NHS UK

NHS

A case study from the heart
Cardiac Surgery

What really happens


Dental Optical GP Surgery Primary Care Trust Local Hospital Regional Hospital District Hospital Cardiac General Hospital


2005

It all started with tooth ache. It had been five years since I had needed to consult a doctor.

10th October, 2005
We had just managed to change our dentist from one thirty miles away to one in the town. The call came to have our teeth inspected so we duly went. Full head X-rays were taken and others of areas of concern. You have decay around the gum margin of your lower left six and the dentist suggested a composite filling round the gum margin, other than that he should remove the crown and redo it.

29th October
The composite filling was put in place.

27th March, 2006
First signs of feeling unwell. Flu like symptoms with cough.

18th April, 2006
Still feeling unwell. Flu like symptoms with cough. Endocarditis?

26th May, 2006
The composite filling did not work and the whole tooth with crown was removed because the dentist did not think he could get the crown off without breaking the tooth. Prior to the removal of the tooth I was given antibiotics for a week, this was in addition to the amoxyillin penicillin I had been given prior to this and previous inspections.

The removal of the tooth and the penicillin type drugs had improved my health no end, for prior to this I had not been feeling 100%. So I thought that I had better get an MOT from the doctor as I had not had to visit them since I registered with them five years ago. I made an appointment and was given a date in two weeks time!


2006

15th May, 2006
Meanwhile I went to the opticians (1) for an eye test and he explained I had slight deterioration in the left eye which I already knew, but did not mention the right eye which I had been told to have tested by an optician on the telephone.

16th May, 2006
Woke up and could not see through my right eye. Eventually the lower half cleared, but not the top. I telephoned the doctor's surgery and was told that they were not open until nine o'clock and I should go to the local hospital which I duly did. Immediately I was seen by a nurse practitioner who telephoned the local district hospital which had an eye consultant E1 and I was seen by the consultant at eleven o'clock. You have had an renal vein thrombosis and it is unlikely that the sight will return, but it might. Have a neck scan and a blood test. I will see you in a month. So I told the desk clerk who said that they would send me an appointment. I am still waiting for that appointment in 2007. So off I went to the departments concerned and had my blood taken by one one of a number of nurses discussing their love life, and at radiography my name was taken and I was told "we will send you an appointment for the scan". There was no one else waiting to be seen.

22nd May, 2006
The day came to see the doctor and I duly attended at the time appointed 4.55pm and I saw a woman GP (1) who appeared to be more interested in my allotted time span of ten minutes for the consultation than me. First I was told we have not started doing MOT's yet. It was an expression I had used to imply that I needed a health check as I had been feeling unwell, but the expression seemed to have been wasted on her and I was asked what was wrong with me. I thought I ought not to have made the appointment and looked at the home doctor book at home. She looked at her computer screen and said she had had a letter from the eye consultant and that they should test you for cholesterol, make a appointment for a blood test. The outcome was that I asked to have my heart checked as it was five years since the last tests were done on it. She said that she would write to the local hospital consultant and that they would contact me with a date.

25th May, 2006 and again on the 30th May, 2006
I went to the doctors for the blood test and sat in an almost empty waiting room on both occasions for twenty minutes whilst the nurse kept walking in and out of her room which was empty. I eventually got the blood taken for the tests.

15th June, 2006
Received letter from local hospital doctor who would like me to make an appointment and would write again near the time of the appointment.

3rd July. 2006
Got a letter from the local hospital for an appointment on the 10th July for an ultrasound scan of the carotid artery.

10th July, 2006
Went to the local hospital for a carotid artery ultrasound, the outcome of which was that I was told that there was a slight narrowing and he would write to the ophthalmic surgeon.

15th August, 2006
Letter from local hospital stating that I was nearing top of outpatient consultants list for a heart scan.

31st August, 2006
Local hospital for a heart scan regarding the forthcoming local consultants appointment.

20th September, 2006
Visited the local hospital regarding the heart scan and had another chest heart monitor. Saw young doctor H1 who was the consultants registrar. I was told I had narrowing of the aortic heart valve and I needed open heart surgery to replace the valve. I should see the consultant in six weeks prior to him making an appointment for an angiogram two to three months after the consultation.

21st October, 2006 flue jab
Letter of confirmation of appointment on 3rd November at local hospital.

24th October, 2006
Talked things over with a doctor GP (2) from my surgery mainly about forthcoming surgical events and treatments. Not much advice given, but he did say were he would go for heart surgery.

25th October, 2006
Rung the local Primary Care Trust for information about heart surgery arrangements in this area. Passed from one person to another who supposedly knew something about the Trust working with regard to the heart patents. I was told that I should have been offered choice of hospital where I wished to be treated before I knew what was wrong with me and what treatment I wanted as you could not change after the decision had been made. Could only go to Specialist heart surgery hospitals that the Trust had a contract with.

3rd November, 2006
Appointment day. 9.05am Sister from the local hospital rang to say that doctor would not be in today for my 11.00 appointment and a letter would follow with a new appointment in two weeks. On TV news saw that crisis meeting was being held at the local hospital at 12.00. Is that why the doctor cancelled my appointment?
Letter from local hospital informing me that I would be seen on the 15th November, 2006 was sent to me.

15th November, 2006
11.40 local hospital appointment day. Arrive and was informed that the doctor was running 45 minutes late so we left and came back at 12.25. Doctor H2 explained that the scan revealed that another valve was leaking which meant that two needed replacing with the other one narrowing. Told by the doctor that he would put me on the list for an angiogram at the local hospital with facilities for doing this procedure and that they would inform me of date and time. Raised again my desire to have the surgery performed at another hospital not in this Primary Care Trust area and was asked my reasons, and why I did not want to go to the local hospital. Explained it was more convenient for me and the family to have it performed at the hospital of my choice. I had been informed by the local Primary Care Trust that they had a contract with the hospital of my choice, but not with all others through out the UK.

30th November, 2006
8.40 appointment at local hospital for an endoscopy. After a shunt was inserted for injection of a general anaesthetic and the staff got the machine switched on the doctor H2 carried out the procedure. I awoke without any side affects that I was at the time aware of. Had lunch and was taken home.

28th December, 2006
Received a letter dated the 19th December stating that I was on the list for a coronary angiography otherwise known as an angiogram.

2007

19th January, 2007
Found white nodules on my tonsils so tried to get an appointment at the doctors surgery by walking to the surgery. Arrived about 10.30 am and was told that no doctors could be seen on any day until 1.40 pm - no cover available. Make an appointment. An appointment made to see woman doctor GP (3) at 4.10 pm. No treatment given at appointment.

21st February, 2007
Primary Care Trust in Deficit and still awaiting an appointment as at today's date.

1st March, 2007
Primary Care Trust making appointments in the new financial year starting April. My angiogram is set for 11am on the 6th March, to be taken in the morning and collected in the evening.

6th March,2007
Arrived area Cardiac Hospital at the appointed time for the coronary angiography and was faced by a collection of PortaKabins signed by the words Cardiac Care Unit fronting, in the background, the steel girders of a new area Cardiac centre. Preliminary paperwork was carried out with interviews, but nothing happened until 2.45pm when the procedures took place. Told that they had only dealt with the blood vessels not the valves and that a report would be sent to my hospital doctor who would send an appointment to see him. After which lay on a bed for two hours and tried not to move. A sandwich and tea were then offered so I accepted as I had not eaten since 9am. Write ups of the days work put on the desk for dispatch to the relevant hospitals. At just after 6pm I was collected and taken home. The unit had carried out twelve procedures during the day and were looking to do others.

17th March, 2007
Received a letter dated the 15th March stating that an appointment had been made for me to see the hospital doctor at 11.40am on the 18th of April, 2007.

My dentist has run out of NHS Primary Care Trust money, so is not treating his patents until the next financial year starts and has gone on holiday. A routine check has been rebooked twice by the dentist for the new financial year.
Local Primary Care Trust has run out of money and is cutting down on work carried out by hospitals to avoid too big a deficit for the year 2006/2007 ending March.

18th April, 2007
After arriving at the local hospital I was being weighed I was seen by the doctor's H3 registrar as the doctor H2 had taken his wife to a nearby district hospital for an eye operation. I was not examined, just asked how I felt and told what the letter said about my angiogram and that the result could be managed by medication, but I was not told when that treatment would start. He noted which hospital the procedure was to be carried out and that the doctor had written to them and I would hear from the the hospial in due course. That was it and I was told to see my local doctor. I explained that it took three weeks to get an appointment with him so he booked me in to see the doctor at the hospital in three months. Cancel the appontment if I had heard from the hospital carrying out the operation.

1st June, 2007
My appointment made over three weeks ago with the doctor had been brought forward from this afternoon. I had decided to see a different doctor GP (4), my fourth, to see if things would be more efficient with a change. I had made the appointment to renew my aspirin prescription, that done, I was asked why I was not taking the Lapitor for the high cholesterol 75. I said I had been told by the registrar at the hospital that it would not help my valve problem and so stopped taking it. Reluctant to believe this the doctor asked me to start retaking it, which I agreed to. I then said it was well over a year since I first came to see the doctor and I had not heard from the General hospital doing the surgery. I also mentioned that I had not had the three week follow up appointment from the hospital dealing with my eye problem. I was then told that he had only ten minutes to deal with me and he would write to the two hospital consultants concerned.

2nd June, 2007
Copies of the doctors' GP (4) letters to the two hospital consultants arrived in the post with the last letters from them, the eye one had been sent to the wrong address.

9th June, 2007
Letter arrived from the District hospital stating that an appointment had been made for me to see a doctor at 9.50 on the 5th June, 2007. As there was no mention of what clinic it was I deduced that it was the three week follow up appointment from a year ago at the eye clinic brought about by the letter from my doctor GP4.

19th June, 2007
I turned up at the appointed time and made my way through the District hospital's front entrance, where pallets and skips were present, and made my way along dirty carpets and worn out directional lines to the eye clinic. I had my eyesight tested with glasses and asked to wait. Eventually I was called in to see a doctor E2 wearing a clean white coat, not the one mentioned in the letter, but one of his assistants. After various eye drops and ophthalmoscopy examinations he said that he could not do anything for me beyond advising the use of a proprietary brand of eye wash and that I should be discharged with impaired vision.

28th June, 2007
Went for my cholesterol blood test at the doctors at 9.15. The task was undertaken by a nurse wearing her street clothes who made ready her syringe and I was soon out of the room which was open to the garden outside.

3rd July, 2007
Had a cough that has persisted for two weeks so telephoned my local doctors' surgery and was told I could see a doctor in two weeks, but I could see a Nurse Practitioner at 9.40am so I took that. On arrival I was directed to an adjacent uninviting shed. After several minutes I was invited in for a consultation and after an examination was prescribed a course of Amoxyillin.

9th July, 2007
Rough night coughing so the doctor was asked to visit. A new young doctor GP (5) arrived about twelve thirty and prescribed a stronger dose of ciprofloxacin with the proviso "if it's a virus it will not matter what we throw at it, but this may work".

18th July, 2007
Due day for appointment at the local hospital to see the doctor handling my case. No surprise when I turned up and saw another Registrar H4. After asking him what was happening it transpired that the hospital doctor handling my case had NOT WRITTEN to the surgical team at the General hospital after the angiogram on the 6th of March, nor when reminded by a Registrar on the 18th April. He did manage to write on the 17th of June two weeks after my doctor had written to him on the 1st of June asking why he had not heard from the General Hospital surgical team. The Registrar then examined me and said that he would write again to the head of Surgical Team at the General hospital as I had not heard from them and would send copies of this letter and others relating to non referral to me. He was leaving the local hospital the next day and so I could not contact him again.

At twelve o'clock that day the Local Hospital Trust announced 600 redundancies over two hospitals to meet a deficit of twenty million pounds. Final decision to be made in October.

When I got home a letter awaited me from a cardiac surgeon at the General hospital with an appointment on the 13th August to have an ECG, chest xray and then see the surgeon.

21st July, 2007
Letter dated 19th July arrived from the local hospital with a follow up appointment for the 24th October. No copies of letters enclosed.

23rd July, 2007
On the Monday contacted the cardiac surgical appointments section at the General hospital to explain the late arrival of their letter and what had happened and to ignore the letter from the registrar to the Surgical Director as I wished to stay with the original cardiac surgeon. Their advice was also to stay with the original surgeon. This was agreed.

30th July, 2007
The letters sent on 27th July turned up from the local hospital with an appointment with a member of the surgical team.

7th August, 2007
A letter arrived from the Surgical Director of the General Hospital Cardiac surgical team with an appointment to see him on the 14th August overriding the previously made appointment.

9th August, 2007
Another letter from General Hospital Cardiac surgical team with an appointment on the 19th September for cardiac ultrasound. This is a duplicate to that performed at my local hospital on 31st August 2006. Has the time lag made the other out of date?

13th August, 2007
A telephone call was made to confirm that I was still with the original surgeon as agreed on the 23rd of July with the appointment clerk despite the letter from the Surgical Director. The appointment clerk said that the earliest date now available for an appointment was the 27th September, 2007. That evening I consulted a GP6 as to how to interpret the information and what action to take and was advised to go with the original surgeon. The expertise of the two cardiac surgeons: Original cardiac surgeon - adults and the Surgical Director - paediatric, their number of procedures and survival rates.

14th August, 2007
A telephone call was made to confirm what had been discussed on the 13th and was told that the original surgeon may now not take me back on his list and that they would let me know the outcome within ten days.

5th September, 2007
In order to find out what was happening with regard to a new appointment several telephone calls were made to the cardiac surgery unit during the afternoon which were answered by a recorded message announcing that the person who should answer the telephone was out of the office and not at their desk, but would ring back. Left a message outlining the situation.

6th September, 2007
No return telephone call was made by cardiac surgery unit, so contact was made again by phone. The appointments supervisor informed us that the original local hospital doctor has been asked by the original surgeon to re-refer me and the local hospital doctor was told to telephone me and explain what was happening. No such information has been forthcoming from the local hospital doctor.

7th September, 2007
Contact was made with cardiac surgery unit and a formal complaint made. The outcome of which was to telephone my GP and get him to write requesting that I see the cardiac surgeon requested.

10th September, 2007
Letter delivered by hand on the Monday to GP's secretary who said the GP was on holiday. She would deal with it and telephone back to say that the Cardiac unit request had been carried out.

13th September, 2007
Telephone call from the GP's secretary to say that she had actioned the request for an appointment.

15th September, 2007
Letter arrived from Cardiac unit with an appointment for the 1st of October, 2007.

19th September, 2007
2pm appointment at the cadiace unit for an ultra scan. This tooke an hour and a quarter due the radiologist teaching a doctor how to use the intrument and describe what they were looking at. Made reference to fluid in the chest cavity and suggested that I see my GP.

21st September, 2007
After telephoning the local surgery a visit was made and a cancellation was available for the next day apointment at 8.45 am with GP (5). After examination he made appointment with district hospital for me to be admitted to the acute cardiac unit for tests. Requested that I let the nurse practitioner listen to my chest, which was done.

Arrived at the district hospital A and E as instructed. After an hour they found time to direct me to the acute cardiac unit. Time 11.30am. Nurses took particulars and blood tests. Saw a doctor six and a half hours later and had chest x-ray at 6pm. Admitted for the night to see the consultant the next morning. After being examined by the consultant I was given diuretic to remove the fluid from my chest and discharged at 1pm.

23rd September, 2007
Started telephoning my GP for an appointment for a follow up to my hospital admission last Friday, but failed to get through. In the end contact was made at the surgery for an early follow up appointment. Given an appointment with my GP on the 16th October.

1st October, 2007
Went to cardiac unit for ECG and chest x-ray and an appointment with the cardiac surgeon. After examination and discussion given the choice of tissue or mechanical valves for the two values to be replaced and told that the surgery would take place "soon".

2nd October, 2007
Telephoned the dentist for a check up and any remedial work prior to heart surgery. Given an appointment for the 10th October for an inspection prior to heart surgery, but told that any work could not be carried out until after the surgery.

9am appointment with GP (5) for confirmation of diuretic dosage for chest fluid and discussion of forthcoming valve replacement operation and types of valve.

10th October, 2007
Had dental inspection and an appointment was made for 12th October for remedial treatment to a filling. Dentist away for a month from next week.

12th October, 2007
Visited the dentist after taking amoxillin and had the work carried out.

15th October, 2007
Letter arrived written on the 5th, posted on the 11th and received on the 15th of October from the Consultant Cardiothoracic Surgeons secretary informing me that I was on his waiting list for surgery and would be written to in due course to come to the hospital to have the surgery carried out.

16th October, 2007
Went for blood pressure test with nurse at doctors. Normal.

19th November, 2007
Went for blood test for cholesterol with nurse at doctors.

21th November, 2007
Went to see GP (5) as I had run out of the diuretic for chest fluid as I was unable to make an appointment sooner after a new telephone system had been installed. Given emergancy supply of tablets as back up. He stated that he had not heard from the cardiac surgeon at the cardiac unite I visited on the 1st of October and that I should make a complaint to the appropriate authorities.

27th November, 2007
Went for annual check up following the blood test for cholestrol on the 19th November 2007 with a nurse. Told that my creatinine level was rising and a further blood test should be taken. Told that the test 28th June, 2007 also showed that it was rising, but no action was taken.

3rd December, 2007
Went for blood test for with nurse and took urine sample.

3rd December, 2007
Telephone call from the heart surgeons sectretary. An admission date was set for the 8th of January, 2008 for the valve replacement the next day the 9th of January. Report to the hospital at 9.30 am on the 27th December for pre admission checks.

7th December, 2007
Went to see GP (5) about the results of the tests taken on Monday. The kidney problem needs monitoring and I should go for a kidney scan at the local hospital and an appointment would be made by the hospital. Given more diuretic tablets. Informed GP5 of impending heart surgeary on the 8th of January, 2008.

18th December, 2007
The Local Healthcare NHS Trust announced that the Local Hospital cardiac monitoring unit was to close and that the hospital was to be downgraded.

19h December, 2007
Letter from the Local hospital with an appointment for a kidney scan on the 11th January. Rang to ask if it could be made before that date, but was told not and another appointment would be sent for a month after my surgery.

27th December, 2007
Went for the pre admission checks. A group of patients for admission for various cardiac surgery procedures over the next two weeks were given a talk on what was about to take place. Checks of height, weight (the electronic weighing machine refused to work), electro cardiograph, blood and urine sample, x-ray and interview over a three hour period were carried out.

7th January, 2007
Announcing the world's first national screening programme for heart disease, strokes and diabetes, the Prime Minister will promise every adult in Britain a "health MoT" in a drive to prevent serious illness. He also gave patients the right to be treated within 18 weeks or 126 days.

8th January 2008
Telephoned to see if there was a bed available. There was a bed, come in for two o'clock. Arrived and was seen by the consultant surgeon who states the operation is scheduled for tomorrow afternoon at 2 p.m., but there may be a problem arranging for the operation to take place tomorrow, and final confirmation would be given at 10 am tomorrow morning. Then various tests take place with five doctors, one of whom asked me why I was there, and nurses taking yet more duplicate notes. Then I was asked to take part in a survey by another doctor.

9th January 2008
The saying goes “If it aint broke don’t mend it, but if it is, mend it quickly”. It is 597 days since I first went to see the doctor. Eight o'clock another anaesthetist visits me prior to surgery. Change into surgical gown after antiseptic shower procedure and twelve hour fast. Ten o'clock consultant surgeon arrives with retinue to tell me the operation is off due to confused reasons which bear down on anaesthetists being off sick. Come back next week.

14th January 2008
Telephoned to see if there was a bed available. There was a bed, come in for two o'clock. Arrived and was seen by the consultant surgeon who states the operation is scheduled for tomorrow morning at 8 a.m.

15th January 2008
Prepared for operation at 7 a.m. 10.30 am told it is cancelled. Operation is scheduled for tomorrow morning at 8 a.m It is now 603 days since I first went to see the doctor.

16th January 2008
Operation at 8 am and finished at 2 pm. It is now 604 days since I first went to see the doctor.

17th January 2008
Came round from operation in intensive care. Later transferred to a ward.

26th January 2008
Discharged and went home.

7th February 2008
Blood test with nurse at GPs. One week.

14th February 2008
Blood test with nurse at GPs. One week.

15th February 2008
1.10 pm ultrasound for kidneys and prostrate. Told that nothing could be seen.

21st February 2008
Blood test with nurse at GPs. One week.

3rd March 2008
Six week check up. Had chest x-ray and ECG prior to appointment at 2.20pm, seen at 4.30 pm by the Consultant's Registrar. Told all looked fine. Raised the issue of home blood test kit and 1/2 gram Warfarin tablets - told he would write to my GP. He failed to give me an urgent medicine prescription so I assumed he would tell the GP to prescribe it as soon as he got the letter.

6th March 2008
Blood test with nurse at GPs for two weekly test and told the space between appointment would not be longer, despite the Hospital Surgical Registrar telling me it would be three monthly when the dose had stabilised.

10/11/12th March 2008
Tried to get an appointment with my GP, as I had not heard from him, to upgrade my medicines as directed by the Registrar of the Surgical Team at the hospital where my operation was carried out. I was to allow 10 days for the post, but after several telephone calls and a visit to the surgery i failed to get an appointment. What do I do now?

Our GP Surgery has 5 Doctors, who work 4 days a week, each doctor being in the surgery for 3 hours a day with no mid day cover. 17th March 2008
Finally got an appointment to see the GP at 8.45am. He had had a letter from the Registrar stating that he had seen me, but it made no mention of the home blood test kit and 1/2 gram Warfarin tablets he said he would write to my GP about. I did get the 1/2 gram tables, but the GP's procedure as to how often blood tests were to be taken did not coincide with the Registrars. The Primary Care Trust was blamed for a home test kit not being issued to patients.

20th March 2008
Blood test with nurse at GPs for two weekly test. When I rang for the results of the test they were not back from the hospital. A telephone call finally arrived and I was told to increase the dose despite the level in my blood going down. The blood test was brought forword to one week.

27th March 2008
Blood test with nurse at GPs. The blood test back to two weeks time.

10th April 2008
Blood test with nurse at GPs. Next test in four weeks.

8th May 2008
Blood test with nurse at GPs. Next test in one week.

15th May 2008
Blood test with nurse (2) at GPs, bruising occurs. Next test in one week.

22nd May 2008
Blood test with nurse at GPs. Next test in one week.

29th May 2008
Blood test with nurse at GPs cancelled and made with another nurse (3) in the annex where there were only children's seats left to sit on in the wating area. Next test in two weeks.

2nd June 2008
Six Month check up. Had ultrasound and blood pressure test prior to appointment at 2.10pm and another during, seen at 3 pm by the Consultant's Registrar, the second one I had seen. Told all looked fine, something the Radiologist had already told me. Raised the issue of medication, but was told it was not his job and the anticoagulant clinic should be consulted. Told him one was not available in our area. Why not an anticoagulant consultation at this appointment. Next appointment in twelve months.

12th June 2008
Blood test with nurse at GPs. Next test in one week. Told that a Roche Diagnostics laboratory testing kit will be used to do on the spot tests at the surgery starting in July when all staff are trained.

Elsewhere Roche Diagnostic testing kits are being used at home to save visits to the surgery, time and money. A Glenelex saliva based swab kit is also available, and undergoing trials is Pradaxa a new tablet which could replace Warfarin and do away with a regular blood tests and visits to the surgery.

19th June 2008
Blood test with nurse at GPs. Next test in two weeks.

7th July 2008
Blood test with nurse at GPs. Next test in two weeks.

21st July 2008
Blood test with nurse at GPs. Next test in two weeks. Primary Care Trust has still not approved the use of the Roche Diagnostics laboratory testing kit for Warfarin at the surgery causing inconvenience to patients.

4th August 2008
Blood test with nurse at GPs which I found had been changed to nurse (2) and a bruise ensued. Told the Roche Diagnostics laboratory testing kit would not be in use until October because the local Primary Care Trust had not yet approved it.

2nd September 2008
Blood test with nurse (1) at GPs. She failed to get sample from the over used vein on one arm and had to gain access from vein in the other arm. Told again the Roche Diagnostics laboratory testing kit would not be in use for some time as the local Primary Care Trust had not arranged for everyone to be trained to use it.

7th September 2008
Blood test at GPs with nurse (1) assisted by another person or nurse (4) with the computer program. The Roche Diagnostics laboratory testing kit was used. Told to continue with amount Warfarin specified less 1 milligram on Sunday. Come back next week.

10th September 2008

Six month dental check up. Scale and clean. No antibiotic to take prior to appointment because of directive by NICE not to give it.

14th September 2008
Blood test at GPs with nurse (1) assisted by another person or nurse (4) with the computer program. The Roche Diagnostics laboratory testing kit used.

21th September 2008
Blood test at GPs with nurse (1). The Roche Diagnostics laboratory testing kit announced the room was too cold so would not work and the test was taken with a syringe.

22nd September 2008
Fasting blood test and blood pressure reading at GPs with nurse (1) prior to Statin appointment.

29th September 2008
Blood test at GPs with nurse (1) assisted by another person or nurse (4) with the computer program. The Roche Diagnostics laboratory testing kit used.

Went to a new opticians (2) recommended by the hospital for an eye test and was told I did not require new spectacles.

30th September 2008
Blood test at GPs with nurse (1) assisted by another person or nurse (4) with the computer program. The Roche Diagnostics laboratory testing kit had arrived and a finger test was carried out. Now I have a sore marked finger. The results of the test were analysed with the aid of a computer program which showed an increased dose that should be given, almost double the original doses. When queried it transpired it was because I have a mechanical valve. Had I been given the wrong dosage since January? On consulting with the duty doctor it was decided to increase my dose by 1/2 milligram so as not to increase the dose too rapidly and test again in a week. No printed readout given, just verbal adjusted dosage read from notes on paper. Checked with doctor at the Cardiac General Hospital where the surgery was carried out who confirmed that the reading was normal and the dose should not be increased. Telephoned the duty doctor at the GPs who said to carry on with his prescription and check again at the next blood test. He also said that this was the first day of using the new testing equipment and software.

4th October 2008
Had influenza vaccination. Should have been alerted to reports of patients developing phenytoin, warfarin or theophylline toxicity following influenza vaccination and occuring up to 28 days post vaccination, but no warning was given.

4th November 2008
Heart clinic as follow up to fasting blood test and blood pressure reading at GPs with nurse (1). Nurse (5) took blood pressure and various particulars, most of which were known.

5th November 2008
Blood test at GPs with nurse (1) using the Roche Diagnostics laboratory testing kit. The reading was the same as before the influenza vaccination and the nurse using the Roche.

19th November 2008
Blood test at GPs with nurse (1) using the Roche Diagnostics laboratory testing kit. The reading within range so recall test in four weeks.

17th December 2008
Blood test at GPs with nurse (1) using the Roche Diagnostics laboratory testing kit. The reading outside their range so recall test in two weeks.

31st December 2008
Blood test at GPs with nurse (1) using the Roche Diagnostics laboratory testing kit. The reading outside their range so recall test in one weeks.

7th January 2009
Blood test at GPs with nurse (1) using the Roche Diagnostics laboratory testing kit. The reading outside their range so recall test in one week.

14th January 2009
Blood test at GPs with nurse (2) using the Roche Diagnostics laboratory testing kit. The reading outside their range so recall test in one week. Why is the Cardiac General Hospital reading guide lower than the GP Surgery guide reading? Who do you believe?

21st January 2009
Blood test at GPs with nurse (1) using the Roche Diagnostics laboratory testing kit. The reading inside their range so recall test in two weeks.

4th February 2009
Blood test at GPs with nurse (1) using the Roche Diagnostics laboratory testing kit. The reading inside their range so recall test in four weeks.

18th February 2009
Six month dental inspection. Come back for a make good filling in the upper left canine.

4th March 2009
Blood test at GPs with nurse (2) using the Roche Diagnostics laboratory testing kit. The reading outside their range so recall test in two weeks. Two sticking plasters on fingers as not enough blood found after the first attempt.

17th March 2009
A minimal filling undertaken to upper left canine. Come again in six months time.

18th March 2009
Blood test at GPs with nurse (1) using the Roche Diagnostics laboratory testing kit. Come in one week.

24th March 2009
Blood test at GPs with nurse (1) using the Roche Diagnostics laboratory testing kit. Come in two weeks.

8th April 2009
Blood test at GPs with nurse (1) using the Roche Diagnostics laboratory testing kit. Come in four weeks.

1st May 2009
Medicine check with GP (5). Took blood pressure. I then asked if medication can be over subscribed as I wake with aches and pains and feel it is the statin Lipitor that was causing it. After a lot of defence I was allowed to come off it for four weeks return to it for two weeks and return for an assessment.

6th May 2009
Blood test at GPs with nurse (1) using the Roche Diagnostics laboratory testing kit. Come in two weeks.

20th May 2009
Blood test at GPs with nurse (1) using the Roche Diagnostics laboratory testing kit. Come in four weeks.

1st June 2009
Twelve Month check up. Had chest xray and ECG test at 1.00pm prior to appointment at 2.00pm with the Consultant’s Registrar, the third one I had seen. Told all looked fine and he was signing me off, with care being passed to my GP. Raised the issue of medication, but was told his brief was for surgical care and was the responsibility of my GPs. Difficult to get objective medication advice.

12th June 2009
Medicine check review with GP (5). Said there was no appreciable difference when taking Statin or not. I suggested that it may be the interaction of the medication taken at 6 pm. It was suggested that I try only taking the Warfarin at this time and taking the other medication earlier in the day. It was also mentioned that the local Primary Care Trust would not pay for a lower dose tablet 10 mg of Lipitor - I had been on 20 mg since I started taking the dosage - Lipitor statin leaflet stated start on the lowest dosage.

17th June 2009
Blood test at GPs with nurse (1) using the Roche Diagnostics laboratory testing kit. Practice had received letter from Consultant’s Registrar stating that Warfarin range should be what they had prescribed and not what the GPs software indicated. By taking the medication before meals three times a day, making the Warfarin the third to be taken on its own, seems to have improved the quality of life and done away with side effects. Same dosage and come in six weeks.

27th July 2009
Put names on another Dental Practice waiting list after finding a "TO LET" sign on the premises of our old dental practice and a written notice on the door stating that the practice was shut and had moved to a new address on the 22 July, 2009. No notification had been received by us.

28th July 2009
Blood test at GPs with nurse (1) using the Roche Diagnostics laboratory testing kit. Reading 3.2 same so no alteration to dosage return in six weeks.

8th September 2009
Blood test at GPs with nurse (1) using the Roche Diagnostics laboratory testing kit. Reading in range 3.4 so no alteration to dosage, return in fifty six days.

23rd October 2009
Went to GPs for fasting blood test for Statin cholesterol prior to CHD (Cardiac Heart Disease) clinic assessment on the 2nd November, 2009 with nurse (6). When I got there today nurse (1) realised that I should have had my warferin blood test at six weeks, not fifty six days, and so did the test using the Roche Diagnostics laboratory testing kit today. Reading in range 3.4 so no alteration to dosage, return in six weeks.

2nd November 2009
Went to GPs for CHD (Cardiac Heart Disease) clinic assessment on the 2nd November, 2009 with nurse (6). All Ok, although reality is not 100%. Blood pressure high, so have it checked on the 16th November 2009.

11th November 2009
After finding the address to which the Dental Pactice had moved I made an appointment by telephone and attended at the appointed time, but was not seen for 45 minutes. Dental inspection took place and was told no work needed doing. Make an appointment for a dental inspection for six months.

14th November 2009
Letter from GP Surgery Prescription Review: National Institute for Health and Clinical Excellence (NICE) recently published new guidance for prescribing Medicines to lower cholesterol. The letter stated that "Following a discussion between the practice doctors, and the local Primary Care Trust, the practice had decided to make changes to the cholesterol lowering medicines prescribed for their patients." It continued "After a review of your notes we have decided to change the medicine that we prescribe for you." Your cholesterol medication has been increased from 10 mg Lipitor (Atorvastatin - a synthetic statin [28 tablets for £24.64 - available 10,20,40,80 mg]) to 40 mg Simvastatin - a semi synthetic statin based on lovastatin, a weaker medication (28 tablets for £3.57 - available 10,20,40,80 mg). An accompanying local Primary Care Trust leaflet gave the reasons as Simvastatin is now their first choice in order to lower their costs.

16th November 2009
Blood pressure test at GPs with nurse (1). Normal no further action.

20th November 2009
Letter from GPs Surgery informing me that the Swine Flue Vaccine will be administered on the 28th November. Telephone for an appointment.

2nd December 2009
Blood test at GPs with nurse (1) using the Roche Diagnostics laboratory testing kit. ·4 rise so recall in two weeks, continue same dosage.

16th December 2009
Blood test at GPs with nurse (1) using the Roche Diagnostics laboratory testing kit. INR reading up so recall in 6 Days, decrease Warfarin dosage.

22nd December 2009
Blood test at GPs with nurse (1) using the Roche Diagnostics laboratory testing kit. INR reading down so recall in 8 days, same Warfarin dosage.

30th December 2009
Blood test at GPs with nurse (1) using the Roche Diagnostics laboratory testing kit. INR reading down and within range so recall in 14 days, same Warfarin dosage. Warfarin delivery from Pharmacy 21 days after ordered - taken up with GP surgery - delivered within two hours.

13th January 2010
Blood test at GPs with nurse (1) using the Roche Diagnostics laboratory testing kit. INR reading down and within range so recall in 28 days, same Warfarin dosage.

5th January, 2010
I went to the opticians (1) for an eye test and a new optician did a thorough examination and recommended I see my doctor prior to an examination of my left eye at hospital. She also recommended a tinted lens to try to combat more frequent migraines. A dispensing option then put together a computation for a new pair of spectacles.

2nd February, 2010
I went to the opticians (1) to collect the spectacles. The spectacles presented were not as ordered so order cancelled.

5th February 2010
Letter from GP stating that a report had been received from the optician and would I make an appointment for a consultation.

10th February 2010
Blood test at GPs with nurse (1) using the Roche Diagnostics laboratory testing kit. INR reading down, and out of range so recall in 14 days, Warfarin dose increased to what it was when it was static.

16th February 2010
Went to GP (5) in response to his letter from optician and his to me. The letter from the optician had changed from what had been said to me to what had been retold in the letter. The GP went on to suggest that high blood pressure could lead to loss of vision. GP took blood pressure and said it was high and that I should check at home for two or three weeks and then book for a telephone consultation. First reading at home was normal.

23rd February 2010
Blood test at GPs with nurse (1) using the Roche Diagnostics laboratory testing kit. INR reading within normal range, recall in 28 days dose as normal.

23rd March 2010
Blood test at GPs with nurse (2) using the Roche Diagnostics laboratory testing kit. INR reading within normal range, recall in 42 days dose as normal.

4th May 2010
Blood test at GPs with nurse (1) using the Roche Diagnostics laboratory testing kit. INR reading out of range, recall in 14 days dose variable.

18th May 2010
Blood test at GPs with nurse (3) using the Roche Diagnostics INR laboratory testing kit. INR reading within normal range, recall in 28 days dose variable.

20th May 2010
Went to GP (2) with various problems starting with stomach pains and eyesight problems, but never got to a foot and ankle problems before i was ushered out having had the statutory 10 minutes. Booked a blood test for June 3rd and took two urinary test kits to administer at home.

24th May 20010
Took the two home urine test kits into GPs to be sent away for testing.

3th June 2010
Blood test at GPs with nurse (1) to be sent away for testing regarding visit to GP2 on the 20th May.

15th June 2010
Blood test at GPs with nurse (3) using the Roche Diagnostics laboratory testing kit. INR reading within normal range, recall in 42 days dose variable.

5th July 2010
Attended at the appointed time 11 am and was seated in the dental chair which was lowered to the horizontal position - the head rest gave no support to the head and was uncomfortable. Dental inspection took place and a scale and polish took place. I was told a crown could be made for a premolar, but no other work needed doing. Make an appointment for a dental inspection for six months. At 2 pm I was sitting in a chair when both arms tightened up and pain travelled down the arm from shoulder to the hands and fingers. After massage the pain lessened. The diagnosis was cervical spondylosis which can be caused by "head back syndrome". Two days later at 2 pm whilst sitting a reoccurrence of the symptoms happened in the left arm and after massage subsided.

27th July 2010
Blood test at GPs with nurse (1) using the Roche Diagnostics laboratory testing kit. INR reading within normal range, recall in 42 days dose variable.

19th August 2010
I went to the opticians (2) for an eye test and a new optician did a thorough examination and said that new spectacles would not improve my vision, but that my pressure readings were high, which may br a sign of Glaucoma and that a further test was required. An appointment was made to have it carried out at the opticians.

31st August 2010
I went to the opticians (2) again. After several tests I was informed that he would inform my GP asking him to make an appointment for me to see a hospital eye consultant for further tests.

6th September 2010
GP (5) telephoned regarding the letter received from the optician for referral to a hospital consultant due to deterioration to my left eye and possible Glaucoma. After conversation I was asked to collect details for making my own appointment with a hospital consultant from the GPs reception desk.

7th September 2010
Blood test at GPs with nurse (1) using the Roche Diagnostics laboratory testing kit. INR reading point one below normal range, recall in 21 days dose variable.

28th September 2010
Blood test at GPs with nurse (1) using the Roche Diagnostics laboratory testing kit. INR reading point three up normal range, recall in 28 days dose variable.

29th September 2010
Telephoned hospital and was given appointment in 64 days 1st December to see eye consultant for further tests.

26th October 2010
Blood test at GPs with nurse (1) using the Roche Diagnostics laboratory testing kit. INR reading point four down normal range, recall in 7 days dose two point five.

2nd November 2010
Blood test at GPs with nurse (1) using the Roche Diagnostics laboratory testing kit. INR reading a further point one down, recall in 7 days dose variable between two point five and three.

9th November 2010
Blood test at GPs with nurse (2) using the Roche Diagnostics laboratory testing kit. INR reading up point seven and back in normal range, recall in 14 days dose variable between two point five and three.

23rd November 2010
Blood test at GPs with nurse (1) using the Roche Diagnostics laboratory INR testing kit. INR reading up point five, but still just in normal range, recall in 28 days dose variable between two point five and three.

1st December 2010
Unable to get to the hospital and attend appointment on the 1st December, 2010 due to ice and snow and so telephoned the hospital to cancel. I was told a new appointment would be sent to see the Consultant for further eye tests. New appointment was sent for the 2nd February, 2011.

21st December 2010
Blood test at GPs with nurse (1) using the Roche Diagnostics laboratory INR testing kit. INR reading up point two, but still just in normal range, recall in 14 days dose two point five.

23rd December 2010
CHD (Cardiac Heart Disease) review appointment at GPs with nurse (6) for 17th January, 2011 written on the 30 November, 2010 and sent on the 23rd December, 2010

4th January 2011
Blood test at GPs with nurse (1) using the Roche Diagnostics laboratory INR testing kit. INR reading down point five, but still just in normal range, recall in 4 weeks dose two point five. CHD blood test for cholesterol with nurse (3).

5th January 2011
Attended to have a filling replaced in a lower left premolar, which would need a crown, so an appointmet was made for the 5h of April to have the work commenced.

17th January 2011
CHD (Cardiac Heart Disease) review appointment at GPs with nurse (6). No print out given after consultation. Influenza vaccination with nurse (3).

1st February 2011
Blood test at GPs with nurse (1) using the Roche Diagnostics laboratory INR testing kit. INR reading down a further point 2, and within normal range, recall in 6 weeks dose two point five.

2nd February 2011
Attended rearranged appointment from 1st December, 2010 with Senior Eye Consultant. Further tests told that both eyes had degeneration, the left worse than the right, both eyes had different problems. No mention was made of Glaucoma. New appointment requested by Consultant within a month for Retinal scan at District Hospital as no equipment was available at this Local Hospital. .

1st March 2011
Attended rearranged appointment from 2nd February, 2011 at District Hospital for retinal scan to my left eye which took 5 minutes after a 30 minute wait with drops in eyes.

15th March 2011
Blood test at GPs with nurse (1) using the Roche Diagnostics laboratory INR testing kit. INR reading down a further point 1, and within normal range, recall in 6 weeks dose two point five. Blood pressure taken that confirmed home reading that was requested by telephone.

5th April 2011
Attended to have a lower left premolar prepared and impressions taken for a crown to be fitted on the 12th of April.

12th April 2011
Attended to have a lower left premolar porcelaine crown fitted after a 30 minute wait.

14th April 2011
Attended arranged appointment with Eye Consultant. Eye tests and drops placed in both eyes and told that a letter of the consultation would be sent to my doctor and would I like a copy. Confirmed that I would. Further tests before confirmation of previous eye test, told that both eyes had degeneration in accordance with age and that nothing further could be done. Again no mention was made of Glaucoma. The consultant had LegoLand reservations dates displayed on his computer screen.

19th April 2011
Lost all sight at midday. Sight in right eye started to return leaving the left completely black for 15 minutes when it too started to return leaving it sore. Did not return to doctor or hospital for further consultation after what I had been told. Nobody had attempted to treated the cause.

26th April 2011
Blood test at GPs with nurse (1) using the Roche Diagnostics laboratory INR testing kit. INR reading up a further point 2, and within normal range, recall in 6 weeks dose two point five.

19th May 2011
Attended to have upper left canine filling replaced.

7th June 2011
Blood test at GPs with nurse (1) using the Roche Diagnostics laboratory INR testing kit. INR reading up a further point 3, and within normal range, recall in 6 weeks dose two point five. On waiting room wall. Doctors' Polite Notice: Only one set of symptoms per appointment.

19th July 2011
Blood test at GPs with nurse (1) using the Roche Diagnostics laboratory INR testing kit. INR reading down a further point 6, and within normal range, recall in 6 weeks dose two point five.

26th July 2011
Upper left 4 crown fell out. Telephoned for appointment and was asked to attend at 1.55 pm, which I did, and it was replaced.

15th August 2011
I went to the opticians (2) for an eye test and the optician did a thorough examination and said that new spectacles would not improve my vision. See him in 12 months time for a check up. New lenses would only by an extra expence.

30th August 2011
Blood test at GPs with nurse (1) using the Roche Diagnostics laboratory INR testing kit. INR reading down a further point 3, and below normal range, recall in 1 week dose remains two point five.

6th September 2011
Blood test at GPs with nurse (1) using the Roche Diagnostics laboratory INR testing kit. INR reading up a further point 4, and within normal range, recall in 4 weeks dose two point five.

23 September 2011
In response to a Postal request for a urine sample I returned it. Whilst there I asked if a doctor was available and was told doctor (6) could telephone me for a consultation that afternoon so an appointment was made. Vertigo was diagnosed and I was asked to attend for a blood test at the drop in clinic.

29th September 2011
Went to GP (6) in response to his telephone request to visit him for a blood test at the drop in clinic. His reading was slightly high, but my previous two reading at home were normal. General discussion about my general medical problems and my situation.

1st October 2011
Attended for recommended Influenza immunisation.

6th October 2011
Blood test at GPs with nurse (1) using the Roche Diagnostics laboratory INR testing kit. INR reading down point 4, and below normal range, recall in 2 weeks dose remains two point five.

11th October 2011
Verigo and voimiting. On call doctor called who arranged reception at District hospital and said do not waite for ambulance go sraight to District Hospital Local Hospital. .

18th October 2011
Blood test at GPs with nurse (3) using the Roche Diagnostics laboratory INR testing kit. INR reading up point 7, and within normal range, recall in 4 weeks dose remains two point five.

20th October 2011
Urgent message from my Pharmacist. My Warfarin dosage had been increased by the doctors surgery to a 5 mg tablet from .500 mg tablet without checking by the surgery with the GP. After discussion with the Pharmacist, the Pharmacist contacted the doctors surgery and a new procedure put in practice that will not allow any alteration to to the smg on the prescription without the GP's authority.

15th November 2011
Blood test at GPs with nurse (1) using the Roche Diagnostics laboratory INR testing kit. INR reading up point 1, and within normal range, recall in 6 weeks dose remains two point five.

13th December 2011
At 9.15 pm what appeared to be a TIA Mini-stroke occurred and cleared after briefly losing my sight. Fifteen minutes later a lower left 4 dental crown began bleeding at its outer gum margin with some pain. Applied a patent toothpaste to it and rinsed my mouth. It stopped, but a headache remained before going a sleep. .

14th December 2011
Home visit by GP (7) who confirmed my diagnosis of TIA Mini-stroke and gave me a check over. Said a hospital Stroke Clinic appointment would be arranged and that I should attend the next day for a blood and MRI test.

15th December 2011
Blood test at GPs with nurse (1) using the Roche Diagnostics laboratory INR testing kit. INR reading down point 4, and within normal range, recall in 6 weeks dose remains two point five.
Emergency dental appointment. After examination Amoxicillin capsules were prescribed prior to a root filling through existing crown on the 3rd January, 2012.

26th October 2011
I went to the opticians (3) for an eye test and examination. After a discussion he suggested that Computer/reading spectacles would help with those aspects of sight. New varifocal lenses could help with my spectacles and suggested fitting them to my existing frames.

21st December 2011
I went to the opticians (3) to collect spectacles. The computer/reading spectacles were fitted and I said I would try them. The varifocal lenses were fitted to my existing frames, but left me felling sick when I looked through the lower reading centre section and the top section seemed to impose one lenses on the other. The lenses were removed and my old varifocal refitted. See him in 12 months time for a check up.

22nd December 2011

Arrived at the District hospital General Medicine Clinic for my TIA Mini-stroke assessment with a Doctor. After weight and ECG chest scan I had interview with the doctor and told I was to have a MRI Neck Scan, Echocardiogram Heart Scan and a MRI Head Scan. Only the neck scan was undertaken and no date was given for the heart and head scan.

6th January 2012
Arrived at the District Hospital Radiology Department for a MRI Ultrasound Head Scan .

11th January, 2012
Local hospital Medical Diagnostic Unit for echocarddiam (heart scan) ultradound regarding the forthcoming local consultants appointment.

12th January 2012
Blood test at GPs with nurse (1) using the Roche Diagnostics laboratory INR testing kit. INR reading down point 1, and within normal range, recall in 6 weeks dose remains two point five.

6th February 2012
Attended to have a lower left premolar porcelaine crown redrilled and filled through centre. It broke up and emergancy repairs were done. An xray was attempted, but not completed. I said the inside was rough and only then was I told to make an appointment to check to see if the refilling was successfull and a new crown fitted. Work on upper left three to bring up to normal standard was then undertaken after a remimder from me that this was part of this appointments time.

23rd February 2012
Arrived at the District hospital General Medicine Clinic for my TIA Mini-stroke assessment back up inteerview with a Doctor. Had blood Pressure taken by nurse. Had the interview with the doctor and told I that the ECG chest scan, MRI Neck Scan, Echocardiogram Heart Scan and a MRI Head Scan tests were satisfactory.

6th March 2012
Blood test at GPs with nurse (1) using the Roche Diagnostics laboratory INR testing kit. INR reading up point 1, and within normal range, recall in 6 weeks dose remains two point five.

17th April 2012
Blood test at GPs with nurse (1) using the Roche Diagnostics laboratory INR testing kit. INR reading down point 1, and within normal range, recall in 6 weeks dose remains two point five.

29th May 2012
Blood test at GPs with nurse (1) using the Roche Diagnostics laboratory INR testing kit. INR reading down point 1, and within normal range, recall in 6 weeks dose remains two point five.

5th July 2012 GP Telephone consultation. Did not telephone.

6th July 2012
GP telephone consltation after surgery contacted. GP Prescribed Chloramphenicol Eye Ointment to teat irritation and eye watering.

10th July 2012
Blood test at GPs with nurse (1) using the Roche Diagnostics laboratory INR testing kit. INR reading up point 3, and within normal range, recall in 6 weeks dose remains two point five.

26th July 2012
GP Yearly check spoke of eye treatment, bumps on skin and occasional pains in the centre of chest which I thought was indigestion. He increased my blood pressure tablet dose from 1.5 to 5 to keep the pressure above 130. Make appointment for a blood test and make appointment to see him two weeks.

31st July 1012
Blood test at GPs with sister who also sorted out continuity of monthly prescription.

8th August 2012
GP appointment cancelled 30 minutes before appointment time. Reason given having to do home visits for another doctor. ? Sort out Prescription

13th August 2012
GPs to check out what had gone before. All satisfactory.

15th August 201
I went to the opticians (2) for a check up. Thorough examination and told long sight had improved, but reading could be improved with new spectacles.

17th August 2012
Attended for examination and advice prior to having damaged crown that had been left replaced and advice on crowned upper lateral inner gum margin fill. Tried to talk me out of having damaged crown replaced and just smooth off the laters damaged edge. Two exrays undertaken. Appointment in October.

21st August 2012
Blood test at GPs with nurse (1) changed to (2) on arrival using the Roche Diagnostics laboratory INR testing kit. INR reading up point 1, and within normal range, recall in 8 weeks dose remains two point five.



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