An independent provider in the City of Nottingham area

4. Mr P complains on 1 October 2024, the Provider failed to:

• thoroughly investigate his hip pain or refer him for further scans, treatment, or to secondary care • provide him with a route forward to help investigate his unresolved physical symptoms or explain where and how he could get a referral to secondary care • make clear a further appointment to discuss an ongoing care plan was on offer • explain or address his complaint fully, providing a response lacking empathy and compassion.

5. As a result of this, Mr P says he has had to live with constant left-sided pain which prevents him from exercising, working, or carrying out normal daily activities. He says he can no longer sit, stand or walk without severe discomfort and the hip problems cause referred pain to his lower back and upper body. Mr P also says he has been forced to rely on taking daily diclofenac which has its own health risks and the pain in addition to the stress of not having a clear path forward has caused poor sleep, low mood and social isolation. Mr P says the Provider’s lack of action has caused an avoidable delay and loss of opportunity for an earlier reassessment and onward referral, leading to prolonged uncertainty about whether there are unresolved problems with his hip. He says the poor complaint handling has caused additional emotional distress.

6. As a result of his complaint, Mr P is seeking an apology, service improvements and financial remedy.

7. The Mr P told us he had been suffering with chronic hip for five years prior to his complaint. During this time, Mr P had seen various teams regarding his chronic pain including rheumatology, spinal surgery, and physiotherapy.

8. On 1 October 2024, Mr P had an appointment with the Provider. It told Mr P that no further tests were necessary and offered psychological pain management options going forward but no further physical investigations.

12. 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 for the issues Mr P has brought to us.

Lack of referral or plan for further physical investigation of the hip

13. On 1 October 2024, Mr P attended an appointment with a practitioner from the physiotherapy team. Prior to this appointment, Mr P had been previously assessed by the rheumatology team, the spinal team, the pain management team and a sports science and exercise consultant.

14. Mr P told us he wanted further investigations to completely rule out a physiological issue with his hip. This might have included a Magnetic Resonance Angiography (MRA) scan. This is an investigation to assess the labrum (a cartilage rim covering the edge of the hip socket) and consists of the hip being injected with a radioactive dye which is then more easily visible on the scan.

15. Our adviser told us an MRA is a gold standard test to identify labral tears as they are difficult to pick up on standard MRI (magnetic resonance imaging) scans. They explained that unlike a standard MRI scan, an MRA cannot be requested by the Provider. It can only be requested by secondary care in a hospital, usually a hip surgeon.

16. During Mr P’s appointment, the practitioner undertook a full history and examination of Mr P. Upon reviewing the medical records, our adviser told us the practitioner completed a comprehensive history, thorough assessment and appropriate examination for the symptoms Mr P had presented with. They referred to CSP standard 8.3. We consider the practitioner acted in line with section 8.3 as appropriate information relating to the service user and the presenting problem was collected.

17. The Provider was unable to refer Mr P for an MRA, therefore Mr P would have required a referral to secondary care for the further tests and investigations he was seeking. Our adviser told us there was no clinical indication from Mr P’s appointment that a referral to secondary care (hospital) for further investigations was indicated, and an appropriate range of suitable options were presented to Mr P both during the appointment and in a follow up letter.

18. We are of the view that the care provided was in line with sections 8.4 and 8.5 of the CSP standards. This was because analysis took place which helped formulate an appropriate treatment plan, and appropriate treatment options were identified based on the best available evidence.

19. We recognise the impact Mr P’s ongoing pain is having on his life. After reviewing the evidence and advice from our adviser, we consider the Provider appropriately reviewed and examined Mr P in line with CSP standards. We have also seen no indication that the Provider should have referred Mr P for further tests itself, or to secondary care. We will not be taking any further action on this matter.

Communication about a secondary care referral and ongoing care plan

20. Mr P told us that if the Provider could not or would not refer him for further physical investigations then it should have signposted him to a place which could, such as his GP. He also told us the Provider did not make clear to him that a further appointment was on offer to discuss in more detail his ongoing care plan.

21. We reviewed Mr P’s records and noted that there was a discussion between Mr P and the practitioner at the end of the appointment where options going forward were considered. It appears that this conversation was relatively short, however as Mr P was 20 minutes late to the appointment, we would reasonably expect this.

22. It is noted in the appointment records that Mr P’s available options were discussed but a plan was not finalised and a letter would be sent out so Mr P could reflect on the options. It also says that Mr P was told he could book a follow up appointment if he wanted to discuss things further.

23. We also reviewed the follow up letter which clearly outlines options the Provider could offer and finishes with a section entitled ‘Your Choice’. This reiterates that Mr P was welcome to contact the Provider at any point to discuss things further.

24. CSP standards section 7.2 says members should communicate effectively with service users to ensure effective and efficient services. We consider the Provider’s communication with Mr P regarding his ongoing options and care plan was in line with CSP standards as it told him this both in the appointment, despite a lack of time, and in a follow up letter sent the same day.

25. Our adviser noted that as Mr P clearly wanted an MRA scan or further investigations, it would have been helpful for the Provider to have told him how he could get a referral to secondary care (through his GP) and there was an opportunity in the follow up letter to outline this. However, this is not a requirement and we therefore see no indications of a failing regarding this matter. We consider the practitioner acted in line with section 7.2 of the CSP standards and effectively communicated the options available to Mr P through the Provider. We will not be taking any further action on this matter.

Complaint handling

26. Mr P told us he was disappointed with the Provider’s complaints process and felt its formal response did not explain or address his complaint fully. He also told us he felt the response was lacking empathy and compassion.

27. We have carefully reviewed Mr P’s original complaint to the Provider, it’s formal response and the internal investigation completed by the Provider into Mr P’s concerns. Our complaint standards say organisations should be thorough and fair when looking into complaints and give fair and accountable responses. We are of the opinion that the Provider’s investigation and response was in line with this.

28. This is because we have seen evidence that the Provider answered each of the points Mr P raised in his initial complaint. It does so in a manner which sets out the issues, explains how each issue was looked at and considered, and explains the outcome. We consider this is in line with our additional guide as part of our complaint standards.

29. Additionally, we have considered the level of empathy used in the Provider’s response. It recognises at several points the impact Mr P’s issues have had on him and how his experience with The Provider may have contributed to this. We recognise that Mr P felt the response was not empathetic enough and are sorry to hear how this made him feel dismissed. We are of the view that the Provider has tried to show empathy and recognise the effect the events had had on Mr P. We have not seen any indications of a failing regarding the Provider’s complaint response and will not be taking any further action on this matter.

30. We recognise Mr P has had a particularly challenging time with his ongoing chronic pain and the significant impact this continues to have on his daily life. We hope our explanations set out above are clear and helpful. We hope Mr P is reassured that his concerns have been investigated impartially and with independent clinical advice. We wish Mr P all the best going forward.

1. We have carefully considered Mr P’s complaint about a healthcare provider in the Nottingham area (the provider). We are very sorry to hear of the circumstances surrounding Mr P bringing his complaint to us, and the impact the events have had on his life, particularly his ongoing pain.

2. We have considered all information provided to us by Mr P and the Provider and obtained independent clinical advice on the issues. We have seen no indication anything went seriously wrong in the Provider’s decision to not refer Mr P for further investigations or to secondary care for his ongoing hip pain.

3. We have also seen no indication anything went wrong in the communication between the Provider and Mr P regarding an ongoing plan for his care, or with the Provider’s complaint handling.