Recipient

Northfield Medical Centre

First report 15 Dec 2016•Latest report 15 Dec 2016

Recipient record

Reports, concerns and published responses

Health and care · Healthcare site. This page brings together reports naming this recipient and response statements clearly connected to concerns raised in those reports.

Reports: 1
Published responses: 100%
Concerns addressed: 2
Stated actions: 5

Reports over time

Reports naming this recipient by issue year.

Evidence profile

Report topics

Share of this recipient’s reports compared with all other recipients.

100%published responses found

5stated actions described

Topic comparisons are not available in the current evidence snapshot.

Concerns and recipient responses

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

15 Dec2016
Leicester City and South Leicestershire
Concerns raised3
1. Failure to involve next of kin in significant decisions for a patient with declining cognitive function
2. Failure to record the rationale and patient consent for a change of GP
3. Failure to record consideration and outcome of the patient's capacity
Responses linked to these concerns
Each statement is shown once, even when linked to more than one concern.
Actions described in response 3
1. Action
  Create a written, party-approved policy for future locality projects defining GP registration changes and responsibility for informing next of kin.
  Stated planned
2. Action
  Require care homes to confirm patients’ awareness, consent and appropriate next-of-kin notification when capable residents change GP practice.
  Stated planned
3. Action
  Require care homes to confirm next-of-kin notification and consent when residents lacking capacity change GP practice, with capacity concerns escalated.
  Stated planned
Respondent positions 2
1. Position
  Care homes are responsible for confirming patient awareness, consent and, where appropriate, next-of-kin notification when facilitating GP practice changes.
  Redirects responsibility
1. Position
  The GP practice cannot directly inform next of kin because of patient confidentiality and practical difficulties identifying relevant family members.
  Unable to act
AI-generated summary

Francis James Lea · 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

Francis James Lea, who was living in a care home, was transferred to a new GP without his family being informed. After a hospital admission for a seizure, his prescribed anti-epileptic medication was not continued because the new GP was unaware of the admission and prescription. The report raised concerns about involving next of kin, recording the rationale and consent or capacity assessment for changing GP, and ensuring a safe transfer of care between the care home and GP surgeries.

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 Northfield Medical Centre; that does not assign responsibility.
PFD Monitor interpretation
Failure to involve next of kin in significant decisions for a patient with declining cognitive function
Wider context from the report
“(1) For a patient in a care situation, with declining cognitive function (as set out in his home care plan) it would seem appropriate to consider involving the next of kin in any significant decision such as change of GP. This would have enabled the family (who always ensured they accompanied Mr Lea for any medical care) to pass on the updated information, and this outcome would have been avoided. ”
Open source report
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 Northfield Medical Centre; that does not assign responsibility.
PFD Monitor interpretation
Failure to record the rationale and patient consent for a change of GP
Wider context from the report
“(2) There appeared to be no notes on the patient's medical record regarding the rationale for this change, or any consent from the patient that he was in agreement that it should take place. There was also no record of whether any consideration of his capacity had been undertaken, and if so what the outcome of that decision was. ”
Open source report
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 Northfield Medical Centre; that does not assign responsibility.
PFD Monitor interpretation
Failure to record consideration and outcome of the patient's capacity
Wider context from the report
“(2) There appeared to be no notes on the patient's medical record regarding the rationale for this change, or any consent from the patient that he was in agreement that it should take place. There was also no record of whether any consideration of his capacity had been undertaken, and if so what the outcome of that decision was. ”
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
Create a written, party-approved policy for future locality projects defining GP registration changes and responsibility for informing next of kin.

Verbatim wording from the response
“With regard to a safe and effective transfer of care, it has been agreed that to avoid any similar accidents, for any future locality projects there will be a written policy which needs to have been signed off by all parties as to the clear process of facilitating any change of GP registration and who will be informing the next of kin where appropriate.”

Source location
2016-0447-Response-by-Northfield-Medical-Centre
Page 2 · response
Published 12 February 2017
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
Require care homes to confirm patients’ awareness, consent and appropriate next-of-kin notification when capable residents change GP practice.

Verbatim wording from the response
“In order to avoid such a situation arising again, we will as a practice be liaising with the care homes to request that:”

Source location
2016-0447-Response-by-Northfield-Medical-Centre
Page 2 · response
Published 12 February 2017
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
Require care homes to confirm next-of-kin notification and consent when residents lacking capacity change GP practice, with capacity concerns escalated.

Verbatim wording from the response
“In order to avoid such a situation arising again, we will as a practice be liaising with the care homes to request that:”

Source location
2016-0447-Response-by-Northfield-Medical-Centre
Page 2 · response
Published 12 February 2017
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
Care homes are responsible for confirming patient awareness, consent and, where appropriate, next-of-kin notification when facilitating GP practice changes.

Verbatim wording from the response
“• Where a patient, with capacity, who is resident in a care home, changes GP practice and this change is facilitated by the care home, arrangements are put in place for the care home to provide written confirmation that the patient is aware of the change, the patient gives consent to the change and that where appropriate the patient’s next of kin have been informed.”

Source location
2016-0447-Response-by-Northfield-Medical-Centre
Page 2 · response
Published 12 February 2017
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
The GP practice cannot directly inform next of kin because of patient confidentiality and practical difficulties identifying relevant family members.

Verbatim wording from the response
“Mr Lea agreed to change GP practice and there was no suggestion that he did not have the capacity to make the decision to change GP. In such circumstances, the GP practice is not in a position to inform the next of kin due to the duty of confidentiality owed to the patient and practical difficulties of identifying relevant members of the family or next of kin.”

Source location
2016-0447-Response-by-Northfield-Medical-Centre
Page 1 · response
Published 12 February 2017
Open published response

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

Reports, concerns and published responses

Reports over time

Concerns raised3

Failure to involve next of kin in significant decisions for a patient with declining cognitive function

Failure to record the rationale and patient consent for a change of GP

Failure to record consideration and outcome of the patient's capacity

Actions described in response An action is something this recipient says it has done, is doing, or plans to do in response to the concern raised.3

Respondent positions A position is what this recipient says about the concern when it does not describe a specific action.2

Actions described in response 3

Respondent positions 2