Decision Report 201407590

Summary

Mr C complained that for a period of over three months he attended the practice with symptoms of a painful and swollen foot and that they did not refer him to hospital for specialist advice. Initially he was referred to A&E where he was diagnosed as suffering from deep vein thrombosis (a blood clot in the vein). The pain became so unbearable that Mr C again attended A&E where an MRI scan (a scan used to diagnose health conditions that affect organs, tissue and bone) was arranged and this showed that he had peripheral artery disease (narrowing of the arteries which affects the legs). Mr C had had to endure surgery and believed that the practice should have referred him back to the hospital sooner.

We took independent advice from a GP adviser. The adviser said that it appeared that Mr C had developed acute ischaemia (lack of blood supply) of his right limb and that this usually occurs as a sudden event on the background of a patient having peripheral vascular disease (a common condition in which a build-up of fatty deposits in the arteries restricts blood supply to leg muscles). However, although the practice had recorded Mr C's continuing symptoms (indicative of peripheral vascular disease) they failed to undertake appropriate investigations themselves or make a referral to the vascular clinic. Our adviser pointed out that although the practice failed to provide Mr C with reasonable care for his peripheral vascular disease his requirement for surgery was as a result of an acute event which could not have been predicted. We upheld the complaint.

Recommendations

We recommended that the practice:

• apologise to Mr C for the failings we identified; and
• share this report with all GPs at the practice and reflect on the adviser's comments.