The Practice dealt with Mrs E’s letters as complaints
11. Before we decide if we should investigate a complaint, we look at whether there are signs the organisation has got something wrong. We do this by comparing what should have happened with what did happen. We have done this and, we have not found any indications that something has gone wrong with how it handled Mrs E’s letters.
12. Mrs E told us the Practice had falsely accused her of writing complaints and it did not give her copies of these ‘complaints’ when she asked it to. She asked the Practice to give her copies of these complaint letters.
13. In its final response dated July 2021, the Practice did not give Mrs E copies of the complaint letters but clarified which letters it was referring to. It went through the chronology of each letter and contact it treated as a complaint and gave dates to further explain this. It explained ‘For clarity, the practice treats any dissatisfaction with our service as a complaint, and refer to and investigate them as such. I apologise if this terminology caused any confusion or was not made clear’.
14. We have copies of Mrs E’s letters on file. Mrs E wrote in one letter she did not intend on that letter being a complaint. She asks in her letters for a ‘full report’ on what the Practice has investigated her for. In one letter she says her, and her family have concerns about her health. Her letters are largely a chronology of events and comments. In one she wrote ‘I am informing you as a patient what comments I have received from my GPS [sic] appointments this year I feel sorry that they feel that way towards me’. In another she wrote ‘I explained the severe stinging pain in my head and my neck felt swollen, I was told it was all in my head […]’.
15. We can see from the correspondence we have the Practice was initially unsure what to do in response to her letters. In its final response it acknowledged her letters were more informative requests for information rather than complaints but as she raised concerns about a GP’s comments, this is why it gave her a complaint response.
16. The current NHS England Complaints Policy defines a complaint as ‘[…] an expression of dissatisfaction about an act, omission or decision, either verbal or written, and whether justified or not which requires a response.’ We can see the Practice used a similar definition as part of its own complaint handling.
17. Mrs E’s letters were not typical complaint letters, but they do include a few expressions of dissatisfaction and she wanted a response from the Practice. The Practice saw some expressions of dissatisfaction and decided to treat her letters as a complaint, investigate her comments and give her a response. This is in line with NHS England’s Complaint policy, the Practice’s own definition and our ‘Principles of Good Administration’. Our principles say organisations should respond to customers’ needs flexibly. The Practice was flexible in how it applied its complaint policy to make sure Mrs E got a response.
18. We can see the Practice did not give her copies of these complaint letters when she asked for them. We appreciate the Practice could have given her copies as this was a straightforward request. Instead, the Practice explained which letters it was referring to. We know Mrs E has copies of these letters as she sent them to us. We therefore feel the explanation the Practice provided responded to her needs, in line with our ‘Principles of Good Administration’.
19. For the reasons above, we have seen no indication anything went wrong with how the Practice handled Mrs E’s letters.
20. For the avoidance of doubt, our decision here is about how the Practice classed her letters as complaint letters. We have considered how the Practice removed her and her husband from its list due to ongoing complaints as a separate issue, with a separate impact on them both (see below).
Removal from the Practice list
21. Mrs E said the Practice did not follow the BMA guidelines it quoted when it removed her and her husband from its list. She said the Practice removed her after her son complained to the Practice and it did not give her or her husband a warning before this or invite them in to discuss any concerns.
22. The Practice’s notification of removal letter dated July 2020 said it removed her and her husband due to ‘ongoing complaints’ and because it felt the complaint from her son was a ‘personal attack’ on members of the Practice and showed a breakdown of the doctor/patient relationship.
23. The BMA guidance 'Removing patients from your practice list' says a Practice should give a written warning of removal to a patient before removing the patient unless it is not reasonable to do so. It states complaints which are a personal attack on members of the Practice or those which contain clearly unfounded allegations can show a breakdown in the doctor/patient relationship. It says it is the breakdown of the relationship which should form the basis of any decision to remove a patient from the list. The guidance also says ‘if the behaviour of one patient has led to their removal, this does not mean the removal of other family or household members should automatically follow. The practice should consider how it looks to observers if a family were to be removed from the list without explanation for a single disagreement with one family member.’
24. The Practice did not give a warning to Mr or Mrs E before removing them. According to the Practice’s response it removed them because of a third party complaint (their son’s), which it felt amounted to a breakdown in relationship. It is also unclear why the Practice felt it was appropriate to remove Mr E from the list as he had no contact with the Practice at all. He is also an elderly and vulnerable individual with many health conditions and the Practice has not explained in its response why it felt this removal was appropriate.
25. We asked the Practice to reflect on the BMA guidance, and it acknowledged it made mistakes. This is all evidence the Practice did not follow the BMA guidance above and because of this there are clear indications something went seriously wrong.
26. The GMC guidance 'Ending your professional relationship with a patient' also says in paragraph 4 doctors should not end a professional relationship with a patient due to complaints. Paragraph 5 gives a list of actions the Practice should take before ending a relationship which includes a warning, doing what it can to restore the relationship and exploring alternatives. It also says the reason for ending the relationship should be fair.
27. The Practice said it removed Mr and Mrs E due to complaints, and after receiving a complaint from Mrs E’s son. We have seen no evidence the Practice took any of the steps in the GMC’s guidance before removing Mr and Mrs E. It acknowledged in its response it should have explored alternatives other than removal and it said it will make sure it follows the BMA guidance in future. This is additional evidence there are indications something went seriously wrong here.
28. We considered the impact this had on Mr and Mrs E. Mrs E as her husband’s carer was very stressed by the Practice’s removal as she had to find a new GP for herself and her husband within the eight day notice period. She also had to make sure her husband had enough medication. She said they did not have a GP Practice for one month and her husband became ill during that time.
29. In its response the Practice apologised for the distress Mrs E suffered. It also acknowledged it made mistakes and explained it would follow BMA guidelines in future. It said it was not in a financial position to offer compensation for the distress.
30. Mrs E felt the Practice had not put things right as it did not offer her compensation for the distress it caused her and her husband. She also wanted an explicit apology from the Practice that it did not follow the BMA guidelines.
31. We can agree a resolution with an organisation if we can achieve a satisfactory result for the complainant with minimal intervention. We concluded a detailed investigation would not be necessary if the Practice agreed to a resolution at this stage. We also considered we would likely reach the same outcome at the end of an investigation, but this would be a longer process.
32. We reviewed ‘Our guidance on financial remedy’ which suggests appropriate amounts of compensation according to impact. Based on this, we do not think an apology alone is enough to put right the impact the Practice’s actions caused. We considered the impacts Mr and Mrs E suffered individually to calculate an appropriate compensation amount. There is evidence Mrs E suffered considerably more distress from the removal as the carer of Mr E and so we have suggested a higher amount for Mrs E (£400). We have suggested a lower amount for Mr E (£150) as the impact on him was not as great.
33. We wrote to the Practice on 7 October 2021 and explained we had seen indications it had not followed the BMA and GMC guidelines explained above. We proposed the following:
· a written acknowledgement to Mr and Mrs E for the mistakes it made and a written apology for the impact the removal had on them
· £550 to remedy both Mr and Mrs E for the distress and inconvenience they suffered as a result of the removal.
34. On 14 October 2021 the Practice agreed to resolve this complaint by taking the actions above. We discussed the apologies the Practice had already given and what Mrs E felt it needed to apologise for more explicitly. It agreed to send Mrs E its apology letter on 21 October 2021 and gave us details as to how Mrs E can arrange the compensation payment.
35. This resolution is in line with our ‘putting things right’ principle of our ‘Principles of Good Complaint Handling’ as it gives Mr and Mrs E an appropriate and proportionate remedy.
36. For the reasons above, we will not be investigating Mrs E’s complaint further. We are sorry to hear of the distress the Practice’s actions caused Mr and Mrs E, and we hope this resolution gives Mrs E closure on her complaint.