Decision Report 202104829

Summary

C complained about the care and treatment their adult child (A) received from the practice. A had undergone surgery to remove infected fluid on the right lung. Gabapentin (an anticonvulsant medication primarily used to treat partial seizures and neuropathic pain) was prescribed to manage nerve pain at the incision site. The practice later stopped prescribing gabapentin and A’s mental health deteriorated significantly.

C complained about the abrupt withdrawal of gabapentin. They highlighted that gabapentin had been prescribed to manage ongoing nerve pain following surgery and noted the risks of sudden withdrawal. The practice stated that prior to the discontinuation of gabapentin there had been an increase in early requests for renewal of medication, which caused concern. A had not attended appointments with the GP or with cardiology (specialists in diseases and abnormalities of the heart). The GP felt that they could not justify further prescription of controlled drugs without seeing the patient.

We took independent advice from a GP. We found that there was no record of any significant harm from gabapentin or evidence of overuse, or had there been any discussion around reducing or stopping gabapentin. We noted that gabapentin is known to cause problems during the withdrawal period and it should therefore be withdrawn slowly. We also found that no withdrawal support was given. In light of this, we considered that the practice had failed to appropriately manage A’s prescription for gabapentin and upheld C’s complaint.

We also found failings in the practice’s handling of C’s complaint.

Recommendations

What we asked the organisation to do in this case:

• Apologise to A for abruptly stopping gabapentin. The apology should meet the standards set out in the SPSO guidelines on apology available at www.spso.org.uk/information-leaflets.
• Apologise to A for the complaint handling issues. The apology should meet the standards set out in the SPSO guidelines on apology available at www.spso.org.uk/information-leaflets.

What we said should change to put things right in future:

• Complaint acknowledgements should include all the information required by the Model Complaints Handling Procedure. Points of complaint should be agreed with the complainant at the outset. Points of complaint should be addressed in the response. Care should be taken with the tone of the response.
• GPs should be familiar with the guidelines for withdrawal of medicines associated with dependence.
• The practice should have a policy around how they contact patients especially when their phones are unobtainable. Alternative modes of communication like home visit, letter or taking help from a household contact to confirm phone number could help clinicians provide safe care to patients.

We have asked the organisation to provide us with evidence that they have implemented the recommendations we have made on this case by the deadline we set.