A medical practice in the Derbyshire area

3. Mr I complains about the care and treatment he received from the Practice. He complains the Practice:

· was abusive towards him for not wearing a face mask when he attended on 6 October 2021 for blood tests · refused to treat and carry out blood tests on 6 October 2021 · removed him from its patient list because he complained · has ‘fobbed him off’ (with regards to his complaint) by not providing him with all call recordings he requested and CCTV footage of the incident on 6 October 2021 · inappropriately discussed the incident on 6 October 2021 with staff members from another Practice (that is joined with the Derbyshire Practice in this complaint).

4. Mr I says the way the Practice asked him to wear a face mask was vindictive, nasty, and made him feel small and awkward. He says if staff had asked him politely, he would have worn a mask and waited to be seen.

5. He says that by the Practice refusing to carry out his blood test on 6 October 2021, this caused him distress and upset. Mr I has polyps on his gall bladder and requires three monthly ultrasound scans to monitor these. He also has stomach problems and requires blood tests, which was the reason for his visit to the Practice on the day of the incident. He said the Practice refusing to treat him, and then removing him from its patient list, prevented him having other check-ups (his last ultrasound was back in July 2021). Also, he was left without access to a GP for a period of three to five months. During this period, Mr I had to attend A&E and out of hours services when he needed medical attention, which impacted on his health and wellbeing.

6. Mr I says he felt frustrated and uncomfortable about going back, especially knowing that staff at the Practice had talked about him to such an extent that staff at the second practice were aware of what happened. He feels he would have been treated differently by staff because of this and finds it unacceptable.

7. Mr I seeks disciplinary action against the staff members he says abused him, refused to treat him, and caused him to be removed from the patient list. He also wants disciplinary action against those who inappropriately talked about him after he initiated his complaint, and those who failed to provide him with all call recordings and CCTV footage he requested.

8. Mr I attended the Practice for a blood test on 6 October 2021.

9. He says he was asked by the receptionist to wear a face covering or he would not be seen. He says staff were abusive towards him and spoke to him like something on the bottom of his shoe, telling him to: “get a face mask on.”

10. When he said he did not have a face mask, Mr I says he was told to “get out” by the receptionist. Mr I says he told the receptionist he would wait outside in the car park until his appointment time, and then he left the building.

11. Not knowing whether he was going to be seen, Mr I went back into the building to ask. He says he was spoken to in an aggressive manner by the receptionist, and that they were very rude to him in front of the other patients in the waiting area. He says this made him feel very small and very awkward.

12. Mr I says, despite it no longer being a legal requirement to wear a face mask, the Practice refused to see him and carry out his blood tests. He says he was not offered a mask, a visor, or any other alternative, and at no point did he refuse to wear a face mask as the Practice alleges.

13. Mr I says a healthcare assistant came outside to the car park and was aggressive towards him, pushing their hand up in his face. He says at one point, they called him a name for not having had his vaccine, and that the lead nurse screamed at him.

14. He says, on two occasions, staff approached him outside stomping, shouting, and waving their arms. He says staff were rude, aggressive, unprofessional, and abusive towards him.

15. As part of the complaints process, Mr I requested copy of CCTV footage of the incident on 6 October 2021, as evidence to support how the staff were abusive towards him.

16. The Practice says it reviewed this footage as part of its investigation, and refers to it in its response, but explains it is unable to provide Mr I with a copy because it has an obligation to protect the other patients featured in it.

17. Mr I says there was only him and two staff members in the car park at the time. He says nobody else was present and believes the Practice has done this to protect itself.

18. Mr I strongly believes the Practice still has the CCTV footage but is not prepared to share it.

19. He also requested a copy of all call recordings between him and the Practice. The Practice has provided Mr I with some of these. It has also considered call recordings as part of its investigation, but Mr I says he is dissatisfied with this because the Practice did not provide him with everything he asked for.

20. Mr I moved address in March 2019 and says he completed a change of address form at that time. He says he gave the form to the receptionist that day.

21. On 7 October 2021, some two and a half years after the move, and the day after the incident mentioned above, the Practice sent him a letter advising him to register with a new Practice nearer to his home address. The letter said he should do this within the next 28 days, as after this time the Practice will be asking Patient Registrations to remove him from its patient list.

22. Mr I says after he moved, he was told on many occasions by staff at the Practice that he would still be able to be a patient, as long as he was aware he was outside the Practice boundary and would not be eligible for a home visit. Mr I says he did not have any problems with this or the additional distance he had to travel to attend. He also said this to the Practice Manager when he spoke to them on 7 October 2021.

23. On 12 October 2021, Mr I sent a letter to the Practice Manager appealing against the decision to remove him from the patient list. He stated that he moved address in March 2019, and it had not been a problem until now, as in after he raised a complaint. He said he was asked to confirm his address every time he contacted the Practice, as part of data protection, and it had not been an issue. He feels the only reason he has been asked to register elsewhere is because he made a complaint against the Practice and members of its team. He finds this unprofessional, petty, and malicious.

25. Before we decide if we should investigate a complaint, we look at whether we can achieve the outcomes the complainant is seeking. We also look at whether there is another organisation better placed to deal with the concerns raised. As we cannot achieve Mr I’s outcomes, we have also considered whether another organisation is better suited to giving an answer to Mr I’s complaint, and whether it could provide the outcomes he seeks.

26. We have had detailed discussions with Mr I about the outcomes he is looking for, and he has said he is seeking nothing more than disciplinary action against the staff members involved in his concerns.

Abuse and refusal to treat

27. Regarding the concerns Mr I has brought to us, our Service Model Guidance (SMG) says there will be occasions where we decide not to investigate a complaint. The SMG says if we cannot achieve the outcome the complainant is seeking, we should decline to investigate.

28. Mr I wants disciplinary action against staff members at the Practice. This is not something we can achieve if we were to take the complaint through to investigation. As we are an independent organisation and not a regulator, we are unable to impose disciplinary action against individuals.

29. The General Medical Council (GMC) is a public body that maintains the official register of medical practitioners within the United Kingdom. It investigates the actions of individual clinicians to see whether there have been any failings and has the power to impose warnings and sanctions against individuals registered with it. It can agree undertakings and has the power to restrict, suspend, or revoke a doctor’s registration. The same applies for Nurses, but this would be done via the Nursing and Midwifery Council (NMC).

30. We have previously discussed the role of the GMC and NMC with Mr I and how they are better placed to investigate the conduct of the clinical staff members involved, and their decision not to treat him. They are also better placed to achieve the outcomes he is seeking. We have also told Mr I that while he has the option to approach these organisations, we are unable to say what the outcome would be or how far they would take his complaint. We have provided Mr I with contact details for the GMC and NMC in the event he wishes to contact them.

CCTV, call recordings, and disclosure of complaint details

31. Mr I seeks disciplinary action against the staff who failed to provide him with all call recordings and the CCTV footage he requested. As mentioned above, disciplinary action is not an outcome the PHSO can achieve. If we were to take this complaint to a detailed investigation, and if we were to find failings, we would also not be able to guarantee the Practice would take disciplinary action against its staff members. This would be an employment matter and would be confidential between the Practice and the employee.

32. The Information Commissioners Office (ICO) is an independent body set up to uphold information rights. Its role is to uphold information rights in the public interest, and it covers legislation such as the Data Protection Act, Freedom from Information Act, Privacy and Electronic Communications Regulations, and General data Protection Regulations.

33. Once a concern is raised with the ICO, it is recorded, considered, and the organisation’s performance is looked at against its obligations, to help establish whether there have been any breaches. It also looks at what improvements it might expect the organisation to make.

34. In cases where a clear and serious breach of the legislation has taken place, it will take direct action on the specific concern raised. If it decides there has been a serious failure to comply with the law, it will provide advice and instruction to help ensure the organisation gets it right in future. If an organisation is not taking its responsibilities seriously, it may also take enforcement action where appropriate.

35. The ICO are therefore better placed to investigate this part of Mr I’s complaint. It can examine his concerns, as well as how the Practice dealt with his subject access request for the CCTV footage and call recordings and establish whether the Practice is in breach of any legislation and regulations. We understand Mr I is also concerned the Practice has deliberately delayed providing the call recordings, so they are no longer available. The ICO can determine whether the Practice has followed the appropriate retention policy, under the relevant data protection laws. It could also look at whether any data protection breaches took place, in any communications between staff members at the two Practices, following him initiating his complaint.

36. Although the ICO will not take actions against individual staff members, it can look at Mr I’s concerns about the availability of the recordings and whether staff at the Practice have breached any laws in not providing him with them. Mr I is aware of this.

37. We acknowledge Mr I is already aware of the ICO’s existence because he told us by email, on 26 April 2022, he has contacted the ICO and sent all necessary information over to it to consider.

Removal from practice list

38. In its response, the Trust says the Practice Manager has asked for their apologies to be sent on to Mr I as, on reflection, they can see why he would feel the timing of the request for him to move practices was inappropriate.

39. The Practice Manager confirms as soon as they broached the subject with Mr I, they realised it was the wrong time to ask and they should have waited for a more suitable time to discuss this with him. This is supported by the Clinical Lead who also felt it was not appropriate to send Mr I the notification letter the day after both the incident and him raising the complaint.

40. As additional learning, it was suggested a more rigorous process would be established around the removal of patients. Authority would be given at the designated level e.g., both practice manager and clinical lead both agreeing.

41. The Trust says the investigation also highlighted the tone and content of the notification letter was not appropriate. The letter states the patient has 28 days to register elsewhere and if they fail to do so, they will be removed from the Practice list. Suggestions were therefore made for this letter template to be reviewed and improved across the service, as soon as possible.

42. If we look at the action that has already been taken to remedy this part of the complaint, it is clear the Trust and Practice have acknowledged and apologised for the timing of providing Mr I with this notification. They have said what improvements are going to be made going forward. These include establishing a more rigorous process around the removal of patients and improving the content and tone of the notification letter will be treated as a priority.

43. This is in line with our principles of good administration and complaint handling which states, where errors occur, organisations should offer an apology and rectify the error. In addition to this, our principles for remedy also say organisations are expected to seek continuous improvement from complaints made.

44. If we were to conduct a detailed investigation into this complaint, we would consider the Trust has put in place appropriate improvements (as per our principles) to remedy the injustice suffered by Mr I. We do, however, understand this is not enough for Mr I and he would like disciplinary action to be taken against the individuals involved.

45. Due to the above, we will not be looking into Mr I’s complaint any further. We hope we have explained the reasons behind our decision clearly. We appreciate this may not be the outcome Mr I was looking for in coming to the PHSO and we do not underestimate the impact the issues raised have had on him.

1. We have carefully considered Mr I’s complaint about a medical practice in the Derbyshire area (the Practice). This Practice is overseen by Derbyshire Community Health Services NHS Foundation Trust (the Trust). We recognise Mr I’s frustrations, and we are sorry to hear about his experiences with the Practice.

2. Given the nature of the complaint, we have decided there are other suitable dispute resolution forums who are better placed to deal with these issues. As an organisation, we are also unable to achieve the outcomes he is seeking.