Low Moor Medical Practice

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First report 12 Oct 2023•Latest report 12 Oct 2023

Reports, concerns and published responses

Reports over time

Reports naming this recipient by issue year.

* 2026 is projected from reports observed to 7 Sep 2026.

Reports
1

Naming this recipient

Published responses
100%

Found for named reports

Concerns addressed
1

Across all linked responses

Stated actions
9

Described in responses

Concerns and recipient responses

Statements from Low Moor Medical Practice linked to the concerns in each report. Select any concern, action or position to view the source wording.

  1. West Yorkshire (Western)

    AI-generated summary

    John HOARE · Prevention of Future Deaths report

    This summary was generated using AI from the published report. Please read the original report for the complete account.

    Report summary

    John Hoare died at Airedale General Hospital on 31 March 2020 after contracting Covid-19 while detained under the Mental Health Act 1983. The principal concern was a gross failure in lithium prescribing and dispensing after his discharge to a care home, which contributed to deterioration in his mental health and his subsequent detention. The report states that the detention was preventable, although it could not be concluded on the balance of probabilities that it caused his death.

    Read the report on judiciary.uk

    Source evidence

    How this individual concern was interpreted

    PFD Monitor created a concise, searchable interpretation from the report wording shown below. The report was sent to Low Moor Medical Practice; that does not assign responsibility.

    PFD Monitor interpretation

    Failure to provide basic medical attention in relation to lithium prescribing and dispensing

    Wider context from the report

    “But the fact remains, secondly, that there had been a gross failure to provide basic medical attention in relation to lithium prescribing and dispensing that resulted in John being sectioned. ”
    Open source report

    Source evidence

    How this respondent action was interpreted

    PFD Monitor created a concise, searchable interpretation from the published response wording shown below.

    PFD Monitor interpretation

    Ensure clinical pharmacists identify medications, including shared-care medicines, that must be issued without interruption.

    Verbatim wording from the response

    “Medications to always issue.”

    Source location

    Response from Low Moor Medical Practice
    Page 2 · response
    Published 2 November 2023

    Open published response

    Source evidence

    How this respondent action was interpreted

    PFD Monitor created a concise, searchable interpretation from the published response wording shown below.

    PFD Monitor interpretation

    Discuss with the local pathology laboratory receiving lithium results as individual results rather than within broader biochemistry lists.

    Verbatim wording from the response

    “Lithium results.”

    Source location

    Response from Low Moor Medical Practice
    Page 2 · response
    Published 2 November 2023

    Open published response

    Source evidence

    How this respondent action was interpreted

    PFD Monitor created a concise, searchable interpretation from the published response wording shown below.

    PFD Monitor interpretation

    Register Norman Lodge patients as temporary residents so their home practices remain involved in care.

    Verbatim wording from the response

    “Norman lodge - Change to Temporary Registration.”

    Source location

    Response from Low Moor Medical Practice
    Page 2 · response
    Published 2 November 2023

    Open published response

    Source evidence

    How this respondent position was interpreted

    PFD Monitor created a concise, searchable interpretation from the published response wording shown below.

    PFD Monitor interpretation

    Shared-care drugs and intermediate-care units fall outside core general practice and are covered by Local Enhanced Services.

    Verbatim wording from the response

    “This issue took place involving a “Shared care Drug” prescribed to a patient in an “Intermediate care Unit”. Both Shared Care Drugs and Intermediate Care units our outside Core General Practice and are covered by Local Enhance Services. The Shared care medication LES covers care in General Practice of patients while they are stable on medication. This patient had been discharged from hospital after admission with Lithium toxicity – by definition – not stable.”

    Source location

    Response from Low Moor Medical Practice
    Page 1 · response
    Published 2 November 2023

    Open published response
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Information checked against published PFD reports and official responses · Data reviewed 7 Sep 2026 · About data quality and limitations

Data last updated 7 September 2026