A practice in the Barnet area

4. Miss I complains the Practice:

• did not refer her quickly for an ADHD or autism assessment in June 2021

• did not allow her to select a service provider using the NHS right to choose pathway.

5. Miss I says she did not know she had not been referred until she contacted the Practice in January 2023, 18 months later. She says she has lost trust in her GP and the delay meant she continued to experience difficulties associated with autism and ADHD.

6. She says she also experienced a significant deterioration in her mental health due to the stress, distress and anxiety of the delays and difficulties in progressing her complaint.

7. Miss I would like a financial payment of £5,000. She would also like an apology from the Practice and service improvements.

8. In May 2021 Miss I says she went to the Practice for an autism assessment due to ongoing concerns she had. The Practice referred her to a learning disability charity for an autism pre-assessment. This was done in June 2021.

9. Miss I told us that during the pre-assessment process she was told she also showed signs of having ADHD. She was also screened for this condition.

10. The charity said she met the pre-screen criteria for autism and ADHD. It wrote to her and her GP to confirm this and ask for the GP to make a referral for autism and ADHD assessments.

11. Miss I says the charity told her an assessment could take up to 18 months and there was no need to follow up before this time. She told us she was satisfied the referral was in hand. She got a copy of the letter from the charity and assumed the Practice had too.

12. On 9 January 2023, after 18 months had passed, Miss I contacted the Practice and was told it did not get the letter. Miss I says a GP then acknowledged getting the letter but said it had been misfiled. The Practice contacted the charity who confirmed it had been sent and provided another copy.

13. The Practice made attempts to refer Miss I for assessment but the providers it went to were not accepting referrals. The Practice says this is the first time Miss I had asked for an autism referral and this had not been mentioned before.

14. In around March 2023, Miss I found she should be entitled to make a referral through the right to choose pathway. She says the Practice told her this was not an option.

15. Miss I contacted her MP who wrote a letter of complaint to the local Integrated Care Board (the ICB commissions NHS services in the area) on her behalf. The ICB sent a complaint response dated 1 June 2023 and apologised that the referral had been made to providers when the service was closed. The ICB explained it was working with the Practice to understand the issues.

16. Miss I approached the Practice again. She had a phone consultation with a GP on 4 October about her wish to use the NHS right to choose pathway. She says she was told by the doctor they could not progress the referral for her. The GP referred her back to the Practice secretaries.

17. Miss I complained again to the ICB on 22 September. On 8 November she brought her complaint to us, before getting a final response from the ICB. The ICB sent its response on 5 February 2024 with a copy of the Practice’s response letter dated 18 October 2023.

20. The law says we cannot investigate a complaint where a person has (or had) the option to take legal action, unless we consider this is (or was) unreasonable in the circumstances.

21. We have discussed this with Miss I to understand her circumstances and the outcomes she wants. We do not consider whether legal action would succeed but whether it would be a reasonable option to look into.

22. Miss I says the Practice failed to refer her for an autism and ADHD assessment and this resulted in a delay of at least 18 months. She also says she was stopped from choosing a preferred service provider through the right to choose pathway. During this time she did not get treatment and support and she says her mental health deteriorated significantly.

23. We think Miss I could make a clinical negligence claim. In line with our legislation, we considered whether it would be reasonable for her to explore this option to achieve her outcomes.

24. We discussed this with Miss I and sent her a copy of our severity of injustice scale (a tool we use to decide how much someone has been affected by what happened and what an appropriate payment to put this right would be).

25. Miss I says she wants a financial payment for the impact the Practice’s actions had on her mental health, employment and relationships. Miss I says she has had to pay for private therapies including counselling and hypnotherapy to try and help. She told us how these events led her to withdraw socially and the level of stress she has experienced is making her pre-existing medical conditions worse.

26. Miss I wants about £5,000 which is level five on our scale. Typically, level five cases are some of the most serious cases we see. We think the amount of payment Miss I wants is more than we would be likely to recommend if we were to uphold her complaint.

27. If Miss makes a legal claim, a court would be able to carefully consider and assess an appropriate amount of compensation for the impact Miss I has experienced. We would not want to disadvantage Miss I by looking at her complaint as it seems she may have a greater chance of achieving the outcome she wants by taking legal action.

28. Miss I also wants service improvements and an apology as outcomes to her complaint. While this is not something a court would be able to order, these outcomes are secondary to the financial payment she is looking for.

29. We asked Miss I if there were any barriers that would stop her from taking legal action. She said she has not approached any solicitors or explored this but there were no barriers to her doing this.

30. We advised Miss I to contact solicitors and to give them the evidence she has given us. This would give the solicitor the best opportunity to fairly review any possible claim. If Miss I decides not to go ahead with legal action, it is open to her to bring her complaint back to us.

31. We agreed a period of almost three weeks to allow Miss I to approach solicitors and shared information with her about organisations that may be able to give legal advice.

32. Miss I later emailed us and explained she had contacted four or five solicitors and each had said they did not accept mental health cases. She said she has been trying to get hold of the Law Society and has also been given names of some solicitors who may take on mental health claims.

33. We recognise Miss I has been proactive in approaching solicitors. We have seen no evidence that she cannot take legal action or that it is not reasonable for her to explore this further.

34. We recognise Miss I may need more time to make these enquires and we reassure her that she may ask us to reconsider her case at a future date if she decides not to take legal action. Miss I may also ask us to reconsider her complaint if there are any outstanding issues after she has completed legal action.

35. It is important that she does so quickly. This is the because the law says we should not consider complaints made more than 12 months after the person became aware of their concerns. We can put this time limit to one side, but only where there is good reason to.

36. We recognise these circumstances have been distressing for Miss I. We appreciate the time she has taken to explain the details of the complaint to us. We hope this decision clearly explains the reasons we have decided we are unable to consider her complaint further at this time.

1. We have carefully considered Miss I’s complaint about a GP practice in the Barnet area (the Practice).

2. We are sorry to hear about the delays in referring her for an autism and attention deficit hyperactivity disorder (ADHD) assessment by the NHS right to choose pathway and how this affected her. Miss I told us this has been a difficult time and it greatly affected her mental and physical health.

3. We think Miss I could take legal action to resolve her complaint so we have decided to take no further action. The reasons for our decision are given below.