3. Mr E feels that there was maladministration (where an organisation does something wrong) by the Practice. He says that the Practice cancelled a referral for his young son, A, to a paediatric surgeon without good reason and without telling Mr E and his family.
4. Mr E says his son had an extended period of pain and distress because of this.
5. Mr E is seeking accountability and an apology for these failings.
6. A was taken to his GP when he was experiencing pain and issues with urinating in October 2020. On 13 October 2020, the Practice made a hospital referral to the local trust (the Trust).
7. In January 2021, A’s parents chased up the Trust referral. The Practice informed the family it only accepts urgent referrals when there is severe restriction to the flow of urine and it advised the family private healthcare was an option. The private referral document was attached to the cover letter, but the wording of the letter implied it was up to the parents to decide whether to go down the private referral route.
8. There are no records of Mr E declining the private referral or confirming a decision to pursue it. Mr E says he found out on 6 September 2021, when seeking a progress update, that his son’s NHS referral had been cancelled. He made a complaint to the Practice on the same day. A received an NHS appointment in November 2021.
11. When we consider 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 signs that something went wrong.
12. Mr E complains the Practice cancelled his son’s referral to the Trust on the incorrect basis that he had sought a private referral appointment. He believes this led to his son being left without medical support for an extended period.
13. We reviewed the complaint file to understand the Practice’s response to this issue. We can see the Practice said it did not cancel the Trust referral. It explained this would have been done at the Trust’s end, so even if the referral was cancelled, any administrative error was not the Practice’s responsibility.
14. In line with its role as the organisation asked to provide further care, it is generally the Trust which cancels or rejects referrals from a practice. ‘Clinical responsibility when delegating roles – NHS e-Referral Service’ says ‘…a clinical provider can accept, redirect or reject new referrals sent to their service’.
15. This guidance also highlights how a non-clinician (an administrator, for example) can log into the e-referral system and perform all the service functions of a service provider on behalf of a clinician. The guidance says that, if the provider cancels, rejects or redirects a referral, it is still responsible and accountable for the decision to delegate.
16. We have seen the referral record, which supports the Practice’s explanation, as it shows the Trust removed the referral from the hospital’s list. A was shown as having been booked outside the NHS e-referral service, so the Practice removed him from the worklist the following day.
17. As we can see in A’s case, the referral was cancelled by the Trust on the basis the ‘patient was booked outside of the NHS e-Referral Service’. We contacted the Trust to find out why it made its decision to cancel this appointment.
18. The Trust said all referrals on the electronic referral system (ERS) drop off it after 26 weeks. It explained the process in place at the time of A’s referral was that the booking administration team would remove the referrals from ERS before the 26-week mark, then add them to another system (the Patient Centre) to make sure they were not overlooked. To move the referral to the Patient Centre, the referral in ERS would have to be cancelled.
19. As such, the referral request was still live and awaiting an appointment in the Trust’s booking systems, but it would show as being booked outside the NHS referral system. The available evidence shows the Trust cancelled the referral on one system not due to any error initiated by the Practice but simply due to the need to transfer the referral to another system.
20. The Trust also told us all paediatric urology appointments and procedures were delayed or cancelled during the COVID-19 pandemic, and this created a longer than normal waiting time. We understand this likely added to Mr E’s concerns something had gone wrong and that A was having to wait a long time due to mistakes in the handling of the referral.
21. The Trust’s response supports the explanation the Practice provided to Mr E. As the Practice told him, it had not cancelled A’s NHS referral and had not given him an emergency referral because Mr E made a complaint.
22. The evidence available in this case shows the Trust ultimately removed A from the ERS in line with its administrative process of transferring referrals to a different system, and this is what led to much confusion between the Practice and the family. We hope our enquiries have helped to clarify what happened and reassure Mr E his son was not denied the opportunity for a timely appointment due to mistakes by the Practice.
23. After carefully considering Mr E’s complaint and reviewing the evidence provided, we have not seen any signs of mistakes by the Practice. As such, we will take no further action.
1. We have carefully considered Mr E’s complaint about a GP practice in the Oldham area (the Practice). We have not seen any evidence of mistakes by the Practice in the handling of the referral, so we have decided to take no further action.
2. We were sorry to hear about Mr E and his family’s experience with an NHS referral for their young son. We recognise this was a distressing time for the family, and we hope the information below clearly explains how we reached our decision.