Decision report 201203873

Summary

Mrs C complained about the care and treatment that her mother (Mrs A) received from the medical practice during two days when she was at home between being discharged from hospital and going into a hospice. When Mrs A was discharged, hospital staff requested a GP home visit for the following day. However, this request was missed, and it was not until Mrs C phoned the practice that a home visit was arranged. The following day, a hospice nurse visited Mrs A and found that her pain was severe and that she needed to be in the hospice for this to be managed effectively. The nurse phoned the practice for another home visit, so that Mrs A could be given further pain relief before she was transferred to the hospice. However, this request was not identified as urgent, and it took a further call to the practice to prompt the visit. When the GP arrived she did not have appropriate medication with her and had to go to a pharmacist to get some.

We obtained independent advice on this complaint from one of our medical advisers. They confirmed that there were delays in providing a home visit the day after Mrs A came out of hospital. This was because the practice did not pick up the request from Mrs A's discharge letter or from a call from staff at the hospital. The adviser considered that the GP attending on the second day should have had appropriate pain relief with her when she came to the house, as she was aware of the reason for the visit. She also said that the GP had not administered appropriate pain relief. We upheld Mrs C's complaints as there was evidence that the practice had not responded appropriately to calls for home visits and had not provided appropriate pain relief to a patient in severe pain. We did, however, note that they had already identified some of these failings and had put in place systems for improving communication in relation to home visits.

Recommendations

We recommended that the practice:

• put in place a system that ensures that actions identified in patient discharge letters are carried out;
• ensure that they are familiar with, and take account of, Scottish Intercollegiate Guidelines Network Guidance 106: control of pain in adults with cancer to ensure appropriate pain relief is used;
• ensure that where a home visit is required for pain relief for palliative care, the doctor attending has access to the appropriate pain relief prior to attending; and
• apologise to Mrs C for the additional distress caused by the failings identified in our investigation.