A practice in the Newcastle upon Tyne area

4. Mr W complains the Practice did not monitor him correctly from 2013 when he had a chronic condition. He also says the Practice did not answer his questions about why it did not monitor him or provide statistics on the number of patients it has with annual health checks.

5. He says this meant there was a delay in a diagnosis, and he had to have an urgent operation for his heart in December 2024 and now has a pacemaker and may need further surgery. He would like systemic improvements to the monitoring and treatment of chronic conditions.

6. What follows is a short summary of events. We do not include all details as both parties to the complaint aware of these.

7. Mr W is a 90 year old gentleman who underwent an urgent Transcatheter Aortic Valve Implantation (TAVI) operation for aortic stenosis in December 2024. Aortic stenosis is when the aortic or mitral valve is too narrow and does not open fully. The aortic valve is one of the four main valves in the heart.

8. During the TAVI procedure a catheter is passed through a blood vessel, usually in the groin, a new replacement valve is inserted through the catheter and is fixed in place on the top of the damaged valve.

9. Mr W says the Practice failed to monitor his health appropriately and in line with NHS guidelines from 2013. He says the Practice failed to take account of his chronic glaucoma which he says can lead to increased risk of cardio-vascular issues.

10. Mr W believes the lack of appropriate monitoring prevented an earlier diagnosis of his heart problem. He says because of this he now has a pacemaker and potentially will need further coronary artery surgery and vascular surgery for sub renal and Iliac aneurysms and must take medication for the rest of his life.

Health Checks

14. Mr W complains the Practice failed to carry out annual health checks in accordance with NHS guidelines. He explained he had an urgent Transcatheter Aortic Valve Implantation (TAVI) operation for aortic stenosis. He further explained if annual health monitoring had been carried out by the Practice, he would have been diagnosed with aortic stenosis earlier.

15. Mr W says the Practice did not consider his diagnosis of glaucoma which can lead to an increase of cardio/vascular problems. Mr W made his initial complaint to the Practice in December 2024.

16. The Practice response dated 6 January 2025 gave details of the NHS Health check criteria for patients between the ages of 40 and 74 years old. The criteria for the NHS health check includes no health check taken place within the last five years and no previously identified diseases such as coronary heart disease, chronic kidney disease, diabetes, hypertension, atrial fibrillation, transient ischaemic attack, familial hypercholesterolaemia, heart failure and peripheral arterial disease.

17. It explained that Mr W had a health check in 2013, and this meant in line with the guidelines his next health check was due in 2018/19. It advised that due to the number of elderly patients it has and its limited nurse appointment capacity it was striving to provide the best service it could. It said due to Covid-19 some routine services were suspended, and this caused a backlog, but it was able to carry out the annual health check in November 2021.

18. The Practice explained in October 2024 Mr W was referred to the Rapid Access Chest Pain Clinic with a diagnosis of angina. It explained his angina diagnosis has now triggered the annual health check.

19. Mr W responded to the Practice on 13 January 2025. He explained to the Practice he was aged 77 years and eight months when he had his health check in 2013, so the guidelines referenced by the Practice were not relevant.

20. The Practice response on 13 February said it understood Mr W’s frustration about a delay in the diagnosis of aortic stenosis. It explained that during health checks it is not routine to listen to the heart in a way that would identify this. Therefore, a yearly health check would not have given an earlier diagnosis.

21. Mr W responded to the Practice on 24 February. He again reiterated his complaint and explained he felt this was a missed opportunity for early diagnosis of aortic stenosis.

22. Mr W also said the Practice had contradicted its claims regarding routine monitoring of patients with a chronic condition. He said a chronic condition is described as a condition lasting more than three months and he had been receiving medication for glaucoma since 2013. Mr W said glaucoma is an incurable, progressive disease which has been ignored.

23. We considered what happened based on the medical records, guidelines and our clinical advice.

24. Our adviser explained that Mr W did not meet the criteria for the yearly NHS health check as he was over 74 years old in 2013. This means the NHS guidelines for 40-72 years olds was not relevant for his care. They explained NHS Health Checks are only offered to patients aged 40–74, so patients over 75 are not routinely invited and are managed through routine clinical care instead.

25. NHS England guidance on Improving care for Older People, provides information to GP Practices where patients with older age and frailty can be assessed. However, our adviser told us considering Mr W’s medical history he did not appear clinically frail and was not routinely taking multiple medications which would trigger intense follow up care or monitoring.

26. Mr W did not meet the criteria for an annual NHS health check. But patients over 75 years old can ask GPs for an assessment which should not be refused as part of providing clinical care. The standard General Medical Services Contract says patients over 75 years old should have an accountable GP and the GP should ensure a patient receives a health check if requested within a reasonable period.

27. We can see from Mr W’s records during a consultation on 16 January 2025 he raised his concern that he had not had a health check. It was explained to him he could have booked a health check at any time. This appears to be in line with the GMS contract which says patients over 75 should receive a health check if required.

28. As we noted above, Mr W told us he was concerned the Practice did not consider his diagnosis of glaucoma which he said can lead to an increase of cardio/vascular problems. We asked our adviser if Mr W’s diagnosis of chronic glaucoma meant he should have had further health assessments or risk management of any kind.

29. Our adviser explained chronic glaucoma is not classed as an illness/condition which needs to be followed/monitored by GP on regular/annual basis. NICE CKS for glaucoma says GPs should promote the use of eye drops and adherence to treatment, continue to prescribe any specialist medications, monitor any reactions to eye drops, provide any relevant information, and refer to a consultant ophthalmologist to discuss other therapeutic options of their IOP cannot be reduced sufficiently with SLT or pharmacological treatment or both to prevent the risk of progression to sight loss

30. Mr W’s records show the Practice processed his prescription requests for eye drops, liaised with the ophthalmologist, and carried out medication reviews in line with the NICE CKS guidelines. There is nothing documented within the guidelines which say Mr W should have been monitored on a regular basis by his GP for this condition.

31. We have noted the Practice response does explain the guidelines for the NHS Health Check for patients between 40–74 years. Mr W did not fit the criteria for these guidelines due to him being older than 74. The guidelines used by the Practice therefore appear to be incorrect.

32. We can see this error was made in explaining why Mr W was not asked to the Practice for yearly health checks. However, it does not appear this this poor explanation caused a delay in a diagnosis for Mr W.

33. Taking into consideration information received from Mr W, the Practice, our adviser and relevant guidelines we can see Mr W did not meet the criteria for an NHS Health Check due to his age. He also did not have any conditions meaning he required regular check-ups and his glaucoma was monitored in line with NICE guidelines.

34. We cannot see any indications of service failings in this part of Mr W’s complaint and will therefore close the complaint at this stage.

Freedom of Information request

35. On 6 February 2025 Mr W submitted a Freedom of Information request to the Practice. Mr W asked for ‘The percentage of all 1534 registered patients over 76 years of age who have attended an annual health check clinic in each of the last three years. The data, should ideally, be presented as a percentage for those patients listed as having a chronic sickness, and a separate percentage for those patients who are not registered as chronically sick.’

36. The Practice response dated 13 February 2025 said. ‘Regarding your request for specific information, the Freedom of Information Act is intended to provide access to data we already hold. It is not an opportunity for us to conduct new research on your behalf.’

37. We have considered this part of Mr W’s complaint, and it is more suited to the Information Commissioner’s Office (ICO) than us. The ICO can look into his complaint as they can investigate Freedom of Information requests.

38. If Mr W takes his complaint to the ICO and the ICO decide the Practice have not handled his request correctly the ICO can issue a decision notice to the Practice ordering it to disclose some or all of the information.

39. We cannot investigate this part of Mr W’s complaint further as there is an alternative dispute resolution forum available to him.

40. We can see Mrs W has had a troubling experience and would like to thank him for giving us the opportunity to look into his concerns. Complaints give us valuable insight into the organisations we investigate, and we recognise this has been an emotionally challenging process for Mr W. We would like to thank him for sharing his experience with us.

1. We have carefully considered Mr W’s complaint about a GP Practice in the Newcastle area (the Practice). We were sorry to hear about Mr W’s experience and can see from what he told us how worrying and upsetting this event was.

2. After giving full consideration to Mr W’s complaint regarding regular health check-ups, we have seen no indication of service failings from the Practice. In relation to Mr W’s Freedom of Information request we have decided the Information Commissioner’s Office (ICO) are better placed to consider this complaint.

3. We hope that the information we give below will explain our decision for Mr W and give him some reassurances that the Practice did not get anything significantly wrong and why. We hope this clears up any confusion caused by the Practice response which refers to guidelines that did not apply in Mr W’s case.