Decision Report 201300654

Summary

Mr C complained about the care and treatment provided to his late mother (Mrs A) by her medical practice over a three-year period before she died in 2012. Mrs A had a complex medical history with many severe and debilitating conditions, which had been present for a number of years. Mr C raised a number of issues about the care and treatment provided for his late mother's conditions, including the treatment she received for leg ulcers, chronic kidney disease (CKD) and epilepsy, dietary issues, and nursing infection control methods. Mr C also complained that the GP had not communicated adequately with him and/or Mrs A.

Our investigation, which included taking independent advice from one of our medical advisers, found that the care and treatment provided to Mrs A was reasonable, appropriate and timely. The adviser reviewed Mrs A's medical records and found no evidence (other than one lapse in monitoring kidney function) that her care and treatment was deficient. National guidance on the management of CKD says that kidney function should be monitored at least every three months, and there was at one point a gap of six rather than three months in testing Mrs A's kidney function. There was no explanation for this gap but the adviser said that it had no detrimental effect on Mrs A's overall condition.

We did, however, identify failings in communication and upheld Mr C's complaint about that. We found that some of the written communications from the GP to other healthcare professionals contained subjective comments about Mrs A and her lifestyle. After Mr C complained to the practice, the GP acknowledged that the comments were not appropriate and apologised to Mr C for the distress this had caused him. The adviser agreed that the comments were not appropriate and said that they had detracted from the GP's otherwise professional approach to Mrs A's care. The adviser was also concerned that at times the GP appeared to make unilateral decisions about Mrs A's care without discussing them with her and/or Mr C.

Recommendations

We recommended that the practice:

• ensure that the GP reflects on their practice in relation to communication and discusses any learning points at their next appraisal.