A practice in the Stratford-on-Avon area (GP Surgery A)

3. Ms E complains about GP Surgery A (GP A), GP Surgery B (GP B), and South Warwickshire University NHS Foundation Trust (the Trust). She complains about the impact on her son’s care of her removal from GP A and B’s lists and being restricted from accessing Trust services.

4. Ms E says these actions put her son’s health at risk as he has a heart defect that needed treatment. She says she was humiliated and caused distress due to the worry about this and is now in financial difficulties due to the impact of the stress she was under.

5. Ms E seeks a financial remedy.

6. In June 2020 Ms E was notified in a letter from GP A that she had been removed from its patient list due to a breakdown in doctor patient relationship. She later joined the patient list at GP B.

7. In February GP B sent Ms E a letter stating her behaviour towards staff had been abusive and that she would be removed from the patient list if this did not cease. Shortly after, that month, Ms E was notified in a letter from GP B that she had been removed from its patient list due to an incident on 9 February where the Police were called. She was then placed by NHS England on the NHS Special Allocation List to access primary care services.

8. In April 2021, following an incident at one of its hospitals a few days earlier, Ms E was sent a letter by the Trust to notify her that her behaviour had been unacceptable and that if this continued her access to services may be restricted to protect staff.

9. Ms E made complaints to GP B (also escalated to NHS England), and the Trust, in 2021.

12. The law says a person needs to make their complaint to us within a year of becoming aware of the problem. We cannot investigate complaints brought to us after one year, unless we consider there is a good reason to do so. We have discussed this with Ms E to understand the reasons why she could not do so. We have also considered the time each organisation has taken to respond to Ms E.

13. We recognise that often a person will not be able to complain to us within a year of events happening as the NHS complaint procedure can sometimes take over a year to be exhausted. In order to be able to justify there was good reason why a complaint is made to us outside the time limit we need to establish that this happened for reasons outside the persons control and there were no avoidable delays on their part.

14. For example, if a person had to wait for a response for some time and had made reasonable attempts to chase up periodically, we could make allowances for this. If there are significant gaps unaccounted for where they could have taken action to progress matters but did not, such as after getting a response, we cannot justify making allowances.

15. We asked Ms E if she could explain any long gaps between the events in question and her approaching the Ombudsman. She said that she complained within one year after receiving response from the NHS and she I believed this was the way to complain. She told us she was not aware of any other ways to complain and was specifically waiting for NHS responses.

16. We have taken this into consideration and looked at the complaints about each organisation in turn:

GP A 17. Ms E was removed from GP A’s patient list on 12 June 2020 so she would have been aware of being unhappy about this from that point. To be in time she would have needed to bring her complaint to us before 12 June 2021. The complaint was brought to us by Ms E on 25 April 2024, which is nearly three years past the time limit set for us.

18. She did not complain to GP A until 18 April 2024 after approaching us and her being advised we can only consider complaints that have completed the NHS complaints process first. GP A responded to her complaint on 22 April 2024 stating her complaint was out of time for it to respond due to the length of time since the events in question.

19. It is clear Ms E would have known how to complain, and how the NHS complaints procedure works, much earlier than this as she made complaints about other NHS organisations in 2021. The explanations given do not account for the three years we cannot account for. We cannot say there was any barrier to her bringing this part of her complaint to us much sooner as it seems she had the knowledge and opportunity to do so.

GP B 20. Ms E was removed from the GP B patient list on 11 February 2021, so she was aware of the need to complain at that point. To be in time she would have needed to bring her complaint to us before 11 February 2022. The complaint was brought to us by Ms E on 25 April 2024, which is over two years past the time limit set for us.

21. We see Ms E did complain almost immediately to NHS England about this on 9 March 2021. She received a response from GP B on 23 July 2021, which signposted her to the Ombudsman if she remained unhappy.

22. We also see Ms E continued to try to escalate the complaint with NHS England after this. Our enquiries with NHS England establish that a further response may have been ready to issue around 28 April 2022. We note some confusion here as multiple versions of the same letter exist with different dates on. We are unable to confirm if this was not issued at that time, or was and did not reach Ms E. We see that following her chasing up in 2023 the response was sent to her dated 28 April 2023 along with an apology letter regarding the errors dating correspondence dated 5 May 2023.

23. We have decided to make allowances for any gaps between the original events and the final response being received in April 2023. There is reasonable doubt over whether Ms E could have got to that point sooner due to potential administrative errors on NHS England’s part.

24. We note NHS England’s final response also signposts Ms E to the Ombudsman. As such she would have been able to complain to us in April 2023 at the latest (if not sooner considering GP B’s response in 2021). This leaves a year unaccounted for between NHS England directing Ms E to us if she remained unhappy, and her bringing the complaint to us.

25. The explanations given do not account for the year we cannot account for. We cannot say there was any barrier to her bringing this part of her complaint to us much sooner as it seems, again, she had the knowledge and opportunity to do so.

The Trust 26. Ms E was sent a warning letter from the Trust on 19 April 2021, so she was aware of the need to complain at that point. To be in time she would have needed to bring her complaint to us before 19 April 2022. The complaint was brought to us on 25 April 2024, which is over two years past the time limit set for us.

27. Again, we see she did complain almost immediately to the Trust about this on 5 May 2021. She received a response from the Trust on 17 August 2021. This invited further contact or alternatively signposted her to the Ombudsman if she remained unhappy.

28. Our enquiries with the Trust established that sent an email dated 5 September 2021 to one of the Trust’s general managers. This stated Ms E wanted did not wish to hear from the Trust again and would be taking the matter to her lawyers. The Trust received no further contact from her after this.

29. The explanations given do not account for the two years we cannot account for. We cannot say there was any barrier to Ms E bringing this part of her complaint to us much sooner as it seems, again, she had the knowledge and opportunity to do so.

In summary 30. We see from the contents of Ms E’s correspondence with the various NHS organisations around 2022 to 2021 that this was a difficult time for her and her concerns about her son getting the correct care for his heart condition caused a great deal of stress.

31. We were sorry to learn of this. While it may have played a part in some of the difficulties around those times, we also consider this would be a motivation to try and progress and resolve any complaint as soon as possible. Ms E told us she thought she had one year after a final response to approach us.

32. We accept that she had to wait some time for responses, and this is not her fault. This does not adequately explain the long periods of inaction after receiving them before contacting us. It appears she was provided with clear guidance on what to do and could have been more proactive.

33. We recognise that Ms E still feel strongly about events from those years. We also must consider what can be practically achieved in attempting to investigate events from so long ago. With the passage of time individuals move on and recollections fade. This limits what it is possible to prove or disprove.

34. Unfortunately, the concerns raised are significantly outside the time limit for us, and we cannot identify a good reason why these could not have been brought to us by Ms E much sooner. For this reason, we have decided we should not consider Ms E’s complaint further.

1. We have carefully considered Ms E’s complaint about two GP surgeries and South Warwickshire University NHS Foundation Trust. The complaint falls outside of our time limit, and we have decided there is no good reason for us to put our time limit aside to consider it further.

2. Unfortunately, each element of Ms E’s complaint has been raised with us significantly outside the time limit set for us by law. We can appreciate how upsetting the events from 2021 were for Ms E and how she felt, and still feels, these prevented her son getting the care he needed at that time.