A practice in the Islington area

4. Ms T complains that following pain in her toe on 18 July the Practice did not offer her a face-to-face assessment until 8 August or refer her to a podiatrist. She also complains the Practice delayed responding to her complaint and its responses contained inaccurate information.

5. She says no face-to-face appointment delayed treatment, and she experienced a financial loss as she had to pay for a private podiatrist. She said she had to have her toenail completely removed which added to her anxiety and insecurity especially during the summer months when she felt self-conscious about the appearance of her toe. She says poor complaint handling left her feeling unheard and insignificant and contributed to a sense of helplessness diminishing her trust in seeking further care. She says the experience and how her complaint was handled, led her to lose faith in the healthcare system.

6. Ms T would like an acknowledgement of failings, an apology, service changes, and a financial remedy.

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

8. On 18 July 2023 Ms T contacted NHS 111 as she had an infected right big toe. NHS 111 directed her to an out of hours GP which was not part of the Practice. Ms T sent a photograph of her toe, and it prescribed Flucloxacillin (an antibiotic) which Ms T collected the following day. On 20 and 24 July Ms T had telephone consultations with the Practice. It gave reassurance and advice.

9. Ms T attended a hospital Walk-in Centre on 26 July. It examined her toe and used a scalpel to release infection. It recleaned her toe, dressed it and prescribed a further dose of Flucloxacillin and asked Ms T to return in two to three days for a further review.

10. On 28 July Ms T thought she was having an allergic reaction or anaphylaxis, she felt very unwell and called for an ambulance. The ambulance service advised Ms T to go back to the Walk-in Centre.

11. Ms T was examined at the Walk-in Centre, and it suspected an allergy. She was given chlorphenamine which is an antihistamine. It stopped her prescription of Flucloxacillin and prescribed Doxycycline another antibiotic. It reviewed her toe and advised there was no inflammation or pus pocket, and it was mildly red. It advised her nail was partially loose and again it asked her to return for a review in three days.

12. On 31 July Ms T had a telephone consultation with the Practice. It arranged a further review the following week when she had completed her course of Doxycycline. The hospital Walk-in Centre changed Ms T’s toe dressing on 1 and 4 August. The Practice had a telephone consultation with Ms T on 7 August. It advised her to take pain relief if needed, to soak her toe in warm salty water and to replace the dressing.

13. Ms T had a face-to-face appointment at the Practice on 8 August to review her toe. It removed the dressing. The Practice reviewed Ms T’s toe again on 9 August and applied a new dressing. After a further appointment on 16 August dressings were no longer needed.

14. Ms T complained to the Practice on 16 January 2024; the Practice response is undated. Ms T responded to the Practice on 6 August. She did not receive a response and Ms T’s advocate contacted the Practice on the 16 September and 4 November. Ms T contacted PHSO on 17 December. PHSO contacted the Practice on 31 December and again on 1 March 2025. Ms T received her final response on 26 March.

17. 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 something has gone wrong.

Assessment, treatment and referral 18. Ms T told us that following experiencing pain in her toe on 18 July the Practice did not offer her a face-to-face assessment until 8 August. She told us the Practice relied on telephone appointments and photographs of her infected toe despite her symptoms escalating. She said it did not follow up on treatment following the drainage of the infection at the Urgent Care Centre on 26 July.

19. Ms T also told us the Practice refused to refer her to a podiatrist. She explained she was desperate to see a specialist and requested the Practice refer her to the podiatry service.

20. Our adviser told us there are no specific guidelines relating to when GPs should see patients face-to-face rather than having a telephone consultation. They said in their clinical view having looked at the medical records and what Ms T told us happened, her condition can generally be managed over the telephone if a photograph is provided as it is usually easy to determine from a photograph if antibiotics or a face-to-face appointment is needed.

21. NICE Clinical Knowledge Summary (CKS) says consider prescribing topical antibiotics, such as fusidic acid cream for minor localised infection and consider prescribing a course of oral antibiotics such as Flucloxacillin. It says follow up is not usually necessary, as most infections drain spontaneously without the need for incision and drainage (if this has not already been performed). However, doctors should advise the person that they should return for review if there are changes as it may require incision and drainage), or if it persists and does not discharge or improve.

22. We can see from Ms T’s records oral antibiotics, in her case flucloxacillin, was prescribed. This is in line with the NICE CKS. Ms T’s records also show regular reviews were advised and arranged by the Practice and she was advised to return to the Practice if needed in line with NICE guidelines.

23. Ms T contacted the Practice on 20 and 24 July after she had been diagnosed and given antibiotic treatment two days earlier by NHS 111. Initially the Practice reassured her infection can take time to resolve and to rest her foot and elevate it. By 24 July a photograph she sent to the Practice showed the swelling had reduced but discolouration was getting worse. It told her to keep taking pain relief.

24. Our adviser said the telephone appointment on the 20 July was appropriate due to Ms T only just receiving antibiotics which she would probably not have seen a benefit from at that early point. Then on the 24 July the clinician had reviewed some new photos with their colleagues and determined the toe was looking better. The swelling was better but there was some new discolouration.

25. The antibiotics were still not finished so a follow-up appointment was made to see how her toe was with some new photos. Again, this appears to have been appropriate at the time as her symptoms were improving although not fully resolved, which our adviser said can be normal. Our adviser said there was nothing to suggest she needed an urgent face to face appointment or hospital review at either of these consultations.

26. Our adviser explained if symptoms were not better when she had finished her course of antibiotics this is the point at which the Practice would have needed to examine her face to face or refer her to hospital for treatment. But by this point Ms T had already attended the Walk-in Centre on 26 July where treatment to drain the toe was carried out.

27. We can see from Ms T’s records the Walk-in Centre did not ask the Practice to carry out further reviews, and Ms T was advised to return to the Walk-in Centre for reviews or if she had any other concerns regarding her toe.

28. Ms T had further telephone appointments with the Practice on 31 July and 7 August. It documented her toe was less swollen, but it was still painful for her to wear shoes, and she still had the dressing on. The Practice advised it would not prescribe further antibiotics, and she should keep taking painkillers and soak her toe in salty water. If her toe did not improve then she should return.

29. Ms T told us she felt comments made at the appointments on 20 and 31 July felt like the Practice was dismissing her concerns by downplaying the severity of her condition using terminology such as ‘it is supposed to hurt, its infected’ and ‘soak your foot in salt water. We have seen the transcript of the telephone appointment on 20 July. The GP said, ‘I mean it’s infected, it would be sore.’ and, ‘I know it sounds a bit odd, but heat is good, so if in the interim like two-three times during the day, you do a hot foot soak’, and ‘If you can put some hot water, if you got some salt, that’s good as well, you put the salt in, have a foot soak, you know, in and out, for like, you know, twenty minutes, and then elevate it again’.

30. The above was alongside the GP advising Ms T to keep her foot elevated, to rest and to continue with the antibiotics and to contact the Practice if it does not settle. We can understand that Ms T felt these comments were dismissing her condition, but this is the kind of advice that is given for these types of infection when a patient is already receiving clinical treatment to try to alleviate some of the pain and discomfort while it heals.

31. Further appointments took place on the 8 August 2023 and 9 August 2023 when Ms T’s dressing were changed.

32. NHS podiatry referral guidelines say ‘patients are accepted into the Podiatry Service only if they have both a medical condition and a podiatric need. The podiatry service is provided by Whittington NHS Trust. The Trust website says, ‘Patients are only accepted into the service if they have both a medical condition that puts them at high risk from developing a foot ulcer or unhealing wound and podiatric need.’

33. This is in line with the Practice’s response which explains why Ms T could not be referred to the podiatry team, as she did not meet the criteria of having a medical condition and podiatry need. Our adviser explained there was no clear indication for a podiatry referral. The wound seemed to be healing well, and Ms T was having regular reviews.

34. Taking into consideration information received from Ms T, the Practice records which include the Walk-in Centre records, information from our adviser and the NICE guidance we are satisfied the Practice did not get anything wrong when it has telephone consultations with Ms T and continued treatment started by other organisations.

35. We hope the information provided above gives Ms T some reassurances about what happened and why and that we did not see the Practice got anything wrong in her care and treatment.

Complaint Handling 36. Ms T says the first Practice response which is undated contained inaccurate information. We can see from Ms T’s complaint file this error was made. The Practice acknowledged this error, apologised and said they would correct it.

37. Our Principles of Good Administration say public bodies should give people information and advice that is clear, accurate, complete, relevant and timely. We can see in this case the Practice made an error within its response meaning it was not accurate. This error was clearly made, it was a relatively small and the Practice has acknowledged and apologised for this error. We are reassured that the Practice has addressed the additional distress caused by this part of the complaint already.

38. Ms T also complains the Practice did not respond to her complaint in a timely manner in line with procedure.

39. The Practice website says it should provide a full response in writing within 28 working days unless the investigation is still in progress, in which case it should explain to the complainant the reasons for the delay. The Complaints Regulations say Organisations must resolve complaints speedily and efficiently and keep the complainant informed.

40. Ms T complained on 16 January 2024 and received a response on 17 June. This means it took the Practice five months to respond. She sent a second complaint on 6 August, and the Practice replied, following intervention from us on 26 March 2025. This means the Practice took a further eight months to respond again.

41. In total the time between Ms T making her initial complaint and receiving her final response is 14 months. This is not in line with the Practice complaints procedure or Complaints Regulations, and we consider the Practice got this wrong.

42. When we see an Organisation got something wrong and can see the impact this had, we look at our severity of injustice scale to decide the level of action needed to address this. This is a transparent scale the Ombudsman uses to ensure fairness in our decision making. We look at any complaints we have investigated regarding the organisation to look for any similar failings and remedies recommended. We also look at previous investigations with similar impacts to ensure our remedies are consistent with others to ensure fairness.

43. We looked at the impact Ms T told us about, but just in relation to the failings we found in complaint handling. Ms T says her experience, including complaint handling, led her to lose faith in the healthcare system. She told us the lack of clear communication, delayed responses and failures to address her concerns left her feeling unheard and insignificant and contributed to a sense of helplessness diminishing her trust in seeking further care.

44. We also look at what the complainant has told us they are seeking to address their complaint. Ms T told us she would like an acknowledgement of failings, an apology, service changes, and a financial remedy.

45. We have seen the Practice made errors in complaint handling and this caused Ms T frustration and stress over the time the Practice was handling her complaint. We are satisfied that this impact is at level two of the Severity of Injustice scale. This level includes instances of poor complaint handling where there is a delay of up to around one year. Sometimes this period may be longer where, after looking into things, we do not find evidence that the Organisation got anything wrong in the substance of the complaint. This appears to be the case in Ms T’s case as the delay was approximately 13 months, but we did not find the Practice got anything wrong in her care and treatment.

46. We discussed what we found with the Practice, and it has acknowledged it got complaint handling wrong. The Practice agreed to write to Ms T within four weeks to acknowledge and apologise for its delays in complaint handling and the distress this caused Ms T. It has also agreed to pay Ms T a financial remedy of £120.

47.  We are satisfied an acknowledgement of the errors made, an apology for the impact and a financial remedy of £120 is in line with our Principles for Remedy which say a remedy should be fair, proportionate and reasonable. We are reassured through checking other complaints for the Practice that what Ms T complained about has not been raised with us before. Therefore, we will not take further action on this complaint.

48. We can see Ms T has had a distressing and frustrating experience and would like to thank her for giving us the opportunity to look into her concerns. Complaints give us valuable insight into the organisations we investigate, and we recognise this has been an emotionally challenging process for Ms T. We would like to thank her for sharing her experience with us.

1. We have carefully considered Ms T’s complaint about a GP Practice in the Islington area (the Practice). We were sorry to hear about Ms T’s experience and can see from what she told us how worrying and upsetting this event was.

2. After giving full consideration to Ms T’s complaint regarding telephone appointments and treatment, we have seen no indication the Practice got this wrong. We have found the Practice caused some delays when it handled Ms T’s complaint and made some inaccuracies in its responses. Following discussion with the Practice we have agreed a resolution which we are satisfied addresses the distress this caused to Ms T.

3. We hope the information we give below will explain our decision for Ms T and give her some reassurances the Practice did not get anything significantly wrong in her care and treatment and why. We also hope the resolution we have agreed will address what went wrong during complaint handling.