A practice in the South Kesteven area

5. Mr H complains about how the Practice investigated his right sided pain and swelling between October 2024 and April 2025.

6. Mr H complains:

• the Practice failed to recognise his symptoms as a complication relating to a previous hernia operation and offer surgery • the Practice did not request advice from general surgery about his symptoms • the Practice failed to offer him a surgical option through the NHS.

7. Mr H says he felt let down and disappointed by the Practice. He says he was in pain and did not think he was going to get the treatment he needed on the NHS, leading him to seek private treatment.

8. He wants the Practice to reimburse his private care costs.

9. Mr H previously had a hernia operation on his right side in 2021 at the Practice as part of its Community Surgery Scheme (CSS).

10. In October 2024, Mr H noticed pain on his right side, at the site of his previous hernia operation, and some swelling. He reported this to the Practice, and it referred him for an ultrasound.

11. In December 2024, Mr H’s ultrasound reported mesh wires in the right groin, and a left inguinal hernia (a swelling or lump caused by tissue pushing through a weak spot in the top of the groin).

12. Mr H’s GP referred Mr H to urology and to the CSS at the Practice.

13. Mr H was reviewed at the CSS, the consultant advised Mr H’s GP to refer him to the chronic pain team for ongoing right groin pain.

14. In February 2025, Mr H had a consultation privately about his right sided groin pain. The private consultant said he needed an open exploration of the right groin, removal of the mesh and hernia repair.

15. Mr H provided a clinic letter from the private consultant to the Practice.

16. In March 2025, Mr H noted he would like to have this surgery on the NHS and the Practice agreed to contact the private consultant asking for this to be done through the NHS.

17. The private consultant did not take NHS patients and Mr H had the surgery privately instead in April 2025.

Failure to diagnose his symptoms as a complication

22. 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.

23. In October 2024, Mr H reported groin pain and occasional testicular pain to the Practice. He was seen at the Practice in November 2024 and reported severe pain in the groin, and a cyst on his testicle which was giving discomfort. The Practice referred him for an ultrasound scan.

24. In December 2024, Mr H had an ultrasound scan of his testes and groin. The ultrasound found mesh present in the right groin, and a suspected reducible left-sided hernia (a hernia which can be pushed back into place or reduced). It also found testicular microlithiasis (tiny calcium deposits found in the testicles), and recommended specialist referral for this.

25. The Practice referred Mr H to the CSS at the Practice regarding his pain in the groin, and to urology regarding the testicular microlithiasis.

26. Mr H was seen in the hernia clinic at the Practice in January 2025. The consultant reviewed Mr H, identifying his right sided groin pain. They asked his GP to refer him to the chronic pain team for further investigation and treatment into his right sided groin pain. The referral stated Mr H had persistent pain in the right groin and no recurrent hernia or other cause of pain identified. Mr H says the consultant told him the pain was nothing to do with the surgery.

27. In February 2025, Mr H had a consultation with a private surgeon, who suspected Mr H may have trapped tissue and having a reaction to the mesh used in his original hernia operation, which could be the cause of his groin pain. In the clinic letter, the consultant said they planned to admit Mr H for an operation including an exploration of the right groin, to remove the mesh and tender lump, and repair the right hernia.

28. Mr H complains the Practice failed to recognise his symptoms were related to his original hernia operation and recommend surgery to remove the mesh, like the private consultant identified.

29. The GMC guidance says a clinician must provide or arrange suitable advice, or treatment where necessary. It says to refer the patient to another suitably qualified practitioner when this serves their needs.

30. When Mr H reported groin pain, our GP adviser said the Practice arranged appropriate investigations into his symptoms by organising an ultrasound scan. Following the findings on the ultrasound scan, our GP adviser said the Practice referred Mr H to a consultant surgeon for investigations into his groin pain.

31. We consider the Practice appropriately investigated Mr H’s symptoms and referred him to another suitably qualified practitioner in line with the GMC guidance.

32. The BJS guidance describes chronic postoperative pain as inguinal (groin) pain including a level of discomfort rated as at least ‘moderate’ and impacting daily activities and lasting longer than a three-month period. It recommends starting with an ultrasound in evaluating postoperative chronic inguinal groin pain.

33. The BJS guidance says the treatment of chronic postoperative inguinal pain is complex, and there is risk of around 30 percent that surgery will not be effective, with even a small risk of more pain. It says a tailored approach to surgery is suggested depending on the original repair method, experience of the surgeon, symptoms of pain, physical findings and imaging.

34. It alternatively recommends trigger point infiltration and peripheral nerve blocks (using anaesthetic to an inflamed area to relieve pain) in diagnosing and managing chronic pain after hernia surgery. It recommends a multi-disciplinary approach with a pain specialist. It says this technique serves as an important diagnostic tool for chronic groin pain.

35. Our general surgery adviser said chronic pain is a significant complication of hernia surgery, which can be caused for multiple reasons including infected mesh, or damage to a nerve.

36. Our general surgery adviser said there was no sign of infection of the mesh in Mr H’s ultrasound, or recurrent hernia which would indicate surgery is required immediately. They said surgery could be considered to see if this resolves Mr H’s groin pain, as suggested by the private consultant. They also said referring Mr H to a pain specialist was also appropriate management, as a pain specialist could help with initial diagnosis and treatment, and this management is recommended in the BJS guidelines.

37. The BJS outlines there is a risk further surgery may not be effective in treating groin pain after hernia surgery, and non-surgical approach with a pain specialist can also be considered as well as surgery. In line with this guidance, it was appropriate for the Practice to refer Mr H to a pain specialist first.

38. We understand Mr H recalls the consultant telling him this was not a complication of the surgery. The notes do not reflect this and demonstrate the consultant recognised Mr H was suffering with chronic groin pain and referred him to the chronic pain team for further investigation.

39. There is conflicting evidence about what was said here, and as we were not present, and there is no further evidence we can obtain to help us to reach a decision whether the consultant said this to Mr H or not, we are unable to reach a conclusion about this issue.

40. We are sorry Mr H thinks the Practice failed to recognise his groin pain as a complication of his original hernia surgery and recommend further surgery. We have seen evidence the Practice identified Mr H’s chronic groin pain, and we consider it was appropriate for the Practice to refer Mr H for treatment under a pain specialist first.

41. The BJS guidance says surgery is not always effective in treating chronic pain, and it is recommended to consider both surgical and non-surgical treatments. As such, we consider the Practice’s investigation into Mr H’s groin pain was appropriate and in line with the GMC and BJS guidance.

The Practice failed to offer him a surgical option through the NHS

42. Mr H complains the Practice did not offer him a surgical option through the NHS after his private consultant recommended surgery. He says he was not given an alternative option and had to pay for private treatment.

43. Following Mr H’s consultation with a private consultant, who recommended surgery to try to treat his symptoms, he contacted the Practice about his options on the NHS. Mr H was seen at the Practice in March 2025, where the GP noted they would refer him to the private consultant. Mr H says the GP told him if he wanted the surgery, he would have to pay privately.

44. In March 2025, the Practice referred Mr H to the private consultant. The referral mentioned Mr H’s severe groin pain on the right side, and the private consultant’s plan for surgery. The Practice requested for this to be done on the NHS, but if not, to accept it as a private referral.

45. Mr H contacted the Practice two days later, stating he wanted the procedure through the NHS. The Practice told him it had referred him to the private consultant ideally to have this on the NHS, but if not, to have the surgery privately.

46. The private consultant did not accept NHS referrals, and accepted Mr H as a private patient. Mr H had the surgery privately in April 2025.

47. We have considered whether Mr H has given the NHS the opportunity to provide the care and treatment required before resorting to private care and treatment, and whether the private treatment obtained is the same as the treatment that would have been obtained on the NHS.

48. As we explained above, Mr H was seen by an NHS consultant at the Practice in January 2025, who decided to refer Mr H to the chronic pain team. We have considered this was appropriate treatment.

49. We do not know if Mr H would have been offered the operation in the first instance through the NHS, as Mr H had already been seen by a consultant who referred him to the chronic pain team instead of offering surgery.

50. The GMC guidance says to refer a patient to another suitably qualified practitioner when this serves their needs.

51. Our GP adviser said as Mr H wanted the treatment proposed by the private consultant, it was appropriate for it to request if the consultant would perform this on the NHS, as Mr H requested. This is in line with the GMC guidance.

52. We think, when the private consultant declined Mr H’s surgery on the NHS and offered it privately, Mr H could have returned to the Practice and requested a referral to an NHS hospital. We are sorry Mr H was suffering in pain and felt he had to pay for the surgery privately. We consider Mr H could have returned to the Practice and given it an opportunity to provide treatment through the NHS.

53. We are sorry Mr H felt he was not given an alternative treatment option, and he had to pay privately for his surgery. We have not seen evidence Mr H had no other option than to seek private care, and we cannot guarantee he would have been offered this surgery through the NHS.

54. We consider the Practice referred Mr H to his private consultant as this was the treatment he wanted, which is in line with the GMC guidance. We have not seen evidence Mr H disagreed with this plan. As such, we do not consider this a failing by the Practice, and we are not investigating this further.

The Practice did not request advice from general surgery about his symptoms

55. Mr H complains the Practice told him it would request advice from general surgery about a possible mesh complication, but it did not do this.

56. In February 2025, Mr H reported his pain was getting worse, and his swelling was increasing. The Practice told him it would write to general surgeons regarding pain and swelling in the right groin.

57. In February 2025, we can see the Practice submitted an advice and guidance request to general surgery. This is a service that allows clinicians in primary care to seek advice from another, usually a specialist, prior to, or instead of, a referral.

58. The Practice explained Mr H had pain in the right groin for approximately five months and had swelling. It provided the ultrasound findings and asked for general surgery to provide an opinion on Mr H’s pain. It asked whether the pain was related to the mesh used in his original operation and whether he needed surgery to remove the mesh.

59. By March 2025, the Practice had not received a response from general surgery. By this point, Mr H had a private consultation and requested a referral for surgery.

60. The Practice has told us it did not receive a response from the advice and guidance request, so it followed up with the hospital about this. It said the hospital had chosen not to provide a response to the advice and guidance request, and instead, converted this to an outpatient referral at the hospital, which Mr H attended later in 2025.

61. The GMC guidance says a clinician must promptly provide or arrange suitable advice, investigation or treatment where necessary.

62. In line with the GMC guidance, after Mr H reported his worsening symptoms, the Practice submitted an advice and guidance request to general surgery asking for advice about Mr H’s symptoms. Unfortunately, the hospital did not provide this advice and guidance before Mr H sought surgery privately, as it changed this request to a routine outpatient appointment.

63. We are sorry Mr H does not think the Practice sought advice from general surgery as it said it would, and for the distress this has caused him. There is evidence in Mr H’s medical records that the Practice did request this advice. We consider this is in line with the GMC guidance. As such, we have not seen any indications of a failing by the Practice, and we will not investigate this further.

1. We have carefully considered Mr H’s complaint about a GP practice in the South Kesteven area (the Practice). We are sorry to hear Mr H suffered with groin pain and swelling between October 2024 and April 2025. We recognise he is unhappy with how the Practice investigated his symptoms, and he felt he had to get surgery privately.

2. Mr H complains the Practice failed to recognise he had a complication relating to his previous hernia surgery and offer appropriate treatment. We consider the Practice investigated Mr H’s symptoms appropriately, and we did not find a missed opportunity for treatment. Therefore, we are not investigating this further.

3. He also complains the Practice did not offer him a surgical option through the NHS. We have seen evidence the Practice referred Mr H to his preferred clinician, asking for NHS treatment. We have not seen evidence of a failing by the Practice. As such, we are not investigating this complaint further.

4. Mr H complains the Practice did not contact general surgery for advice about his symptoms as it said it would. The Practice has provided us with evidence that it did, and therefore, we are not investigating this further.