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Making a Complaint about Primary Care Management?

Hi all

I wanted to ask your expert advice! I am trying to raise concerns about my treatment in primary care.

A week ago, prior to an exacerbation which landed me in the hospital for 6 days for the first time in over a decade, I attended a walk-in centre and complained about wheezing/tightness in my chest/needing to use my blue inhaler more often/waking at night with asthma symptoms. I attended the walk-in centre because I had been deregistered from my local GP because I moved house and was now .5 of a mile out of the GP catchment area. I was really looking for referral to a GP or advice on what to do if I deteriorated further.

The nurse listened to my chest and said I had no wheeze, told me that I had a common cold and advised me to take ibuprofen. She had finished the session and I asked her to do a Peak Flow Meter. She said 'you're not asthmatic, are you?' which I thought was odd as I'd told her this about 3-4 times.

As it so happened, I came out ok on this - 75% - but she didn't ask me my best.

I said I was still pretty worried because I am really a nocturnal asthmatic and I knew from the way I felt that I was deteriorating. I sought advice on what I could do if it got worse - she said I should try get an appointment with a GP in the next week or so. I advised her that I had tried but was told that I would need to wait two weeks and I sensed that might cause problems. She said to try again. It ended pretty much like that.

Anyway, I dropped them a line. Not because I felt the nurse had done anything terrible - my PEFR was okay etc - but because I felt that she over-reassured me and that subsequently delayed my decision to call the ambulance (I kept thinking I wasn't as bad as I felt, because she had told me my lungs were clear). I also dispute the fact there was no wheeze as, in the event, I seem to have had quite a nasty little viral infection going on (which still hasn't settled, as I have a morning dip to 55 - 60% going on, yesterday a double dip).

Anyway, I never even mentioned the wheeze in the email. All I suggested in my email was that they a) ensure all asthmatics are routinely assessed with an objective measurement and b) give general advice on what to do if deteriorating/in the event of an attack ie. don't downplay subjective experience of asthma symptoms so much.

I feel that as I am generally so well controlled that my feeling that I was deteriorating should have been taken on board a bit more, as should my increasing nocturnal symptoms.

To be honest, the deterioration was really my own fault because I have been foolish and not been at my asthma clinic this year (which I blame on completely forgetting to do anything I should in the run-up to my wedding!) but I felt the fact that I hadn't been given advice on what to do in the event of an attack should be raised.

To be honest, the reason I have a bee in my bonnet about it is because I went to a walk-in centre, which is often heavily populated by students, and I know that as a student, I was often much more severe and sent away with advice as if I had a common cold (once leading to me collapsing in the high street with a PEFR of less than 100). I felt the nurse just didn't take the asthma side of things into account, and that worries me for other people, particularly young or student asthmatics who, like me, can easily downplay their asthma. I didn't think it was particularly helpful to assure me I was fine when I knew it wasn't without giving some qualification to this.

This was the point that I was raising and I felt I did so in an even and balanced way, stressing that I was highlighting it as a potential learning point and saying that I did not have a problem with what the nurse had decided in relation to my own care.

Anyway, the response I received was most adversarial and told me that I was essentially lying about having to ask her to do my Peak Flow! They said that they couldn't have been expected to do anything else as my asthma wasn't 'life-threatening'. They also said that I didn't request an onward referral to a GP (my whole reason for going in there in the first place!). They said that their asthma management protocols are in accordance with national guidelines (even though they didn't do a Peak Flow as standard?) and they have 'lots of high quality literature available to [their] asthmatic patients' (well and good, but did I get any of it? No).

What do any of you think? Am I being a bit too OTT about it? I honestly just raised the issue as I think it's important that asthma is taken seriously in primary care, and I did feel that the nurse thought I was being really dramatic about my symptoms. However, as I said, I have had very good control over my asthma for a long time and I knew that I was going down hill. And lo and behold, there I was in A&E within 24 hours and have now lost at least a week's work. Hmmm.

Just interested in your opinions : )


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