A practice in the City of Peterborough area

3. Miss B complains about the actions of the Practice, regarding her care and treatment, from 2024 – 2025.

4. Miss B says: • the Practice failed to refer her for an urgent MRI despite showing clear signs of CES and A&E recommending the scan • the Practice did not offer or prescribe alternative pain medication • the Practice removed Miss B from their list of patients with unresolved medical needs and no support plan in place.

5. Miss B says the Practice’s actions had the following impact on her: • rejected referrals caused long term physical impacts, including loss of leg function and collapse episodes due to loss of sensation, bladder and bowel incontinence and severe unmanaged pain • the overall health decline has caused inability to work or live independently – this has had a significant financial impact and having to rely increasingly on others to perform everyday tasks • loss of continuity of care due to delayed/refused referrals and being removed from the Practice • due to her autism, she has not been able to find another GP she can communicate with comfortably since, and is not receiving proper medical support • loss of trust in healthcare.

6. Miss B is looking for the following outcomes to her complaint: • a full investigation into why failings happened at the Practice • formal apology • £10000 financial redress.

7. Miss B has a history of chronic back pain, as well as saddle numbness (loss of sensation in the groin, buttocks, inner thighs and perineal area), incontinence and weakened legs. She is also diagnosed with Ehlers-Danos syndrome (EDS), which causes hypermobile joints, chronic pain and sensitive skin.

8. As a result of this, she was given a prescription for diazepam in the summer of 2023 for her pain. Between then and January 2024, the Practice prescribed her this eight times and she began taking it regularly. The Practice then stopped this due to its potentially harmful qualities.

9. In January 2024, she attended an MRI appointment for her spinal pain, where she was diagnosed with a disc protrusion.

10. Miss B’s symptoms persisted, and in July 2024, after numerous visits to the GP, she attended A&E with suspected CES. CES is a surgical emergency that occurs when the bundle of nerve roots at the lower end of the spine becomes severely compressed. Symptoms can include incontinence, saddle anaesthesia, and sciatica.

11. A&E diagnosed her with chronic back pain and sent her back to her GP for an MRI to be organised. Miss B stated this MRI should have been classed as urgent, given her symptoms.

12. The Practice referred her for a routine MRI, which was not organised until November 2024.

13. A&E gave Miss B diazepam for her pain. She requested this again from the Practice in August, but they explained this wasn’t something they could prescribe, given the addictive qualities of the medication.

14. In November 2024, Miss B attended another MRI. This was reported as showing no changes from January.

15. The Practice referred her to many services, including the Royal National Orthopaedic Hospital, pain management services and hydrotherapy. These were rejected due to Miss B not meeting the criteria, or due to missing documents in the referral letters.

16. Miss B complained about the lack of services supporting her and the lack of pain management in 2025. She also complained to the Practice about the treatment and care she received from one of the GPs.

17. She stated she only wanted to be seen by a female doctor, given the nature of her ailments.

18. The Practice explained that due to being a small practice, it was not always possible to guarantee this. Miss B complained about this, believing it to be a breach of her reasonable adjustments.

19. Miss B’s relationship broke down with her GP and the Practice as a result. The Practice removed her from its patient list in August 2025.

Issue 1 – the Practice did not refer Miss B for an urgent MRI

23. In her complaint to us, Miss B stated, in July 2024, the Practice failed to refer her for an urgent MRI despite her showing clear red flag symptoms of CES.

24. In their response, the Practice stated the GPs and relevant clinical specialists carried out a detailed clinical review of clinical risks. Based on these, it was decided an urgent MRI referral was not appropriate.

25. We found staff acted appropriately in this instance.

26. Miss B had attended an MRI in January 2024 for the same issue. She was not diagnosed with CES at the time.

27. When her pain worsened, she went to A&E. A&E referred her back to the Practice to organise an MRI in July 2024.

28. On the acute trauma referral letter from A&E to the Practice dated 13 July 2024, the diagnosis was stated as “chronic back pain”. Miss B received this diagnosis in January, and again in July, due to no major changes noted in her symptoms. The letter states her back pain was caused by a scoliosis (abnormal curvature of the spine) related disc protrusion.

29. The letter further explained that for five days Miss B had been experiencing back pain radiating into her legs. The letter said Miss B had experienced incontinence for more than two years, and reduced sensation in her perianal area since the birth of her child. The letter stated Miss B’s power and reflexes were normal, but she had reduced sensation in part of her back and right leg.

30. Our adviser explained if A&E had believed Miss B to have CES, they would have had a duty of care to refer her for an MRI within four hours, according to NICE CES guidelines. It would not be usual practice for A&E to ask a GP to refer a patient with suspected CES for a scan.

31. NICE pain guidelines state “Refer immediately, in line with local pathways, adults who have severe low back pain radiating into the leg and new-onset disturbance of bladder, bowel or sexual function, or new-onset perineal numbness, to have an assessment for cauda equina syndrome.”

32. From the information A&E gave to the Practice and the pathway A&E followed when Miss B presented with symptoms in July, it is reasonable the Practice did not suspect Miss B had CES when organising her MRI. This is because her symptoms had been persistent for a long time. Therefore, she did not meet the criteria for an immediate referral, as NICE CES and pain guidelines specify the symptoms must be ‘new onset’.

33. Since the Practice did not suspect Miss B had CES, and her symptoms did not meet the criteria for an urgent referral set out in NICE pain guidelines, a routine referral was appropriate.

34. We understand this is not the outcome Miss B was hoping for. We hope this explanation brings her some comfort, as we appreciate how difficult it must be to believe you have been treated incorrectly.

Issue 2 – the Practice did not provide Miss B with adequate pain management

35. Miss B stated the Practice did not offer sufficient pain management. She said the Practice refused to look at her medical history when providing pain solutions, as many medications were prescribed more than once, when she already showed they did not work for her.

36. Miss B stated during our phone call that the Practice refused to prescribe her diazepam for her EDS, despite it being the only painkiller that soothes her symptoms.

37. In their response, the Practice stated that diazepam is a high-risk dependency drug. They said it would go against their duty of care to prescribe it, based on its side effects.

38. NICE pain guidelines state benzodiazepines (including diazepam) should not be prescribed for chronic back pain. The NHS recommends that diazepam only be used for short term pain caused by muscle spasms, for no more than four weeks. Any longer than this can significantly increase the risk of dependency and withdrawal symptoms.

39. Since Miss B has struggled with back pain for years, our adviser confirmed diazepam is not a suitable medicine to prescribe for long term management. This is because it may be harmful in terms of addiction and side effects.

40. We consider the Practice acted appropriately when refusing to prescribe Miss B diazepam for her EDS. We appreciate how frustrating it must be to not able to receive medication that helps, and hope Miss B finds a treatment that works for her in the future.

41. Miss B’s medical records show the Practice offered a range of painkillers, which Miss B declined, due to them not working for her in the past. The list included opioids and paracetamol, which NICE pain guidelines also advise against, but our Adviser said could have been considered due to a lack of other options.

42. We can see the Practice also offered a range of non-medication based pain therapies, including physiotherapy and knee strapping.

43. Based on this, we believe the Practice provided a sufficient amount of pain management suggestions. We are sorry Miss B has found it so difficult to find a way to manage her symptoms.

Issue 3 – the Practice removed Miss B from their patient list

44. Miss B stated on her complaint form she was removed from the Practice while mid-complaint, with no care plan in place. This left her with no relationship with a GP who understands her needs.

45. She has concerns she will now face further delays accessing support.

46. The Practice said the reason for Miss B’s removal was a prolonged period of breakdown in the relationship.

47. The clinical and management team reviewed the patient-doctor relationship and decided Miss B’s continued care at the Practice was not in the best interests of either party. This was due to the tone of correspondence and Miss B’s lack of confidence in the Practice’s processes.

48. Miss B believes she is being discriminated against due to her autism, and her difficulty with a specific member of staff at the Practice.

49. It is clear in the correspondence between Miss B and the Practice that Miss B was frustrated and disappointed in the quality of her care. We appreciate how difficult this must have been for her, especially with ongoing pain.

50. BMA guidelines state that the removal of a patient should be a rare occurrence. Reasons include an irretrievable breakdown of the relationship between the Practice and the patient.

51. In this instance, we can see the Practice followed guidelines and acted appropriately. In the records, Miss B states she only wants to be seen by one of the GPs at the Practice, due to a breakdown in the relationship.

52. The Practice stated this was not possible, due to the size of the Practice and the number of GPs working there.

53. We would not expect a GP practice to remove patients from the list because they had made a complaint. In this situation we can see Miss B had raised concerns about several aspects of her care and no longer had faith in the Practice staff. The Practice could not meet Miss B’s request to only see one specific GP and felt it could do no more to repair the relationship. With this in mind we consider it was in line with the BMA guidance for the Practice to remove Miss B from the patient list.

54. We recognise this was distressing and inconvenient for Miss B. We also recognise Miss B is worried about her ongoing care and whether future GPs will understand her needs. We wish Miss B well with her future care and building a relationship with a new GP practice.

Issue 4 – the Practice incorrectly referred Miss B to different services, which prolonged treatment

55. Miss B stated the Practice repeatedly mishandled referrals for pain management, hydrotherapy and EDS related treatment. She stated they consistently completed referrals incorrectly or missed information entirely.

56. She also said her independent funding request (IFR) for hydrotherapy was rejected due to missing information, which the Practice was responsible for.

57. An IFR is an application made by a healthcare professional, on behalf of a patient, to ask the NHS to fund a specific treatment that is not routinely commissioned.

58. The clinical funding department emailed the Practice in November 2024, stating hydrotherapy was not suitable for IFR.

59. GMC good medical practice says doctors must make sure any information they communicate as a medical professional is accurate, not false or misleading. This includes taking reasonable steps to check the information is accurate, not deliberately leaving out relevant information, not minimising risks of harm, and not presenting opinions as established fact.

60. We have found it was not the fault of the Practice that funding for hydrotherapy was declined. This is because hydrotherapy could not be provided through IFR in Miss B’s area. We have seen no evidence this was due to missing or incorrect information within the referrals.

61. In the case of the other referrals, we have found no concerns. Miss B is a highly complex patient, so some referrals were rejected as she would be better suited somewhere else, or the places she was being referred to (such as EDS London) do not accept referrals.

62. Other referrals, such as the referral for a Trust in March 2025, were rejected as the service was not provided there. We appreciate this must have been frustrating for Miss B and feel like time wasted.

63. The Practice explained in their response they were guided by clinical advice available at the time, including input from specialists and hospital consultants. They appreciate the distress the experience caused Miss B.

64. Based on the information received, we see no evidence a lack of detail or information was the cause of the referral rejections. We do accept that some referrals were made for services Miss B could not access. We understand how disappointing it must have been to receive so many rejected referrals. We have seen no evidence the Practice did anything wrong in making these referrals. The Practice was acting in good faith by referring Miss B to services it believed may be suitable for her.

65. We appreciate the time and effort it takes to complain to us, and we would like to thank Miss B for bringing this to our attention. We are sorry this is not the outcome Miss B was hoping for.

1. We have carefully considered Miss B’s complaint about the Practice. We understand Miss B has concerns about not being offered alternative pain medications by the Practice and being removed from their patients list. She also complains the Practice did not refer her for an urgent MRI when she displayed symptoms of cauda equina syndrome (CES). She believes that further referrals were delayed or rejected due to procedural failings. We acknowledge how frustrating this situation has been for Miss B, and how much time she has spent seeking support. We appreciate her bringing the matter to us.

2. Having considered Miss B’s complaint, we see no indication of failings from the Practice. This is because they followed appropriate guidance and correct policies when suggesting medication and referring Miss B to other services, as well as for an MRI. We recognise this will be disappointing news for Miss B. This report explains our reasoning in more detail.