A medical practice in the Croydon area

4. Mr A complains the Practice failed to offer him a COVID-19 vaccination as a priority, despite his underlying health condition of severe asthma.

5. He says on 8 February 2021, a locum doctor incorrectly told him he was group 9 (all those over 50) on the vaccine priority list, and he would have to wait. Mr A feels he should have been in group 6 (adults in at risk group).

6. Mr A also complains the locum doctor hung up on him when he questioned their qualifications and complains the Practice did not record the call.

7. Lastly, Mr A complains the Practice sent him a complaint response that was not on letterheaded paper, in an ‘archaic layout’, and did not include doctors’ credentials.

8. Mr A explained he received a text from the NHS, on 13 March 2021, offering him the vaccine because of his ‘underlying health condition’. He says this is evidence the Practice’s stance on his eligibility was incorrect.

9. Mr A says he was caused stress and anxiety by the Practice’s stance and the way it treated him. He says its failure to record the call with the locum doctor means it will be hard for him to evidence his complaint against them.

10. Mr A would like the Practice to:

· change its attitude and provide training to staff

· record all future phone calls

· apologise to him for treating him like an inconvenience and putting the phone down on him

· provide a full explanation of why it categorised him as group 9, and why this then changed.

11. Mr A contacted the Practice on 8 February 2021, to explain he felt he should have the COVID-19 vaccine as a priority due to his asthma. Mr A says he spoke to a locum GP who told him ‘your asthma is not severe’.

12. Mr A says he then told the GP he had been hospitalised in the past because of his asthma and took daily medication. He says the GP continued to insist his asthma did not fit the criteria for priority group 6.

13. Mr A says he then questioned the doctor’s credentials and qualifications, as they were not listed on the Practice website. He says the GP hung up on him at this point. He says he asked the Practice for a recording of the call, but it informed him it did not record calls. He feels this is unfair, as he cannot now prove the GP hung up on him.

14. Mr A received a text from the NHS a month later. This text invited him to book a vaccination appointment ‘because of an underlying health condition’.

15. In responding to Mr A’s complaint, the Practice explained the GP placed him in the correct priority group. It explained it appreciated his desire to get the vaccine as soon as possible but could only offer it when it was available to his priority group.

16. The Practice explained Mr A became upset with the GP during the call. It explained the GP discussed the severity of Mr A’s asthma with him, but felt the issue was not going to be resolved and decided to end the call.

17. We asked the Practice for further information on why the GP did not consider Mr A’s asthma to fit the criteria. The Practice explained Mr A was not on regular oral steroids to control his asthma (as he takes inhaled steroids instead) and was last issued oral steroids in January 2019.

18. Mr A had the first dose of the COVID-19 vaccine on 16 March 2021. He has now had both doses.

Mr A’s complaint about vaccine priority groups

21. Before we decide if we should investigate a complaint, we look at whether there are signs the organisation, or its staff, have got something wrong. We do this by comparing what should have happened with what did happen. We have done this and have not found any indications something has gone wrong.

22. In January 2021, at the start of the COVID-19 vaccination programme, NHSE and NHSI issued detailed guidance for GP practices on how to manage and prioritise vaccines for their registered patients.

23. This guidance (section 4.1) explained GP practices were responsible for identifying patients who were eligible for vaccination, based on their inclusion in the priority groups determined by the JCVI.

24. JCVI guidance states any person between 16 and 64 years old ‘with underlying health conditions which put them at higher risk of serious disease and [death]’ were considered priority group 6. PHE issued further guidance explaining which conditions fit these criteria, including:

· chronic respiratory disease, including ‘asthma that requires continuous or repeated use of systemic steroids or with previous exacerbations requiring hospital admission’

25. PHE later updated this guidance (September 2021) to clarify that patients with asthma should only be considered priority group 6 if:

· they had more than two courses of oral corticosteroids (anti-inflammatory medicine, mimicking adrenal hormones) in the last 24 months OR

· they were taking maintenance oral corticosteroids OR

· they had more than one hospital admission in the last 24 months.

26. We are sorry to hear Mr A experienced stress and anxiety after learning the Practice would not place him in priority group 6.

27. We can see the Practice’s GP considered Mr A’s condition and decided he did not fit the criteria for severe asthma. PHE’s updated guidance provides clarification which indicates the GP correctly interpreted the original guidance.

28. During our phone call, Mr A explained he was last admitted to hospital with asthma around three years ago. As he did not have a more recent admission, or take regular oral steroids in the last two years, he did not appear to fit the criteria for priority group 6.

29. We have confirmed this with reference to Mr A’s medical records, which show he had an ‘acute exacerbation of [his] asthma’ in June 2016, which was the last time he attended hospital with the condition. The records also show he did not receive regular prescriptions (more than two courses) of oral steroids from the Practice, in the two years before his call to the GP.

30. Although Mr A received a text from the NHS inviting him to book a vaccine because of his ‘underlying health condition’, this is not an indication that the GP/Practice made a mistake or failed to act with NHSE/NHSI guidance.

31. On 15 February 2021, the Department of Health & Social Care and the NHS wrote jointly to GPs to advise that a new group of patients had been identified for vaccination prioritisation, based on a new risk assessment of clinical factors. These organisations explained GPs did not need to contact these patients and the NHS would invite them directly.

32. This appears to be what happened in Mr A’s case, as the NHS sent him a text inviting him to book a vaccination appointment. We do not know the clinical reasons the NHS contacted Mr A, but the available evidence indicates the GP interpreted the relevant guidance correctly regarding his asthma.

33. We have decided to take no further action on this part of the complaint.

Mr A’s complaint about the GP’s behaviour and the Practice not recording the call

34. Our ‘Principles of Good Administration’ state organisations should treat people ‘with respect and courtesy.’

35. GMC guidance states ‘calls from patients to healthcare organisations may be recorded for legitimate reasons, for example, for medico-legal purposes, staff training, and audit, provided [organisations] take all reasonable steps to inform callers that their call may be recorded.’

36. We are sorry to hear Mr A feels the Practice’s decision not to record calls has impacted on his complaint. There is no requirement in the guidance for organisations to record calls. As such, there is no indication it has done anything wrong by not recording his consultation with the GP.

37. We can see from both accounts that the GP decided to end the call with Mr A. However, there is no clear indication the GP did this with the intention of being rude to him.

38. We have reviewed the Practice’s record of Mr A’s phone appointment. This details: ‘patient became aggressive…and stated that he did not wish to take my opinion- he said I am not on the list of doctors on the practice website so did not think I am even qualified. I have asked him to make an appointment if he wishes with a GP of his choice’.

39. We recognise Mr A might not feel his behaviour was aggressive. However, the GP’s record indicates they interpreted it as such.

40. Mr A has acknowledged he questioned the GP’s qualifications and experience, and that he disagreed with the GP’s judgement on his eligibility.

41. As such, we consider it was reasonable for the GP to decide there was no merit in continuing the call, and to advise him to book an appointment with another GP.

42. As there are no indications the GP did anything wrong, we have decided to take no further action on this part of the complaint.

Mr A’s complaint about the Practice’s complaint response

43. Our ‘Principles of good complaint handling’ state organisations should ensure complainants can easily access their complaints service and signpost them to the next stage of the complaints procedure.

44. We have reviewed the Practice’s complaint response and do not consider that the layout will have impacted on Mr A’s ability to understand the Practice’s position, or on his ability to escalate his complaint.

45. The response clearly sets out the Practice’s view on the locum GP’s actions and provides our contact details for Mr A, if he wished to take the complaint further.

46. We do not consider the layout to be archaic and consider it was not necessary to include its doctors’ credentials, since this had no bearing on the substantive complaint. There is no requirement for a specific layout in complaint responses and we consider the Practice’s response meets the expectations of our principles.

47. We have therefore decided to take no further action.

1. We have carefully considered Mr A’s complaint about a medical practice (the Practice) in the Croydon area.

2. We are sorry to hear that Mr A experienced stress and anxiety when a Practice locum GP told him he should not be in a higher COVID-19 vaccination priority group. We are sorry to hear Mr A was caused further distress by the way the GP ended their phone call, and then the way the Practice handled his complaint.

3. We have seen no clear indications the Practice placed Mr A in the wrong priority group. We have also seen no indications the GP did anything wrong in ending their call, and consider the Practice’s complaint response was clear.