound and has had to seek private tests and consultations.

7. As an outcome to the complaint, Mrs R seeks financial redress and for the Practice to acknowledge failings.

8. Mrs R is unhappy with the care she received from the Practice when she joined in January 2023. Mrs R had a previous coded diagnosis of COPD and is unhappy with the way in which the Practice handled her care moving forward. COPD is the name for a group of lung conditions that cause breathing difficulties which tend to gradually get worse over time and can limit normal activities.

9. Mrs R approached the Practice for support as her symptoms were worsening and is unhappy with the approach that the Practice took regarding her care.

14. 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.

Access and Diagnosis

15. Mrs R complains that the Practice did not carry out a health check when she joined in January 2023. Mrs R believes that this would have allowed her to be seen quicker for the breathlessness which she was experiencing.

16. Mrs R says that the Practice did not carry out any tests to confirm her diagnosis of Asthma or COPD when she joined in January 2023.

17. In its response, dated 1 May 2025, the Practice explained, it reviews its patient’s chronic illnesses during their birth month. As a Practice with over 30,000 patients, this is the most efficient way to approach chronic disease reviews. For Mrs R, this would mean that her first chronic review would have taken place in August 2023 after joining in January 2023.

18. Mrs R’s chronic disease review then took place on 2 August 2023, during her birth month.

19. We consider there is no clinical guidance available which would demonstrate when chronic reviews should take place. This has been verified by our clinical adviser.

20. There is no clinical guidance to show that any NHS organisations should conduct tests to confirm any previously coded diagnoses. This has been verified by our clinical adviser.

21. We have, however, seen that in its response on 1 May 2025, the Practice has advised that it has an approach on when it conducts chronic disease reviews, the patients birth month. Our clinical adviser has confirmed that this is a reasonable approach.

22. Based on the information that we have seen, we consider the Practice’s approach to conducting chronic disease reviews was reasonable and in line with good clinical care and treatment. We have seen nothing to indicate that the Practice acted inappropriately or that it acted outside of good clinical practice.

23. Based on the information that we have seen, we consider the Practice’s approach to conducting chronic disease reviews was reasonable and in line with good clinical care and treatment. We have seen nothing to indicate that the Practice acted inappropriately or that it acted outside of good clinical practice.

24. As such, we have found no indications of maladministration.

Symptoms

25. Mrs R says she was experiencing symptoms of tiredness and fatigue following her registration with the Practice in January 2023. Mrs R says that the Practice should have been more proactive in seeing her and treating her symptoms.

26. In its response dated 1 May 2025, the Practice advised Mrs R requested an Asthma/ health review on 25 May 2023 which the Practice completed on 13 June 2023 including a full blood test. It then confirms that Mrs R had a COPD review with a respiratory nurse on 15 June 2023 and a chest X-Ray on 22 June 2023. The results of which were normal.

27. Mrs R’s chronic disease review then took place on 2 August 2023, during her birth month.

28. We have carefully considered Mrs R’s complaint and her medical records. We can see that the Practice was proactive in seeing Mrs R and arranging tests. We can also see that it did not wait until Mrs R’s birth month to see Mrs R at her chronic disease review to see her. Our clinical adviser confirmed our view.

29. The General Medical Council’s (GMC), principles of good medical practice say that in providing care, you must, promptly provide (or arrange) suitable advice, investigation or treatment where necessary.

30. Based on the information that we have seen, we consider the Practice was proactive in seeing Mrs R, arranging tests and in line with good clinical care and treatment. We have seen nothing to indicate that the Practice acted inappropriately or that it acted outside of good clinical practice.

31. As such, we have found no indications of maladministration.

Referral

32. Mrs R complains that the Practice failed to refer her to a specialist or for diagnostic scans.

33. In its response dated 1 May 2025, the Practice advised that Mrs R requested an Asthma/ health review on 25 May 2023 which the Practice completed on 13 June 2023 including a full blood test. It then confirms that Mrs R had a COPD review with a respiratory nurse on 15 June 2023 and a chest X-Ray on 22 June 2023. The results of which were normal.

34. In its response dated 11 July 2024, the Practice advised Mrs R had an appointment on 9 November 2023. During this appointment, the clinician advised Mrs R that they would refer Mrs R onward for Pulmonary Rehabilitation. Pulmonary Rehabilitation is an exercise and education programme designed for people with lung disease who experience symptoms of breathlessness.

35. We have seen a referral letter dated 13 December 2023 which was sent to Cornwall Partnership NHS Foundation Trust, referring Mrs R for Pulmonary Rehab.

36. Based on the information that we have seen, we consider the Practice was proactive in seeing Mrs R, arranging tests, referring her onward and in line with good clinical care and treatment. We have seen nothing to indicate that the Practice acted inappropriately or that it acted outside of good clinical practice.

37. As such, we have found no indications of maladministration.

Drugs / Medication

38. Mrs R complains that the Practice prescribed an inappropriate inhaler.

39. Mrs R says that the prescription of the inappropriate inhaler had a negative impact on her overall health and wellbeing as it did not treat her condition appropriately.

40. During an appointment in August 2023, Mrs R’s inhaler was changed to Trixeo.

41. As per NG245: ‘Asthma: diagnosis, monitoring and chronic asthma management’, Mrs R should have been prescribed an inhaler to treat her Asthma primarily. Our clinical adviser has confirmed that when a person has a diagnosis of Asthma and Chronic Obstructive Pulmonary Disease (COPD), the inhaler should primarily be used to treat the Asthma.

42. As the Trixeo inhaler primarily treats the COPD element, our clinical adviser has confirmed that this inhaler was not prescribed in line with clinical guidance and therefore shows an indication of a failing.

43. In a letter dated 29 January 2025, a Respiratory Specialist Nurse from Cornwall Partnership NHS Foundation Trust wrote to the Practice to notify it of its mistake and advise it that she has prescribed Mrs R a different inhaler in line with clinical guidance, Trimbow.

44. In its response letter dated 1 May 2025, the Practice acknowledges that Mrs R had found no benefit following her prescription to the Trimbow inhaler. It also recognises that Mrs R had since been changed again to a Fostair inhaler.

45. As Mrs R found no benefit when she was prescribed the correct inhaler which the Practice should have prescribed in August 2023, it is more likely than not that the incorrectly prescribed inhaler had no clinical impact on Mrs R’s health.

46. Mrs R may have found no benefit to the Trixeo inhaler; however, it did not negatively impact her health. We can see this from Mrs R’s medical records that although she may have continued to experience the symptoms, she did not experience any new, or worsening symptoms.

47. In its response dated 1 May 2025, the Practice have acknowledged that it should not have prescribed the inhaler that it did and offered its apologies for any distress that this has caused.

48. Our Principles of Remedy say that a remedy should be appropriate and proportionate to the injustice sustained. It also says that an appropriate remedy may include apologies, explanations or acknowledging responsibility.

49. We can see from its response letter dated 1 May 2025, the Practice have acknowledged that it made the wrong decision, explained why the original decision was made, and offered an apology.

50. We believe that the organisation has done enough to remedy the injustice that Mrs R experience and as such we have found no indications of an unremedied injustice.

51. We recognise that this will be disappointing for Mrs R, given the impact that this has had on her wellbeing.

1. We have carefully considered Mrs R’s complaint about a GP Practice in Cornwall (the Practice). We were sorry to hear how Mrs R was affected by the concerns she raised.

2. There are elements of Mrs R’s complaint where we have not seen any indications that things went wrong. This means that that from the evidence we have considered, it appears that the Practice provided appropriate care and treatment to Mrs R.

3. However, we have identified indications of service failure in relation to some aspects of Mrs R’s complaint as the service provided to Mrs R was not in line with the standard of service we would expect. We have carefully considered the impact this had, and we have considered whether there is more we would expect the Practice to do to put things right. Our view is that the Practice has taken proportionate action to remedy the concerns Mrs R has raised, and that this had no notable impact on Mrs R’s care and treatment.

4. We will explain the reasons for our decision in this statement. Complaints give us valuable insight into the organisations we investigate, so we would like to thank Mrs R for sharing her experience with us. It is important to acknowledge that although we are unable to look at the concerns she has raised, this does not detract from the experience Mrs R had, or the impact this had on her.