Appointment cancellation
18. Mr H complains the Practice cancelled his appointment on 28 February, saying his wife/a female called and cancelled it for him. Mr H says he does not have a wife and has not agreed to anyone acting on his behalf.
19. The Practice response says the appointment did not appear to have been cancelled in error, from looking at the appointment history, and subsequent appointments in the Practice, as far as it was able to tell.
20. We have reviewed Mr H’s GP records and there is nothing about this appointment or the cancellation within them. We can see there is no record of a family contact/next of kin appointed by Mr H within the records we hold. We have also reviewed the document the Practice sent Mr H, which shows the details of the appointment cancellation from a log. This log is very brief, noting an appointment cancelled and another booked. This appointment booking has a black box, presumably covering another patient’s name/something confidential.
21. We asked for any guidelines or policies the Practice has for security checks on the telephone and for appointment cancellations, but it has not provided any. The Practice has only provided its data protection policy. This states it will not disclose information to family, friends, or spouses unless it has prior written consent, and it will not leave messages with others. This does not cover this scenario. There is no evidence the Practice disclosed any of Mr H’s personal information to the individual who called.
22. From our review of the evidence, we think, on the balance of probabilities, the Practice made a mistake when cancelling Mr H’s appointment. We cannot say exactly how due to the limited evidence available. But we think there are two possibilities.
23. The first is that someone called to cancel Mr H’s appointment without his consent and without the Practice carrying out any checks when the call had not come from Mr H himself. The NHS website guidelines: Can I speak to a GP about someone else's health? says if you have consent, you can speak about a friend or relative’s health with their GP. Mr H says he has not given anyone consent to act on his behalf, and the records support this.
24. The second possibility is that another patient called to cancel their own appointment, or on behalf of their relative, and the Practice mistakenly cancelled Mr H’s appointment instead. We asked the Practice if there were any DNA (did not attend) appointments on 28 February 2020. The Practice did not respond to this.
25. Our ‘Principles of Good Administration’ say: ‘public bodies should be open and truthful when accounting for their decisions and actions. They should state their criteria for decision making and give reasons for their decisions’. Our principles also say ‘public bodies should take responsibility for the actions of their staff’.
26. In line with our principles, we have found evidence of a failing by the Practice. It firmly said it did not make an error in cancelling Mr H’s appointment, when there clearly was an error as it cancelled it without his knowledge. We know he did not call to cancel the appointment as the Practice has said it was a female caller. The Practice response says the appointment history and subsequent appointments meant it could tell the appointment was not cancelled in error. But it did not explain why this was in its complaint response, or to us in our investigation.
27. The Practice should have recognised its mistake at the time, and again when it responded to Mr H’s complaint. Our principles say, ‘when mistakes happen, public bodies should acknowledge them, apologise, explain what went wrong and put things right quickly and effectively’. We cannot see that the Practice did this and we have therefore identified a failing. We have considered the impact of this below.
28. We can see the cancellation and the Practice’s lack of acknowledgement of this error caused Mr H frustration, as he had to make another appointment. We appreciate this was inconvenient for him. We also understand this led to a difficult interaction with staff, which we think the Practice could have avoided. Mr H says that interaction caused him distress, to start shaking, and to have a panic attack at the time.
29. We also think if the Practice had realised on the day that it had made a mistake, in line with our Principles for Remedy, it could have treated rebooking Mr H’s appointment as a priority. It might not have been able to offer him anything sooner, but this was a missed opportunity for the Practice to have done better. We set out our recommendations at the end of this report.
No offer of private room to talk
30. Mr H complains the Practice did not offer him a room to talk in private on two occasions on 28 February.
31. When Mr H found out his appointment had been cancelled, he says he asked for privacy to discuss the matter, but the GP took him into a corridor. He sent us a photo of a poster from the Practice waiting area that says it has a quiet room if someone needs to speak to staff in confidence. He says it did not offer this.
32. The evidence we have seen from Mr H, the Practice response, and the staff statements, show us the conversation between a doctor and Mr H took place in the corridor. However, it is not clear why.
33. Mr H says he asked for privacy. If this was the case, in line with its poster, the Practice should have offered a quiet room. But the Practice response and statements indicate Mr H went into the corridor himself and threatened to go into the GPs rooms. There is not enough evidence to say which account is, on balance, correct.
34. Mr H says this happened a second time, on the same day, when he went back to the reception desk to make another appointment. He says he did not want to give the reason for the appointment as patients were near and the receptionist did not offer him a private room. He says they were dismissive towards him about this, commenting that he did not mind saying other things in public.
35. If this was the case, in line with its poster, the Practice should have offered Mr H a quiet room. We can see Mr H mentions this in his complaint to the Practice on 2 March 2020, but there is no specific reply to this allegation in its response or statements. The Practice response says Mr H was argumentative with the receptionist, who was upset with his behaviour, so the GP spoke to him again and advised him how to make a complaint. There is not enough evidence to say which account is, on balance, correct and what was said between Mr H and the receptionist during that conversation.
36. We are sorry to hear Mr H feels the Practice treated him unfairly. We have considered whether there is any further evidence for us to consider in relation to both incidents on 28 February, but there is not. There is not enough for us to say the Practice did anything wrong. We therefore cannot say there are any failings in relation to this part of Mr H’s complaint.
False claims about his behaviour
37. Mr H complains the Practice falsely said he was intimidating, abusive, and violent towards staff. He says Practice staff have colluded to come up with a narrative that he is violent and abusive to remove him from the Practice.
38. The Practice’s zero tolerance policy states ‘[the Practice] believes that any act of aggression, violence or intimidation, both physical and non-physical from any member of staff, patient, visitor or member of the public is unacceptable’.
39. Mr H says during the incident, staff claimed he abused them. Mr H says the staff said if he called the police, they would show evidence of this in his notes. Staff told him to wait for the GP, so he says he walked around the waiting area and staff thought this was aggressive. He says they felt him talking loudly was abusive.
40. Mr H denies ever abusing the staff and says the Practice has never mentioned this before. He says he is the one being abused by staff and he had a panic attack due to how they treated him. He questions why, if staff thought he was violent or abusive, they did not ask him to calm down or warn him the police would be called, in line with its policy. He says he asked staff to call the police but they would not. He says he was only asked to leave because he did not have an appointment. He feels the Practice has deliberately distorted the facts.
41. The Practice staff said Mr H was shouting and asking for the police to be called as someone had access to his personal details. They felt they did not need to involve the police. They said Mr H was getting very upset and was asked to calm down and take a seat while they tried to resolve the problem. They felt he did not respond to their attempts to de-escalate the situation and became increasingly aggressive towards them. They advised he would be asked to leave if he continued. The reception staff said they needed support and involved two other GPs who also felt Mr H was acting in an intimidating manner, which they thought was reflected by his body language.
42. We acknowledge Mr H feels the Practice treated him dishonestly and unfairly in its allegations about his behaviour. We have considered both accounts and there is a difference in perception. It is clear Mr H did not perceive his behaviour to be inappropriate and it is clear the staff at the Practice did. There is not enough evidence for us to say which account is, on balance, correct. Therefore, we cannot say the Practice did anything wrong in perceiving Mr H’s behaviour to be inappropriate. There is no way for us to know whether staff made false accusations about Mr H’s behaviour or not. We therefore cannot say there are any failings in this part of Mr H’s complaint.
Difficulty getting an appointment
43. Mr H complains that after the Practice cancelled his original appointment, he could not get another until 6 March 2020. He thinks that other patients were offered earlier appointments, even when he asked for the next available appointment.
44. We asked the Practice for its guidelines/policies on booking appointments and its prioritisation of appointments, to see if there are any timescales documented for seeing a patient. It does not have any guidelines that specifically relate to this.
45. The Practice says in its response that it could not give Mr H the same appointment as it had been reallocated to another patient. It says to resolve the problem he was offered to rebook the appointment as there were no available appointments left that day. It says Mr H declined this. It says Mr H was eventually persuaded to return to the reception desk to make another appointment and a staff member booked him the next available appointment for 6 March 2020.
46. As we said earlier, things might have been different if the Practice had realised it had made a mistake in cancelling Mr H’s appointment at the time. But we have not seen any evidence to suggest other patients were given earlier appointments, this is Mr H’s opinion. There is no evidence to suggest the Practice did not offer him the next available appointment. We understand this was frustrating for him and we are sorry to hear he felt dismissed. We have not identified any failings in this part of Mr H’s complaint.
Removal from the Practice list
47. Mr H complains the Practice removed him without warning from its list because he complained about the incident on 28 February 2020.
48. We have looked at the relevant guidelines, including the Practice’s, on patient removals.
49. The British Medical Association (BMA) ‘Removing patients from your practice list’ guidelines say a Practice can remove a patient from its list immediately on the grounds of violence or threatened violence, only where there is police involvement. Otherwise, a Practice must carefully consider the matter and give the person a warning, preferably in writing. This is to give them the chance to amend their behaviour and avoid being removed from the Practice list.
50. The guidelines also say a Practice should not remove a patient from its list because they have made a complaint. An exception to this is where the complaint contains a personal attack on members of the Practice or unfounded allegations showing a serious breakdown in patient and doctor relationship.
51. The Practice’s own policy on removing a patient mirrors the BMA guidelines. It also says records should include all instances of unacceptable behaviour by patients and any actions taken to try to remedy the situation.
52. The Practice records include a warning letter, dated 28 February 2020. Mr H says the Practice never warned him verbally or in writing about possible removal and he only saw this letter after requesting his records. He says he only got a removal letter, dated 6 March 2020. The letter from 28 February says ‘you have been verbally abusive to doctors and other Practice staff on a number of occasions’. We cannot see any evidence of any other documented incidents before or after 28 February.
53. On the PCSE patient removal request form, which the Practice completed on 6 March, it ticked the reasons as ‘threats of violence/actual violence/verbal abuse to doctor or staff’ as well as ‘breakdown of relationship’. The form requires the date the warning was given, or a reason why there was no warning. The Practice wrote that it gave a warning on 6 March. It did not indicate there was a reason to not give a warning.
54. There is an entry in Mr H’s GP records on 6 March which says, ‘warning letter given to patient about removal by hand’. This is ambiguous as it mentions warning and removal. It is also contradictory as the removal request form and removal letter are also dated 6 March.
55. There is strong evidence that the Practice did not send Mr H a warning on 28 February, or any time before 6 March. It had not involved the police on 28 February and so it did not have grounds for an immediate removal, or to not send him a warning.
56. If the Practice had sent the warning letter, dated 28 February, there would need to have been another incident where Mr H demonstrated inappropriate behaviour between then and 6 March for it to remove him from the list. There is no evidence of any further incident. The only thing Mr H did between 28 February and 6 March was make a complaint to the Practice. The BMA guidance says this is not a reason to remove a patient.
57. When we weigh up the evidence, the Practice did not act in line with the BMA guidance, PCSE guidance, or its own policy, when it removed Mr H from its Practice list. It did not issue a warning and had no grounds to remove Mr H without a warning. We have found a failing and have considered the impact this had on Mr H.
58. We understand why Mr H feels the Practice treated him dishonestly, unfairly, and unprofessionally when it removed him from the list, as it did not follow guidelines. We appreciate this has left him without a GP and the need to find a new one, when he should not have had to. We can see the Practice denied Mr H the chance to act on a warning and redeem his relationship with the Practice. We set out our recommendations at the end of this report.
The Practice did not handle the complaint well and did not send policies/guidelines
59. Mr H complains the Practice did not respond to all his concerns. He also says he asked for its policies on cancelling appointments, third parties acting on behalf of patients, its privacy policy, and other guidelines, but it did not send them.
60. Our ‘Principles of Good Complaint Handling’ say public bodies should listen to and consider the complainant’s views, asking them to clarify where necessary, to make sure the public body understands clearly what the complaint is about. Our principles also say they should give clear, evidence-based explanations and reasons for their decisions. They should investigate complaints thoroughly and fairly, basing their decision on the available facts and evidence. Our principles say policies and procedures should be transparent, while respecting privacy of personal and confidential information, as the law requires.
61. We have reviewed Mr H’s complaint letters from 2 March, 20 March, and 7 September 2020. We can see Mr H asks several questions, calling for answers and evidence, about any previous incidents of abuse of staff before 28 February. He also asks about incident reporting, third party individuals telephoning the Practice on someone’s behalf, using phones in the waiting area, booking and cancelling appointments, being offered a room to talk in private, and CCTV. He asked for more information about why the Practice withdrew him from the service, whether it considered his mental health, in line with guidelines, and when the manager became aware of the aggressive behaviour from him.
62. We have reviewed the complaint response and we do not think the Practice did enough to answer Mr H’s concerns. We do not think it provided clear evidence-based reasons for its decision, in line with our principles, to remove Mr H from its Practice list. It only refers to the incident on 28 February and does not provide information about other alleged incidents he had asked about. The Practice refers to a letter that gave ‘a full explanation in writing’ about his removal. We have reviewed this letter, but it is very brief and does not give details about the incidents which led to his removal. It does not respond to Mr H’s concerns about third parties telephoning the Practice on someone’s behalf, incident reporting using phones in the waiting area, or booking and cancelling appointments.
63. In Mr H’s complaint letters, he also requests copies of guidelines or policies on the issues he raised. The Practice only confirms it cannot send Mr H CCTV imaging because of confidentiality, and it provided its zero-tolerance policy. We cannot see the Practice has acknowledged all his requests, or explained whether these items are available. We do not think the Practice dealt with his requests appropriately, in line with our principles. These say policies and procedures should be transparent, while respecting privacy of personal and confidential information, as the law requires.
64. We think the Practice got things wrong when dealing with Mr H’s complaint. We have therefore identified a failing. We understand why he feels the Practice has deliberately hidden things from him and why he feels this is dishonest and unfair.
65. Overall, Mr H says the Practice treated him dishonestly, unfairly, and unprofessionally. We have set out above where we think the Practice treated him this way. He also feels the Practice subtly bullied and discriminated against him. When we weigh up the evidence, we cannot say the Practice’s actions intentionally bullied or discriminated against him. We would need to see it intended to do that and there is no evidence of this. We do, however, understand these events were frustrating and distressing for Mr H, and we can understand his experience.
66. We have looked at what the Practice did to put right the impact of these failings:
· it cancelled Mr H’s GP appointment on 28 February in error and has not acknowledged this · it removed him from its list without a warning · it failed to fully address his complaint concerns or respond to his requests for information.
67. From our review of the correspondence between Mr H and the Practice, we can see the Practice apologised to Mr H that he found reason to complain, and it thanked him for highlighting issues in the Practice that require further training or change. It confirmed it will ensure all staff are updated on conflict resolution training should such an incidence arise in the future, so it will be better managed.
68. The Practice did not accept it got anything wrong. It therefore did not take any action to put right the impact its failings had on Mr H, or to ensure it does not make the same errors in future.
69. We do not think it has done enough and we think there is more the Practice should do to put things right.