Out–of–hours GP service failed to diagnose sepsis

What happened

Mr G had a sudden onset of pain in his right hand and called the out–of–hours service. A GP visited him at home and diagnosed Mr G with gout (a form of arthritis) and gave him a painkilling injection. Later that day, Mr G called the out–of–hours service again and a second GP visited him at home. The second GP agreed with the diagnosis and gave Mr G further painkillers.

Mr G went to his own GP three days later and was admitted to hospital with sepsis (a potentially life–threatening complication of an infection) and cellulitis (bacterial infection of the skin). He developed an abscess and needed five operations and intensive rehabilitation, and he was left with suspected permanent damage to his hand.

What we found

The examinations carried out by the

out–of–hours doctors were not as good as they should have been, and the written records were poor. As a result of this, there was a missed opportunity to treat the infection earlier, and so Mr G had a poorer outcome than should have been expected.

On the balance of probabilities we found that if the consultations had been carried out as they should have been, Mr G would have had earlier treatment and the infection would not have become an abscess. This would have meant surgical treatment might not have been needed, or it would have been limited to fewer and less extensive operations.

Putting it right

The out–of–hours service agreed that the doctors would take further training to prevent the same thing happening again. During the course of our investigation both doctors started this process. The service agreed to share evidence of the training with the doctors' supervisors, and with the Care Quality Commission who are responsible for inspecting GPs.