Decision report 201101741

Summary
Mrs A had been receiving treatment for high blood pressure for a number of years. She had three strokes within six months. Mrs A's husband, Mr C, complained that their GP practice failed to provide appropriate advice to him when he contacted them about the first and second strokes. Mr C also complained that the practice failed to respond within a reasonable timescale when Mrs A's stroke nurse reported high blood pressure results shortly before the third stroke.

In looking at the records, we could not determine exactly what was said when Mr C spoke to the practice on the day Mrs A had her first stroke, as there was no direct objective evidence. However, the records did show that the practice's advice to bring Mrs A to the evening surgery on the day of her first stroke was reasonable. While we acknowledged this, there was no record of advice given to Mr C about what to do if Mrs A's symptoms worsened. In addition, one of our medical advisers was of the view that Mrs A should have been taken to hospital that evening by emergency ambulance. In relation to the day of Mrs A's second stroke, the practice advised Mr C to bring her in for a consultation the following morning. In our view, she should have been seen and assessed on the same day, given her history and unresolved symptoms. Taking all of this into account, and noting the views of our adviser, on balance we upheld this complaint.

In relation to Mr C's second complaint, the records showed that the practice discussed Mrs A's high blood pressure results with the stroke nurse, and arranged for further review and a home visit. Our adviser's view was that the practice acted appropriately in the circumstances. Taking this into account, we concluded that the practice did respond within a reasonable timescale and, therefore, we did not uphold this complaint.

Recommendation
We recommended that the practice:
• review their protocol for the management of hypertension, in terms of the threshold for referring patients to a hospital consultant. This would include urgent referral and emergency ambulance transfer to hospital of patients suspected of stroke if symptoms persist on assessment.