Clinical treatment outside hospital; GP : A GP Practice in the area of Swansea Bay University Health Board Report Date 11/02/2025 Case Against A GP Practice in the area of Swansea Bay University Health Board Subject Clinical treatment outside hospital; GP Case Reference Number 202305597 Outcome Upheld in whole or in part Mr R complained about the care and treatment provided to his wife, Ms R, by a GP Practice in the area of Swansea Bay University Health Board. Specifically, the investigation considered whether a decision to prescribe naproxen (part of a group of medication knows as NSAIDs used to treat plan, inflammation and fever) without a proton pump inhibitor (“a PPI” – medication that reduces acid production in the stomach) was clinically appropriate and whether the prescribing of naproxen, without a PPI, likely caused Ms R to suffer a gastrointestinal bleed and/or stroke (where the blood supply to part of the brain is cut off, causing damage to the brain).
The investigation found that Ms R was prescribed a high dose of naproxen and as such the prescription of a PPI should have been offered alongside it. The failure to prescribe a PPI placed Ms R at an avoidable increased risk of experiencing an adverse gastrointestinal event. This part of Mr R’s complaint was upheld.
The investigation also found that it was more likely than not that the prescription of naproxen caused Ms R to suffer a gastrointestinal bleed. A prescription of a PPI alongside naproxen would have reduced the risk of this occurring. It can never be known for certain what the outcome for Ms R would have been had a PPI been prescribed with naproxen. This will be a source of lasting uncertainty, which is an injustice. This part of Mr R’s complaint was upheld.
The Ombudsman sought and gained the GP Practice’s agreement to apologise to Mr R and Ms R for the failure to offer Ms R a PPI, and to offer them a payment of £500 in recognition of the uncertainty and distress caused by this failure. It also agreed to ensure the GP who prescribed naproxen to Ms R is familiar with NICE guidance on prescribing NSAIDS, in particular how to mitigate any risks this may present through the use of a PPI and the importance of discussing risks with patients.