A practice in the Somerset area

6. Mrs K complains about the care and treatment she received from the Practice. She says the Practice ordered inappropriate tests when assessing her lipoedema symptoms, incorrectly informed her that no local lipoedema services were available, and then took six months to refer her to the appropriate local service. She also complains the Practice failed to provide the compression leggings required for her lipoedema treatment and did not handle her complaint properly.

7. Mrs K says the Practice’s actions led to her experiencing delay in getting correct referral to a lipoedema service. She told us she had to source and pay for private treatment and prescriptions. She also experienced pain as her condition deteriorated and she feels dismissed with the response to her complaint.

8. By bringing her complaint to us, Mrs K wants the Practice to provide staff training on lipoedema and its management, improve staff training on investigating and accessing specialist services, and strengthen staff training on handling complaints. She also wants a financial remedy of £265.97.

9. Mrs K visited the Practice on 29 November 2024, and she presented with symptoms of lipoedema. Lipoedema is a medical condition in which abnormal fat builds up in the legs and sometimes arms.

10. At the appointment a nurse practitioner assessed her, arranged blood tests and referred her to a local hospital for an ultrasound scan to confirm the diagnosis.

11. Mrs K attended the appointment for the tests at the hospital. While the hospital did the blood test, it refused the referral for the ultrasound stating it was not required in assessing lipoedema.

12. The Practice contacted the local lymphoedema service in the area who advised there were no lipoedema services in the local area. The Practice also tried referring Mrs K to an out of area lipoedema service, but the service declined the referral.

13. Mrs K paid privately for an assessment which confirmed her diagnosis of lipoedema.

Inappropriate tests

17. Mrs K says the Practice ordered inappropriate tests to diagnose her symptoms.

18. Mrs K’s medical records show she attended the Practice on 29 November 2024. She reported ongoing abnormal fat build up in her legs and abdomen and asked the Practice to refer her to a specialist lipoedema service.

19. A nurse practitioner assessed her during this appointment. The nurse examined her legs and recorded a treatment plan that included measuring her for compression stockings, arranging blood tests, and requesting an ultrasound scan of her lower limbs.

20. Mrs K attended the appointment for the blood tests on 2 December 2024. Records show that on 4 December the referral team rejected the ultrasound request, stating the scan would not assist with diagnosis. Following this, a note was added indicating the Practice would contact lymphoedema services for advice on how to refer Mrs K for lipoedema. We have seen evidence it did this.

21. In its complaint response, the Practice stated the tests ordered were not unnecessary. It explained as this was her first presentation with these leg changes at the Practice, it had a duty to investigate all possible causes.

22. The NHS describes lipoedema as an abnormal build-up of fat in the legs and sometimes the arms. Symptoms include limbs becoming larger, feeling heavy or tender, bruising easily, and appearing out of proportion to the rest of the body, while the feet and hands are usually unaffected.

23. Wounds UK guidelines state there are no specific diagnostic tests, diagnosis relies on medical history, physical examination, and ruling out other causes. It notes clinicians may arrange blood tests or scans, but only to exclude alternative explanations for the symptoms.

24. The Code says nurses must respect the skills, expertise and contributions of their colleagues and refer matters to them when appropriate.

25. The records show, on the same day the nurse ordered the tests and scan the Practice also planned to measure Mrs K for compression stockings. This suggests the nurse was considering lipoedema but also sought to rule out other potential causes in line Wounds UK guidance and the Code.

26. The specialist service considered Mrs K’s referral and with their specialist knowledge, decided to decline. We are satisfied the Practice acted in line with relevant guidance by adequately assessing Mrs K’s condition and arranging appropriate investigations. For this reason, we will not be taking this complaint further. We hope Mrs K is reassured the Practice requesting the tests was appropriate.

Misinformation and delay in referring her

27. Mrs K says the Practice incorrectly told her there were no local specialist lipoedema services and it took six months for her to be referred to the correct service.

28. On 4 December 2024, when Mrs K’s blood tests were normal and the hospital had declined the ultrasound request, the Practice recorded a plan to contact the local lymphoedema service for advice on referring her for lipoedema treatment. Records show that on 11 December the Practice contacted the service, which advised there was no local ‘in-area’ lipoedema service.

29. On 3 January 2025, Mrs K attended an appointment where the Practice diagnosed her with lipoedema and again informed her no local specialist service was available. Mrs K requested an out of area referral. On 15 January 2025 the Practice referred her to an out of area lipoedema service.

30. On 20 January, the out of area service declined the referral because Mrs K lived outside its catchment area. It advised the Practice to refer her to the local lymphoedema service instead.

31. On 22 January, the Practice responded to the out of area service saying it had already contacted the local service and had been told no lipoedema provision existed, which is why it had referred her to their service.

32. On 24 January 2025, the out of area service confirmed it could not accept out of area referrals and suggested the Practice direct Mrs K to a lipoedema guidebook and online support groups. The Practice passed this information to Mrs K on 27 January.

33. On 21 March 2025, Mrs K saw a private specialist nurse, who diagnosed lipoedema in her legs and arms and confirmed the local lymphoedema service did provide lipoedema care.

34. Mrs K returned to the Practice on 4 April 2025 to share this information. On 2 May 2025, the Practice confirmed the local service did offer lipoedema support and referred her there. Mrs K attended her appointment on 4 July 2025.

35. In its complaint response, the Practice said the delay resulted from incorrect information provided by the local lymphoedema team. It also stated because Mrs K had experienced symptoms for many years, it did not believe the six-month delay significantly affected her clinical situation.

36. The Code states nurses must make sure any treatment, assistance or care for which they are responsible is delivered without undue delay. We have already documented it also states, ‘nurses must respect the skills, expertise and contributions of their colleagues and refer matters to them when appropriate’.

37. Once the Practice received Mrs K’s normal test results, it acted promptly and in line with the Code by contacting the local lymphoedema service to check whether it provided lipoedema care. Unfortunately, it was given incorrect information.

38. The Practice acted in line with the code when it worked with colleagues to identify an appropriate service and passed Mrs K the information the out of area team signposted it to.

39. When Mrs K later returned with new information from a private specialist confirming a local service did offer lipoedema care, the Practice acted quickly and referred her to the correct service.

40. We can see the Practice was proactive in trying to ensure Mrs K was referred to the appropriate service. We have seen the delay was caused by the Lymphoedema service providing the incorrect information. The Practice acted in line with the Code by working with colleagues to provide the right service to Mrs K in a timely manner.

41. We have seen no indications of failings, and for this reason, we will not be taking any further action on this part of the complaint.

Not providing her compression leggings

42. Mrs K says the Practice failed to provide her with the compression leggings needed for her lipoedema treatment.

43. On 21 March 2025, she paid privately for an assessment with a specialist nurse, who confirmed her diagnosis and noted that the lipoedema had progressed from her legs to her arms. The nurse advised compression garments were the only available treatment option under current NICE guidance. She measured Mrs K for compression socks and leggings and advised her to request these on prescription from her GP.

44. On 4 April, Mrs K gave the Practice a copy of the nurse’s report and recommendations. The GP told her the information would be passed to the pharmacy team to arrange a prescription.

45. On 25 April, the Practice issued the compression socks but informed Mrs K the leggings could only be provided on a private, chargeable prescription, or she could purchase them privately.

46. In its complaint response, the Practice said the leggings recommended by the private nurse were not prescribable locally on the NHS. We found no evidence of this explanation in the clinical records.

47. Our clinical adviser explained, although the exact leggings recommended by the private nurse could not be prescribed locally, the Practice should have prescribed a suitable alternative. We found no evidence the Practice considered alternatives.

48. We asked the Practice whether any alternatives were available at that time. It sought advice from the Integrated Care Board (ICB). This is the NHS organisation responsible for planning and funding most local health services. The ICB sent the Practice a list of possible alternatives to the leggings recommended by the private nurse.

49. As an outcome to her complaint, Mrs K told us she wanted the Practice to reimburse the cost of her private treatment and to ensure staff receive training on lipoedema and its management.

50. We contacted the Practice and asked whether it would be willing to resolve the complaint. Specifically, we asked whether it would reimburse the costs Mrs K incurred in privately obtaining treatment.

51. The Practice agreed to reimburse her treatment costs totalling £265.97.

52. As a result of Mrs K raising her complaint, the Practice has become aware of the range compression garments available to lipoedema patients. We consider Mrs K’s complaint has resulted in a service improvement within the Practice.

53. We consider the financial remedy and service improvements to be in line with the NHS Complaints standards which state organisations should see complaints as an opportunity to develop and improve its services and offer fair remedies to put things right.

54. We are pleased the Practice has taken further learning from this and understands the need to confirm whether alternative options are available, ensuring patients can still access suitable treatment even when a specific product cannot be prescribed.

Complaint handling

55. Mrs K says the Practice did not handle her complaint properly, as it did not investigate the source of the misinformation or identify what went wrong and who was responsible. She also says the Practice’s response left her feeling disconcerted and dismissed. We are sorry to hear about Mrs K’s experience.

56. In its complaint response, the Practice explained the nurse practitioner had personally contacted the local lymphoedema service and was advised no lipoedema services were available. We found evidence of this in the records. The Practice stated it would inform staff a local lipoedema service does in fact exist and ensure this learning is shared. It also apologised for the delay the error caused and confirmed it could support Mrs K in following the correct referral pathway.

57. NHS Complaint Standards state organisations should welcome complaints and ensure responses clearly explain what happened, identify any mistakes, show how the organisation is taking responsibility, and outline the actions being taken to learn and improve services.

58. We understand the Practice cannot identify which member of staff from the local lymphoedema organisation provided the incorrect information. However, we can see the Practice acknowledged its error, took learning from the complaint, recognised a local lipoedema service exists, and ensured this information is shared with staff. It also recognised the delay this caused Mrs K, apologised for the unnecessary impact, and referred her to the correct service once the mistake was identified.

59. The Practice has acted in line with the relevant guidance by apologising, taking learning from the complaint, and reminding staff about the local lipoedema service. For this reason, there is nothing further we could add by considering this part of the complaint further.

60. We appreciate this has been a very difficult time for Mrs K, and we hope this explanation reassures her that her complaint have been thoroughly considered.

1. We have carefully considered Mrs K’s complaint about a Practice in the Somerset area (the Practice).

2. We are sorry to hear how Mrs K has been affected. It is clear she has had an upsetting experience waiting to receive support for her lipoedema diagnosis and understandably, Mrs K wants to ensure this does not happen again.

3. We have seen no indications of failings regarding the tests, the delay in referring her and the handling of her complaint.

4. We are pleased to have reached an agreement with the Practice for it to reimburse Mrs K the expense she incurred in seeking private treatment. We think this appropriately resolves the element of the complaint about compression leggings.

5. 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 K for sharing her experience with us. It’s also important to acknowledge that finding no indications of service failure or no unremedied injustice does not detract from Mrs K’s experience of the upset and worry these events cause.