Summary
Mrs C's husband (Mr A) had been diagnosed with lung cancer and discharged to the care of his medical practice. To help manage Mr A's pain at the end of his life, Mrs C was allowed to administer a controlled drug. Despite this arrangement, Mrs C said that the practice failed to manage Mr A's pain reasonably and to make reasonable arrangements to ensure a sufficient amount of pain relief was available. Mrs C also said that the practice failed to communicate with her in a reasonable way about administering pain relief and to keep accurate records. Mrs C said that as a result of this, Mr A suffered intolerable pain before his death, which caused her extreme distress.
I took independent advice from a GP adviser. The adviser considered that in relation to treatment decisions and pain management, the standard of care and treatment provided was reasonable. Moreover, while there were administrative shortcomings in relation to record-keeping, these were not significant and had no detrimental clinical effect on Mr A's care. I accepted that advice. With regard to the governance arrangements in relation to Mrs C's administration of the medication, I found that there was effectively an informal arrangement between the practice and Mrs C which allowed Mrs C to administer a controlled drug without the practice first putting adequate safeguards in place or seeking guidance from a specialist. I agreed with the adviser that it was of concern that GPs continued to prescribe a controlled drug after expressing concerns that Mrs C had administered the medication without clinical advice. Furthermore, the practice failed to ensure that Mr A consented to the arrangement. I upheld this part of Mrs C's complaint and made recommendations.
Mrs C also said that the practice did not respond reasonably to her complaints. I found that the practice's handling of Mrs C's complaints was reasonable and so did not uphold this complaint.
Redress and recommendations
The Ombudsman recommends that the practice:
- ensure the GPs who instructed Mrs C in relation to breakthrough medication and the other GPs who subsequently issued prescriptions for oxycodone seek support from the board's clinical support group, in relation to responsibilities for prescribing and consent under GMC (General Medical Council) guidance;
- ensure the relevant GPs discuss the findings of this investigation at their annual appraisal;
- ensure the relevant GPs familiarise themselves with the GMC guidance as a priority;
- draft a protocol in conjunction with the board to support patients and/or carers to administer prescribed subcutaneous medication by injections; and
- apologise for the failings this investigation identified.