A practice in the Tameside area

5. Mrs V complains about the care and treatment she received from the Practice and the Trust from October 2023 to January 2024.

6. Specifically, she says the Practice delayed her accessing her essential medication.

7. Specifically, she says the Trust: • delayed her accessing her essential medication • did not support her with her mental health on 26 January 2024 • failed to link her chronic rhinosinusitis to her panic attacks • did not handle her complaint appropriately.

8. Mrs V tells us not receiving her medication led to severe panic attacks and A&E admissions. She tells us it caused severe anxiety of which she now takes medication for. She tells us she was diagnosed with chronic anxiety and had CBT and is currently being referred for psychological therapy. Mrs V tells us she has lost faith the Trust will provide her with the right care. Mr W tells us Mrs V is no longer the person she was: she has lost a lot of weight, is not sleeping well and is currently unable to work as a result. Mrs V feels let down by the Trust as a result of its poor handling of her complaint.

9. By bringing her complaint to us, she is seeking service improvements, acknowledgement and an apology for the Trust’s care and treatment and a financial redress.

10. Mrs V has suffered with chronic sinusitis since she was 20 years old. She has been under the care of the Ear Nose and Throat (ENT) department at the Trust since 2022.

11. On 19 October 2023, Mrs V had an outpatient appointment with an ENT consultant at the Trust to review her condition. During this appointment she was prescribed Flixonase and fexofenadine to help control and manager her symptoms. The Trust communicated this prescription to her GP Practice (the Practice) to provide on the same day.

12. The consultant prescribed Flixonase to help relieve symptoms by opening her airways and making it easier to breath. Fexofenadine is an antihistamine and was prescribed to help Mrs T eat without being sick.

13. Following the appointment, Mrs V told us her symptoms became worse and she developed an acute infection which led her to attend A&E on 1 November 2023.

14. Mrs V collected her medication on 3 November.

15. Mrs V complained to The Practice and the Trust and local resolution was ongoing until August 2024.

The Practice - Medication – October 2023

19. Mrs V says after the Trust sent her prescription to the Practice on 19 October 2023, the Practice delayed issuing her this medication. She tells us the medication was essential to her condition of chronic rhinosinusitis. Mrs V tells us she experienced extreme discomfort and anxiety. Mrs V says she had panic attacks without this medication and had to attend A&E as a result.

20. Mr W tells us he and Mrs V feel the Practice should have prescribed the medication quicker than the 12 working days it took.

21. In its response to her complaint, the Practice acknowledged Mrs V’s upset and explained the timescale for issuing her medication. It explained it issues non-urgent medication within 10 working days and set out the reasons for this.

22. It says it allows seven days for discharge information to arrive from the Trust and then gives sufficient time for the prescribing clinician to check there are no risks or interactions with a patient’s current medication.

23. The Practice said it acted in line with its internal 10-day policy.

24. We can see the Trust sent an electronic prescription to the Practice on the same day. We can also see the Practice confirmed receipt of the prescription the next day (20 October 2023).

25. The evidence shows the Practice issued Mrs V’s prescription on 31 October 2023. This was on the eighth working day and was therefore in line with the Practice’s internal policy.

26. The pharmacy then dispensed Mrs V’s medication on 2 November 2023. The pharmacy is separate to the Practice and has its own policy when dispensing medication. For this reason, we would not be critical of the Practice from 31 October to 2 November.

27. Our Principes of Good administration state organisations should follow their own policy and procedural guidance. We have seen evidence the Practice has followed its own policy, and we will therefore not be considering this part of the complaint further.

The Trust – medication – October 2023

28. Mrs V says the ENT consultant told her during her consultation on 18 October 2023 that her medication would be available from her doctor in 48 hours. She says her medication was not available for her to collect for two weeks. She says the consultant should not have told her it would be available in 48 hours if they did not know this for certain. Mrs V says the Trust did not acknowledge the impact this delay had on her mental health.

29. In its response dated 1 August 2024, the Trust apologised for any misinformation or expectations of care which the consultant suggested during her consultation. It also acknowledged the distress Mrs V experienced during the two-week wait for her medication. It explained clinicians expect prescriptions to be available within 48 hours once a request is sent to the patient’s GP. It acknowledged whilst this is expected, there is no formal agreement in place to ensure prescriptions are ready within a specific time frame.

30. It seems the consultant was incorrect in his assumption the medication would be ready within 48 hours. The Trust has accepted this was incorrect and acknowledged there is no specific time frame for prescriptions being prepared. It seems likely the consultant gave his best guess based on previous experiences.

31. We recognise the wait has caused Mrs V some additional worry. We do not think the misinformation provided by the consultant was significant enough for it to be an indication of failing.

32. We are reassured to note the Trust has apologised for any misinformation shared with Mrs V about the timeframe of her medication and shared the learning it has taken from Mrs V’s complaint.

The Trust - chronic rhinosinusitis and panic attacks

33. Mrs V says the ENT consultant in a letter states rhinosinusitis is not linked to her panic attacks. She says there is a well-known link between her condition and anxiety. Mrs V tells us how she regularly suffers headaches, pain from facial pressure and breathing discomfort. She says these symptoms have prevented her from developing a regular sleeping pattern and has caused her stress and anxiety, which led to her panic attacks.

34. The consultant responded on behalf of the Trust acknowledging Mrs V’s discomfort and stating, ‘I’d like to reassure you that sinusitis is not an underlying issue for panic attacks.’

35. We asked our GP adviser if there was any clinical evidence to say Mrs V’s condition is linked to panic attacks. Our adviser explained any physical condition could cause distress and anxiety which could lead to panic attacks.

36. We appreciate the statement the consultant made caused Mrs V upset as she has told us about her anxiety and panic attacks she feels is strongly linked to her rhinosinusitis.

37. We have not identified any clinical evidence to suggest a specific clinical causal link between rhinosinusitis and panic attacks. We think this is what the consultant was trying to communicate and to reassure Mrs V about.

38. We can appreciate how her breathing difficulties could add to her anxiety and cause panic attacks. We therefore do understand why Mrs V was upset by the content of this letter as it does not reflect her very real experience.

39. We do not view what the consultant said to be incorrect and cannot say there are indications of a failing here. We will therefore not take this part of the complaint further.

The Trust - support for mental health

40. Mrs V says on 26 January 2024 she attended A&E with concerns about her breathing and was having a panic attack. She does not feel Trust staff took her mental health concerns seriously and she was therefore not assessed appropriately.

41. In its response, the Trust said it is sorry Mrs V did not feel her concerns were addressed. It said Trust staff were unable to assess her on arrival as she was having a panic attack. It said Mrs V required a formal triage assessment in which Mrs V told Trust staff she felt as though her airway was closing. It acknowledged how feeling this way would have made her more anxious. The triage assessment concluded Mrs V should attend the Urgent Treatment Centre (UTC) to be assessed by a GP.

42. The Trust’s response said Mrs V declined attending the UTC and requested to be seen in A&E. The triage nurse in the A&E department completed Mrs V’s physiological observations, which included blood pressure, heart rate, respiratory rate and oxygen saturation levels. It said all of these observations were within normal range and she was therefore suitable to be seen by a GP in the UTC. The response explained Mrs V was seen by the same GP she had previously seen and was discharged home with a course of Prednisolone (steroids used to treat breathing problems) and co-amoxiclav (an antibiotic).

43. The records indicate Mrs V was triaged as a category five. We asked our A&E adviser if this was an appropriate assessment based on Mrs V’s presenting symptoms. Our adviser explained category five triage assessments are for non-urgent medical issues. They explained the records say the presenting issue for Mrs V was ‘sinusitis,’ which they said was an appropriate condition to be assessed by a GP in UTC, particularly given Mrs V’s physiological observations were within normal range.

44. We referred to the Trust’s information on the UTC website, which states it is for patients who need urgent medical attention but are not in a life-threatening situation. We are satisfied the Trust appropriately triaged Mrs V and decided she was suitable to be assessed in UTC.

45. We are sorry to hear Mrs V did not feel her anxiety was taken seriously.

46. NMC professional standards code states nurses should refer matters to colleagues who have the appropriate skills and expertise.

47. This means recognising the limits of their own expertise and seeking advice or referring on to a more qualified colleague to provide high standards of care and decision-making.

48. We are satisfied the nurse’s decision for Mrs V to be assessed by a doctor at the UTC was in line with the above guidance.

49. The records show Mrs V was discharged from UTC with antibiotics, a course of steroids and an inhaler.

50. We asked our adviser if this was an appropriate treatment plan. Our adviser says given Mrs V had reported an intermittent fever in the previous few days, it was appropriate for the Trust to prescribe antibiotics in case of an infection. Given Mrs V’s reporting concerns over her breathing, the Trust’s action to give a short course of steroids was in line with guidance.

51. We therefore have not seen anything in the records to suggest her assessment and treatment of her breathing concerns or her mental health was inappropriate.

The Trust – complaint handling

52. Mrs V says the Trust failed to comply with its own complaint handling policy. She says it did not acknowledge her formal complaint within three working days, clarify in writing how the complaint handler intended to respond and did not clarify her complaint and explain the process in writing. She also complains the Trust failed to complete its investigation of her complaint with 45 days of receiving the complaint.

53. The Trust has responded to her concerns around the complaint handling and has apologised for it any delays.

54. Due to the demand for our services, we have decided to focus on complaints where people may have faced a significant impact. For example, these may be about a potentially avoidable death or where someone has suffered prolonged pain. These types of complaints are where we can often make the biggest difference. This will allow us to provide the right level of service to those people, as quickly as possible.

55. This means we are not looking into complaints where we can see there has been a less significant impact.

56. When assessing a complaint, we consider where the impact of the events falls on our severity of injustice scale. In Mrs V’s case, we consider the injustice falls at Level 1 on our scale. This is because, whilst we appreciate the complaint handling issues caused her stress, this happened over a relatively short period of time and has not had any lasting significant impact or effect on her ability to lead a relatively normal life.

57. We do not dismiss the impact the complaint handling had on Mrs V and we recognise these complaints mean a lot to the people bringing them to us.

58. We have carefully considered how Mrs V said she had been affected and if there is anything we can act on to resolve her complaint. As we cannot, we have decided not to take further action.

59. We record all the complaints we receive. This means, if we receive a similar complaint about the same organisation or see a pattern from a number of complaints, we may raise this with the organisation in future. I have checked and have not found similar upheld complaints to Mrs V’s that were made recently about the same organisation.

60. We hope this reassures Mrs V that, even though we are not taking forward this part of her complaint, she did the right thing by bringing her complaint to us.

61. We appreciate our decisions on Mrs V’s complaint may not align with her view and we would like to reassure her we have considered all the evidence she supplied and relevant guidance to reach these decisions.

1. We have carefully considered Mrs V’s complaint about Ashton Medical Group (the Practice) and Tameside and Glossop Integrated Care NHS Foundation Trust (the Trust). We are sorry to hear about the challenging time Mrs V has had and the impact it has had her on her mental health.

2. We are sorry to hear Mrs V experienced panic attacks whilst waiting to receive her medication from both the Practice and the Trust. The evidence we have reviewed indicates both organisations followed their own standards and policies.

3. We understand Mrs V felt the Trust did not support her mental health when she attended its A&E department and that the ENT consultant did not acknowledge her sinusitis could have been linked to her panic attacks. We consider the staff provided care and support in line with relevant guidelines.

4. For Mrs V’s complaint about the Trust’s handling of her complaint, we do not consider the claimed injustice meets the threshold for us to investigate further.