Registration process
15. The NHS Constitution sets out the principles and values of the NHS in England and the rights to which patients, public and staff are entitled to. It states patients have a responsibility to keep appointments or cancel within reasonable time and that receiving treatment within the maximum waiting times may be compromised if this is not fulfilled.
16. Miss A complains the process of registering at the Practice was fraught with complications and inefficiencies. She says she was met with unclear guidance and faced unnecessary delays which served as a significant barrier to accessing the healthcare services she urgently required.
17. The Practice has not responded in writing to this part of Miss A’s complaint. It confirmed in a letter dated 11 February 2024 that she had agreed in a telephone call on 11 January 2024 that the complaint could be closed.
18. Miss A’s registration form was signed and dated 5 May 2023, and her details were registered with the Practice that same day. Miss A attended an appointment at the enhanced access clinic at the Practice on 10 May where she underwent an unsuccessful blood test. The records show she intended to rebook the appointment when she had her university timetable, or that she would go to the hospital to get her bloods done.
19. Miss A then received a medication review by a pharmacist from the Practice on 11 May 2023. She was also seen by her GP on 12 May where she discussed hair loss, irregular periods, and recurrent infections.
20. Miss A had another appointment on 19 May where she discussed her symptoms of low mood, hair loss, irregular periods and more frequent headaches. The GP started Miss A on the combined pill to regulate her periods and her sertraline (medication for depression) was maintained at 150mg.
21. Miss A raised concerns during a telephone call with a GP from the Practice on 11 January 2024 about the appointments service. The GP explained the Practice was in transition to a new system of making appointments and confirmed appointments could be made by telephoning the Practice or by booking online.
22. The GP advised Miss A she had missed 11 appointments, and she said she had issues with the ringtone on her mobile and queried why voicemail messages were not left. The GP explained they could not leave voicemail messages for confidentiality reasons and that the Practice had also sent text messages to Miss A which she had not responded to.
23. We cannot see any evidence Miss A met with any barriers for medical care when she registered with the Practice. She had an appointment for a blood test, a medication review and an appointment with the GP all within a week of registering as a new patient. The Practice did attempt to contact her by text message when it could not contact her regarding her missed appointments.
24. The records show that Miss A did not attend a number of appointments, and we acknowledge she has been through a difficult time with her mental health. In line with the NHS Constitution there is responsibility on the patient to keep to appointments and rearrange these if necessary.
25. There is no indication of a failing here and we will take no further action.
Staff professionalism
26. PHSO principles of good complaint handling state organisations should deal with complaints promptly, avoiding unnecessary delay, and in line with published service standards where appropriate.
27. Miss A complains her interactions with staff at the Practice were consistently marred by a lack of professionalism. She said the behaviour she encountered was not reflective of the high standards of conduct expected within the healthcare profession. Miss A also complains the final call she had with a GP was disheartening and appeared impolite.
28. The Practice said it had reviewed the call with the GP and considered the communication was clear and professionally conducted. It said Miss A’s concerns relating to psychiatrist referrals, how the NHS was funded, the way her healthcare was addressed, and how to access a flu vaccination had all been addressed.
29. We are sorry to hear Miss A was upset with how staff communicated with her whenever she contacted the Practice. Our principles of good administration say staff should treat people with sensitivity, bearing in mind their individual needs, and respond flexibly to the circumstances of the case.
30. If staff were rude to Miss A this is unacceptable. We cannot know exactly what was said at each interaction or how it was intended but it is clear she did not find these interactions helpful. This added to her distress when she was already going through a difficult time.
31. In the call recording on 11 January 2024 the GP explained how the mental healthcare system works in the UK and that the NHS is not free to anyone and is only free at the point of contact. Miss A queried why the GP was referencing this and they confirmed it was a concern she had raised in a previous email.
32. The GP also informed Miss A she had not responded to or did not attend 11 appointments with the GP or healthcare assistant. The GP also noted Miss A had only mentioned her mental health on three occasions.
33. The Practice provided us with the telephone call from the GP from 11 January 2024 and we have considered this as part of our investigation. We saw no indications the GP was rude or impolite to Miss A. They provided her with responses to her queries and dealt with her complaint in what we perceive to be a professional manner.
34. Miss A mentioned her frustration during the call about referrals for her mental health and the GP clarified any psychiatry referrals would need to be made by Sheffield Talking Therapies, and the Practice could not refer her directly.
35. Miss A confirmed on the call she was happy with the new Practice she was now registered with. The GP said they would record the complaint had been discussed and that no further action would be taken other than to discuss her concerns at the next significant event or complaints meeting.
36. Our perception of the call is that it was handled in line with our principles of good complaint handling which say organisations should deal with people helpfully, promptly and sensitively bearing in mind their individual circumstances.
37. The GP acknowledged her concerns during her final telephone call and said these would be raised at the next complaints meeting which is in line with our complaint standards on putting things right and taking remedial action. Miss A acknowledged in the call that the GP considered the complaint resolved and the Practice rightly took no further action.
38. There is no indication of a failing here and we will take no further action.
Health issues neglected
39. GMC guidelines on good medical practice say doctors must provide a good standard of practice and care. The guidelines also say if doctors assess, diagnose or treat patients, they must adequately assess the patient’s conditions, taking account of their history (including the symptoms and psychological, spiritual, social and cultural factors), their views and values, and where necessary, examine the patient. GMC guidelines also state doctors should promptly provide or arrange suitable advice, investigations or treatment where necessary.
40. Miss A complains the Practice insufficiently addressed her mental health needs during significant periods of distress which affected her overall health and well-being. She also says the Practice did not take her back pain symptoms seriously.
41. The Practice says Miss A had only mentioned mental health issues on a maximum of three occasions and that she had not responded or did not attend 11 appointments during the time she was registered. It also said she had been referred to both physiotherapy and gastroenterology for her concerns.
42. The records show Miss A spoke with her GP about her mental health on 19 May 2023. During this appointment the GP documented that her anti-depressant was increased two weeks ago and was to be reviewed when she returned from holiday in six weeks’ time. Miss A also discussed her hair loss and irregular periods at this appointment which is in line with NG222 guidelines which say when considering treatments for people with depression take into account any physical health problems.
43. The only other reference to Miss A’s mental health is when she saw a CBT therapist on 7 and 12 October at Sheffield Talking Therapies where she mentioned she had depression and post-traumatic stress disorder. Clinicians felt they could not meet her needs there and she did not attend a follow-up appointment or respond to subsequent contact requests.
44. Our GP adviser noted Miss A could have had treatment for her depression after her appointment with the CBT therapist on 26 October however she did not attend her next appointment and did not respond to a text message asking her to rebook. Our GP adviser said Miss A’s received mental health treatment in line with NG222 guidelines mentioned earlier.
45. Miss A completed a patient questionnaire when she joined the Practice on 5 May which referenced that she has severe back and shoulder pain and has completed 12 sessions of physiotherapy every three months.
46. The records show one entry relating to Miss A’s back pain which is recorded on 7 December 2023. This states she was seen by physiotherapy in March and then missed many appointments. A referral was then made to the musculoskeletal team with the notes recording Miss A has no new symptoms.
47. Our GP adviser explained if this was a longer-term issue, physiotherapy would have been the best option for Miss A. Our GP adviser also noted Miss A had missed multiple physiotherapy appointments and there is no evidence Miss A had raised her back pain as a concern in any other consultations.
48. There is no evidence that Miss A consistently raised her mental health and back pain concerns over the eight-month period she was registered with the Practice. The records show only one entry each for back pain and depression. We would expect the Practice to respond appropriately to any mental or physical health concerns but as there is no evidence Miss A made it aware of these issues, and asked for help, we cannot criticise the Practice.
49. There is no indication of a failing here and we will take no further action.