should I complain to practice mgr about nurse practitioner?

[curlyLJ]

I have seen this nurse practitioner twice - they tend to use her to help the GPs by taking on some of the appointments they are deemed to be able to help with.

Saw her back in Nov as I had been having irregular mentrual bleeding for 6m or so. She said in a very blase manner that it was nothing to worry about and would just be my age (45). At my insistance she sent me for bloods which came back as 'abnormal but expected'. Still not happy I booked to see the GP who immediately booked me for an ultrasound scan and put me on a 2w referral to gynaecology and I am having a hysterocsopy next week due to suspected polyp(s).

Fast forward to a few weeks ago, I rang for a same day emergency appt as I thought I had a chest infection. Saw nurse again. She sounded my chest (back only) for all of 20 seconds, declared it clear and told me to go home and take paracetamol and drink honey and lemon drinks. I told her I had never felt so ill in my life, had severe rib pain which hurt to breathe (she said was down to coughing too much) I was coughing up pinky/brown mucous (bloody?) which she said was irritation in my throat from coughing. Had high temp - was alternating ibuprofen/paracetamol to keep it down, and kept coming over very hot/sweaty. She said she wasn't worried about these symptoms so I left.

To cut a long story short, I ended up in out of hours a few days later, chest infection diagnosed by GP who sounded chest much more thoroughly and was given antiobiotics. Have since had second lot of anti-b's and have had a chest x-ray which shows consolidation in one lung consistent with a pneumonia type infection. Got to follow up in 6 weeks with 2nd x-ray.

Would it be worth complaining about this lady. I know surgeries are stretched and I know there are issues with over-subscribing of anti-b's but I think she made 2 significant errors and could be doing so with other people. Should I complain or just leave it?

I'd certainly the practice manager know what happened, yes.

I had a similar thing with a doctor - I am asthmatic and went in with what seemed to be a very sudden chest infection that happened overnight. He happily declared no need for medication and said "you will probably feel terrible for 2-3 weeks" but didn't want to write a sick note either.

the following day, I could barely drag myself to the surgery, never mind work. I saw a different doctor, and she effectively apologised for his treatment, then prescribed the strongest antibiotics I'd ever had and said "sorry, if this had been yesterday I might have been able to give you a lower dose, but listening to your chest now, I can't take the risk".

I have since heard that many patients call and say "I will see any doctor except him".

oh and I hope you feel better asap!

She should not have dismissed the irregular bleeding as expected due to age. The boundaries seem to get very blurred in surgeries as to what nurse practitioners can see. I am a nurse prescriber but not minor illness trained. In fact I am very reluctant to take on further training as the pressure to see more and more is getting worse.
If I had seen you I would have referred you to the gp for an USS referral at the least (I cannot refer in my role).

Almost everyone at our surgery seems to be seen by a nurse practitioner. You only see a doctor if you book 2 weeks in advance and can prove it needs a doctor.

I saw one for a condition I've seen a doctor about and been diagnosed with previously. She was very blase also and told me to buy over the counter solutions that I knew wouldn't help instead of prescribing the medication I'd had before. They are good for some things but not for others.

The nurse practitioner at my GP surgery is also lacking in knowledge.

She has misdiagnosed me on more than one occasion.

When you phone and ask for a GP appointment, the receptionist is under pressure to book you in with this nurse instead of a GP.

Apparently she has a short list of things she is permitted to diagnose and prescribe for.

Once you are there, she somehow seems to make your symptoms fit one of these conditions.

Yes do complain.
She needs further training and may be working outside her remit. The practice manager needs to follow this up.

That is what worries me. She could make a more serious mid-diagnosis.

I'm not a complainer usually, I just think because it is twice now for me, how many others has she fobbed off incorrectly?!

*mis-diagnosis

Yes you should definitely complain. She's obviously not up to the job. It's not her fault but the practice needs to know what they're doing isn't sufficient for their patients.

It is possible that she is being pressured into seeing patients that are not appropriate for her clinic. It does happen due to staff shortages and lack of appointments.

I would complain.

Pressure to see patients and is no excuse, as a nurse you have a duty of care to your patients and must only work within your capabilities. Please complain.

In general practice the partners are the employers. Most gps are reasonable, but bullying does go on and employees can find themselves in a difficult position with little support.
Duty of care not withstanding, working in the nhs is stressful and I know from personal experience that standing up to one's employer can be difficult.
We don't know the circumstances. The nurse could be underqualified and overworked, she could be careless, she could be overconfident.
The practice manager is the appropriate person to deal with it.

Thanks all. I have submitted the complaint.

My feeling is she is over-confident and diagnosing (or not!) well out of her remit and getting it wrong.

There was a big difference in how she sounded my chest compared to both the GPs I saw. If I had been more vulnerable/much older/compromised immune system, it could have had catastrophic consequences. Chest infections can cause sepsis.

Also, bleeding between periods can also be very serious. The gynaecologist I saw didn't once say it was anything to do with my age. Her attitude towards it and telling me it was fine was very poor.

I would complain.

The first example sounds like lack of knowledge or acting out of her area of competence.

The second sounds like failing to take into account the clinical picture in front of her.

Having 2 together from the same practitioner is a concern the practice needs to know about.