A practice in the North Northamptonshire area

3. Mr R complains about the chest care the Practice gave him between February and July 2025. He specifically complains the Practice: • did not offer appropriate testing or investigations for wheezing cough • prescribed inhaler medication correctly • shed incorrect information about his X-ray results.

4. Mr R says he experienced stress and worry which cause a decline in his general mental health and wellbeing.

5. Mr R wants the practice to make service improvements.

6. Mr R had four appointments with the Practice between February and April 2025 for a cough and wheezing in the chest.

7. The Practice sent a request in mid-April 2025 for Mr R to have a chest X-ray. This took place in mid-May.

8. Mr R transferred to another GP practice in mid-July 2025.

12. Before we decide if we should conduct a detailed investigation of a complaint, we look at whether there are signs the organisation got something wrong. We do this by comparing what should have happened with what did happen. We have done this and have not had any indications that something went wrong.

Cough, wheeze and inhaler

13. Mr R complains between February and July 2025 the Practice did not give him appropriate testing or investigations for his cough and wheezing.

14. The Practice said it reviewed Mr R correctly and gave him appropriate care.

15. NICE, CKS, How should I assess an adult with a suspected infection? says, Ask about: • onset and duration of symptoms • the type of cough (dry or productive) • additional symptoms such as breathlessness, wheeze, pleuritic pain, and fever • smoking status.

Examine the person, including the respiratory system, measure the person’s temperature, pulse rate, blood pressure, and respiratory rate, and assessed signs of confusion.

Be aware that in elderly people with pneumonia, symptoms may vary (for example altered consciousness and gastrointestinal discomfort) and typical symptoms (cough, fever, and difficulty breathing) may be absent.

16. NICE, CKS, Cough: How do I diagnose the cause of a cough, says, ‘For people with acute cough (less than three weeks duration): …Assess whether the person has clinical features of the most common cause: Upper respiratory tract infection, COVID-19, exacerbation of a pre-existing condition, acute bronchitis.

For people with chronic cough (over eight weeks duration): …Assess whether the person has clinical features of the most common cause: Upper airway cough syndrome, asthma, smoking related cough.’

17. The records show Mr R had an appointment at the Practice in early February where his pulse, oxygen saturation, temperature, respiratory rate, and chest examination were recorded.

18. The Practice noted it did not hear crackles or wheezing from Mr R’s chest. It prescribed amoxicillin antibiotics and provided safety netting advice. This is in line with NICE, CKS, assessing an adult with a suspected infection and how do I diagnose cough, as a history of the symptoms and clinical examination took place.

19. Mr R told the Practice in a telephone consultation, he was still coughing and reported chest tightness and wheezing. The Practice prescribed a salbutamol inhaler and clarithromycin antibiotics.

20. These actions are in line with GMC, Good medical practice, paragraph seven, which sets out when providing clinical care, a doctor should adequately assess a patient taking note of history and symptoms, carry out a physical examination, provide suitable advice and prescribed where needed based on the evidence they are presented with. Mr R’s condition was assessed and treatment was given as necessary.

21. The records show in early March Mr R had a telephone consultation with the Practice because he had a cough for over three weeks which worsened when moving. Mr R explained the inhaler prescribed helped his chest tightness but his cough was a problem to him. The Practice followed GMC Good medical practice by prescribing and treating Mr R, giving him doxycycline antibiotics and prednisolone steroid medication.

22. The Practice noted a plan for Mr R to have a chest X-ray if his symptoms did not improve during this appointment.

23. Mr R had an appointment at the Practice in mid-April 2025. The Practice noted Mr R looked alert, had no confusion but still had an intermittent cough. Mr R was noted to say, ‘the inhaler helped’ but if it continued he needed a chest X-ray.

24. The Practice prescribed doxycycline antibiotics and sent a task for a GP to arrange for Mr R to have a chest X-ray. Vista Health, When to get a chest X-ray for a persistent cough advice says, ‘If you have had a persistent chronic cough (three weeks or longer), you should see a GP to determine whether a chest X-ray is needed.’

25. The Practice had been treating Mr R for over three weeks and followed the Vista Health advice by making a referral for a chest X-ray to be completed. This is also in line with GMC Good medical practice, paragraph seven, which sets out a doctor should consider a referral to another suitably qualified practitioner for follow up care when needed.

26. Our adviser told us there is no specific guidance to say when an inhaler is needed to treat a cough. As there were records of Mr R finding relief from his chest tightness and wheeze, this supports the decision to prescribe the inhaler was appropriate.

27. Based on the evidence we have seen, the Practice acted in line with NICE, CKS, GMC guidelines in giving Mr R care and treatment for his persistent cough and wheeze. The Practice considered when it was appropriate to refer Mr R for a chest X-ray and followed GMC guidance and Vista Health advice.

28. We understand and acknowledge the distress Mr R experienced. We hope our explanation goes some way to explain how the Practice acted appropriately with the care and investigations it completed.

X-ray

29. Mr R said the Practice shared incorrect information about his X-ray results which caused him worry and distress.

30. The Practice did not comment directly on this point but gave its apologies if any distress was caused to Mr R.

31. GMC, Good medical practice requires that information given to patients is clear, accurate and up to date, and that clinicians respond honestly to patients’ questions. GMC delegation guidance says, delegation must be clear and appropriate, with shared accountability for safe delegation.

32. The Practice’ own incoming results policy 2.1 says, ‘It is the responsibility of the clinician to view and action the results as appropriate by using the following descriptors: • Normal-no further action • Borderline- make appointment for repeat test/appointment in seven days’ time • Abnormal- make a routine/urgent appointment to see GP or other appropriate clinician in two days or weeks.’

33. Point 2.7 of the Practice policy says, ‘the organisation adopts a proactive approach in the communication of results and patients will be informed of their test results in a timely and clinically appropriate way depending on the level of risk.’

34. The records show the Practice requested Mr R’s chest X-ray in late April 2025 and the Practice received the report on 14 May. The report recorded bilateral calcified pleural plaques suggesting previous asbestos exposure, with no acute consolidation, collapse or pleural effusion. In the record it was coded: ‘XR Chest Report, Borderline, No Further Action (Patient Informed).’

35. This means there are hardened areas on both sides of the lung lining called plaques and these suggest a person was exposed to asbestos in the past. There are no signs of infection or that the lung is collapsing, or that any fluid is around the lungs.

36. Mr R called the Practice in mid-May asking his chest X-ray results. It is noted Mr R was told ‘no further action borderline as per GP instruction’.

37. Mr R had an in person appointment at the Practice on 21 May 2025. He was given an examination and his cough and chest X-ray results were discussed. The Practice noted silent reflux could be a cause of Mr R’s cough.

38. The Practice saw Mr R and his daughter Mrs L in early June where his X-ray results were discussed and a referral was made to breathing specialists.

39. We acknowledge Mrs L said her father was concerned after he believed he was told his X-ray was all clear or inconclusive.

40. Based on the evidence we have seen, the records do not explicitly show what was said by the Practice team following Mr R’s X-ray, other than borderline as found in the notes. The Practice then made an appointment for Mr R’s results to be discussed which is in line with GMC Good medical practice and its own policy.

41. We understand and acknowledge the distress Mr R experienced. We hope our explanation goes some way to explain how the Practice acted appropriately with the care and investigations it completed.

1. We have carefully considered Mr R’s complaint about a practice in the Northamptonshire area (the Practice). We are sorry to hear about the difficulties Mr R experienced with this cough and wheezing care. We understand how frustrating it is to feel you are not getting the care you need.

2. Having considered his complaint, we have seen the Practice provided appropriate care in line with guidance. We hope he is reassured by what we have seen.