The Borchardt Medical CentreIncludes reports addressed to a minister or senior office-holder acting for this organisation.

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First report 4 Jan 2016•Latest report 4 Jan 2016

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
0%

Found for named reports

Concerns addressed
0

Across all linked responses

Stated actions
0

Described in responses

Concerns and recipient responses

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

  1. Addressed to: The Senior Partner, The Borchardt Medical Centre.

    Plymouth, Torbay and South Devon

    AI-generated summary

    Thomas Alexander Burchell · 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

    Thomas Alexander Burchell had a brain tumour and developed progressive seizures after transfer for neurosurgical treatment; the post-mortem medical cause of death was brain swelling and infarction associated with glioblastoma. Concerns included incomplete records of the seizures and inadequate documentation and assessment of earlier headaches and weakness, including delays in processing prior medical records and uncertainty about referral guidance.

    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 The Borchardt Medical Centre; that does not assign responsibility.

    PFD Monitor interpretation

    Failure to document headache assessment and clinical reasoning

    Wider context from the report

    “(1) There is nothing in the records to explain how ████████ came to the view that Thomas was suffering from stress related headaches. Further, there is nothing in the notes to confirm whether or not he asked Thomas any questions at all about his headaches. In his evidence, ████████ had to accept that it was possible he did not do so. ”
    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 The Borchardt Medical Centre; that does not assign responsibility.

    PFD Monitor interpretation

    Inadequate and incomplete recording of clinical events

    Wider context from the report

    “(1) Inadequate and incomplete record keeping. This is in respect of both medical and nursing records. In particular, the seizure chart stated late and finished early. It is far from an accurate or complete record of what happened to Thomas. (2) In a neurosurgical unit I understand there will be patients having seizures on a regular basis. I further understand that it is extremely rare for those seizures to progress as befell Thomas and then prove resistant to treatment. Where a patient does develop seizures, however, I consider that there should be a far more robust and complete record of the relevant events. ”
    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 The Borchardt Medical Centre; that does not assign responsibility.

    PFD Monitor interpretation

    Failure to apply updated Neurology referral criteria for reported weakness

    Wider context from the report

    “(3) In his preparation for a subsequent significant events meeting, ████████ identified that the basis for referring a patient to Neurology had changed. He had previously been under the impression that he needed not only to have a complaint of weakness but also objectively to identify and confirm this weakness. He accepted that the guidance had changed so that a complaint of weakness alone was sufficient to warrant referral. ”
    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 The Borchardt Medical Centre; that does not assign responsibility.

    PFD Monitor interpretation

    Delays in processing incoming clinical consultation records

    Wider context from the report

    “(2) ████████ also accepted in evidence that had he seen the notes and records from the Exeter consultation (which red flagged the headache entry) he would have treated Thomas differently and perhaps taken his concerns more seriously.. It was not completely clear when the records from the Exeter consultation arrived at the Borchardt practice. It was, however, before Thomas’ appointment with ████████ and there may have been several days (perhaps as much as a week) between the arrival of the notes and their “processing” by administrative staff. Such a delay is undesirable. ”
    Open source report
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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