Decision report 201102828

Summary
Miss C complained about the care and treatment provided to her late uncle (Mr A) by his medical practice. Her mother (who is Mr A's sister) had initially made the complaint, but Miss C eventually took it forward on her mother's behalf. Mr A had cancer and was undergoing chemotherapy in hospital.

Several days after he was discharged from hospital, he telephoned the practice asking for a prescription for antibiotics and a telephone consultation with his doctor. His doctor returned the call and issued a prescription for antibiotics.

A few days later, Mr A's sister became increasingly concerned about his condition and telephoned the practice requesting a home visit from a doctor. The practice advised her to contact emergency services. She was dissatisfied with the advice and phoned NHS 24, who arranged with the practice to send a doctor to visit him at home. The doctor arranged for an emergency ambulance to admit Mr A to hospital. Mr A died several weeks later.

Miss C complained that Mr A should have been seen by a doctor after her mother called the practice, and that the practice's response to the request for a home visit was unreasonable.

We upheld Miss C's complaints. We found that, given the seriousness of Mr A's illness, he should have had a face-to-face assessment rather than a telephone consultation. We could not establish what was said between Mr A's sister and the practice during the telephone call. However, we found that the problems of communication were compounded by a lack of specific instructions about the advice from the practice to contact emergency services. As a result, there was a delay in admitting Mr A to hospital and, while this may not have affected the outcome, it was clearly distressing to him and his family. We made recommendations in respect of both the doctor concerned and the practice.

Recommendations
We recommended that the practice:
• reflect on its management of this case particularly in light of the complications of chemotherapy;
• review its record-keeping for telephone consultations;
• apologise to Miss C for the failures identified; and
• review its procedures for house calls in light of this case.