A practice in the Hart area

4. Mr G complains about the care the Practice provided his partner, Ms G. He says she visited the Practice on 18 February 2025 with a chest infection and trouble breathing, but the Practice failed to run appropriate blood tests or conduct an electrocardiogram (ECG). An ECG is a test that records the electrical activity of your heart, including the rate and rhythm.

5. Mr G says the poor care caused Ms G heart failure which led to her death. He says losing her caused him emotional distress and he is struggling to move on.

6. As an outcome of his complaint Mr G would like to find out why the Practice did not look after her, and a written apology.

7. Ms G, a 60-year-old, attended the Practice on 18 February 2025. During the appointment, she informed her GP she had been experiencing a number of symptoms over a week and described them in detail.

8. The GP examined her vital signs, throat and chest. Following the examination, the GP diagnosed her with a respiratory tract infection, prescribed amoxicillin, and advised she return to the Practice or visit A&E if her symptoms worsened.

9. Respiratory tract infections (RTIs) are infections of parts of the body involved in breathing, such as the sinuses, throat, airways or lungs.

10. On 1 March 2025, Ms G was rushed to A&E, where she sadly died following a cardiac arrest.

14. Mr G complains the Practice failed to conduct appropriate blood tests or an ECG when his partner, Ms G, visited her GP on 18 February 2025.

15. During her appointment on 18 February, Ms G reported experiencing symptoms for about a week. She described feeling chesty, which worsened when lying down, accompanied by a productive cough with green sputum and a rattling sensation in her chest.

16. She also mentioned increasing shortness of breath but no chest pain, tightness, headaches, or sinus pain/pressure. Additionally, she reported a runny nose, blocked ears, intermittent fevers, and generally felt unwell, stating this episode felt different from a viral infection she experienced 3–4 weeks earlier. She had tried taking paracetamol but found it unhelpful and she was not using an inhaler. Her records also note she does not drink alcohol and has never smoked.

17. On examination, the GP recorded her oxygen saturation at 99%, temperature at 37.3°C, and pulse rate at 95 bpm. The GP examined her throat and chest, finding her throat normal. Her chest was also normal, with equal air entry in both lungs. However, the GP noted crepitations (crackling sounds) at the right lung base. There was no wheezing or additional crackles, and her left lung presented normal breathing sounds with equal chest expansion. Ms G declined a blood pressure check but stated she would return for one if needed.

18. The GP concluded she had a lower respiratory tract infection (LRTI) alongside an upper respiratory tract infection (URTI). The GP prescribed amoxicillin, recommended over-the-counter remedies such as nasal sprays and steaming, and advised Ms G to contact NHS 111, visit A&E, or return to the Practice if her symptoms worsened or did not improve.

19. Ms G was rushed to A&E on 1 March 2025 and she passed away from a cardiac arrest.

20. In its complaint response, the Practice explained when it examined Ms G on 18 February, her symptoms were indicative of a respiratory infection rather than a cardiac issue. Based on this assessment, the Practice stated conducting blood tests or an ECG at that time would not have been clinically appropriate.

21. NICE Chest Infections guidance states clinical judgement must always be used to assess people with suspected community acquired pneumonia (a lung infection acquired outside of hospital settings) as no combination of symptoms or signs is definitively diagnostic.

22. It further states, when assessing a patient with respiratory illness clinicians should;

23. ‘Ask about their symptoms, specifically asking for: • Onset and duration • The type of cough (dry or productive) • Additional symptoms like breathlessness, wheeze, pleuritic pain (sharp chest pain when breathing/coughing) and fever • Smoking status

24. Examine the patient including their respiratory system. The examination should measure the patient’s temperature, pulse rate, blood pressure, and respiratory rate, and assess for signs of confusion.

25. If an adult had clinical symptoms and signs suggestive of community acquired pneumonia (lung infection acquired outside of hospital settings) assess the severity of the illness using the CRB-65 score. The score is calculated by giving 1 point for each of the following features: • Confusion • Raised respiratory rate – 30 breaths per minute or more • Low blood pressure • Aged 65 years or more.

A score of 0 corresponds to a low risk of death (less than 1% mortality risk), a score of 1 or 2 to intermediate risk (1–10% mortality risk), and a score of 3 or 4 to high risk (more than 10% mortality risk)’.

26. In Ms G's case, the GP assessed her symptoms, confirming the duration; about a week, and type of cough; productive cough with green sputum. The GP also confirmed other symptoms, finding her to have shortness of breath but no chest pain, wheeze, or confusion.

27. On examination, her oxygen saturation, temperature, and pulse rate were normal. While crackling was heard in her chest examination, there were no other significant findings or risk factors. Our clinical adviser explained Ms G’s symptoms were suggestive of community acquired pneumonia.

28. We cannot exactly say what the severity of Ms G’s condition was, in line with NICE guidance, as she declined a blood pressure check. Her respiratory rate was not raised, she was not over 65 years old, and no recorded confusion. Based on the available records, her condition aligns with low-risk severity.

29. According to NICE Chest Infections guidance, when managing patients with community-acquired pneumonia, clinicians are encouraged to advise patients on self-care strategies, such as the use of paracetamol, and to prescribe antibiotics where appropriate. For cases of low severity, amoxicillin is recommended as the first-choice antibiotic.

30. According to NICE Chest Infections guidance, clinicians should consider specific investigations under certain conditions:

• Pulse oximetry: Recommended if oxygen levels are below 90%, which may indicate the need for urgent hospital admission.

• C-reactive protein (CRP) test: Advisable when a patient presents symptoms of a lower respiratory tract infection, a clinical diagnosis of pneumonia has not been made, and there is uncertainty about whether antibiotics are needed.

• Chest X-ray: Typically used when a patient may have an underlying lung pathology (e.g., cancer) or when there is unclear evidence of pneumonia. It is not generally necessary for initial management of suspected community-acquired pneumonia in primary care.

31. Ms G’s oxygen levels were not critically low, and there was no uncertainty about the necessity of antibiotics or evidence of underlying lung pathology. The guideline does not indicate ECG’s or blood tests were required in Ms G’s case. Therefore, there was no clinical need for the Practice to arrange these tests.

32. We have seen the Practice acted in line with guidance by prescribing amoxicillin, offering advice on self-care remedies, and advising Ms G to seek further assistance if her symptoms worsened or failed to improve. We have seen no indications anything went wrong. We hope Mr G is reassured Ms G received appropriate care from the Practice.

33. Complaints give us valuable insight into the organisations we investigate, so we would like to thank Mr G for sharing his partner’s experience with us. It is also important to acknowledge that finding no indications of service failure does not detract from Mr G’s experience, or the upset and worry these events caused.

1. We have carefully considered Mr G’s complaint about a Practice in the Hampshire area (the Practice). It is clear this has been a challenging time for Mr G, and we are sorry for his loss.

2. We have decided not to consider Mr G’s complaint any further as we have seen the Practice acted in line with guidance in the care it provided Ms G.

3. We will explain our reasons for our decision in this statement.