3. Mr B complains the Practice would not prescribe him rescue packs and insisted he attend the Practice.
4. He also complains the Practice removed him from its patient list.
5. Mr B says the events have caused him severe anxiety, to be deeply upset, and led to him having depression. He says the lack of action has led to him having to call an ambulance on several occasions.
6. Mr B wants the Practice to make service improvements and pay him financial compensation.
7. Mr B has a diagnosis of COPD. He receives ‘rescue packs’ of medication from the Practice on request.
8. Mr B saw a respiratory consultant on 2 February 2022, and again on 22 June in hospital.
9. Mr B had an asthma review check with the GP on 18 July.
10. On 29 July the Practice rejected his request for amoxicillin as Mr B needed to provide a sputum sample.
11. Mr B had his annual COPD review with the Practice nurse on 22 August.
12. He also visited the respiratory consultant in hospital again on 28 September.
13. The Practice removed Mr B from its patient list on 20 January 2023.
Rescue packs
17. Before we decide if we should conduct a detailed investigation of a complaint, we look at whether there are signs the organisation got something wrong. We do this by comparing what should have happened with what did happen. We have done this and have not found any indications something went wrong.
18. Mr B says the Practice did not provide him with rescue packs when he requested them and insisted on him attending the Practice. He says this was impossible as he felt very unwell and was struggling to catch his breath which triggers a severe anxiety attack. He also says if he does not have a rescue pack, it means he needs to call an ambulance.
19. The Practice provided a timeline of events which shows when Mr B requested rescue packs and when the GP prescribed them.
20. The records show Mr B has severe COPD, which is why he has been under the respiratory team. We can see Mr B was requesting rescue packs several times a year.
21. The records show the Practice wrote to the respiratory team due to Mr B requesting rescue packs so often, the respiratory team confirmed the Practice should review him each time he requested a new one.
22. NHS guidance for ‘Management of COPD Exacerbations and COPD Rescue Packs – A Primary Care Guide’ says:
‘13. Patients should be reviewed on an individual basis and the decision to provide a COPD rescue pack should be based on the likelihood of further exacerbations and appropriate use of the COPD rescue pack. This may occur, for example, when the patient presents with a second or third exacerbation in a 12-month period or during the patients regular COPD review.
33. Practices should review all people who have had an exacerbation of chronic obstructive pulmonary disease (COPD) when they are clinically stable (for example, 6 weeks after the onset of symptoms of the exacerbation).’
23. The records show Mr B was ordering rescue packs a lot. Because of this, the GP wanted to review him, and this was in line with the above guidance.
24. As Mr B was unhappy, the Practice put the rescue packs on repeat prescription for him which went above and beyond what it was required to do.
25. Our adviser says when reviewing a patient with COPD, the GP would want to see them face to face to do a breathing test.
26. Mr B told the GP he struggled to visit the Practice due to his condition, the Practice did suggest he move to a different practice closer to him so he could access a GP face-to-face when necessary. Mr B chose to stay at the Practice.
27. We consider the Practice acted in line with the relevant guidance as it monitored Mr B’s use of rescue packs and asked him to come into the Practice for face-to-face reviews. The Practice also contacted Mr B’s respiratory team who reiterated the advice to review him. We have found no indication of failing and will not investigate further.
Removal from Practice
28. Mr B says the Practice removed him as a patient. He says he denies any behaviour under the ‘Zero Tolerance’ policy, however, he says he was very aggravated by the way staff were treating him as he felt he was having to justify obtaining medication that could save his life.
29. Mr B says he had been at the Practice since birth and the removal made him feel very ill and exacerbated his condition.
30. The records show the Practice initially issued a ‘Zero Tolerance’ letter to Mr B on 29 July 2022 after noting he was ‘shouting very aggressive saying (the Practice) are trying to kill him’.
31. The Practice sent further ‘Zero Tolerance’ letters to Mr B on 28 December 2022 and 12 January 2023 for his behaviour towards staff. These letters explain the Zero Tolerance policy and say, ‘Any future violation of this policy may result in removal from the Practice patient list.’
32. The ‘Zero Tolerance’ policy says ‘aggressive or violent behaviour towards staff would not be tolerated under any circumstances’.
33. The Registrations Department wrote to Mr B on 20 January 2023 to explain he would be removed from the Practice as of 28 January.
34. NHS England’s ‘Primary medical services policy and guidance manual’ says:
‘3.2.7 Where a practice wishes to remove a patient from its practice list, the practice must normally provide the reason for removal in writing to the patient. Removal may normally only be requested if, within the period of 12 months prior to the date of the request, the practice has warned the patient in writing that they are at risk of removal and reasons for this have been stated.’
35. The Practice acted in line with NHS England’s guidance around removing patients from a Practice. The Practice sent several notice letters to Mr B about his behaviour and told him he was at risk of being removed from the Practice before removing him. We have not found any indication the Practice has done anything wrong, therefore, we will not investigate this further.
1. We have carefully considered Mr B’s complaint about the Practice. We are very sorry to hear the events have caused a decline in Mr B’s mental health.
2. We have seen no indication the Practice did anything wrong. The Practice acted in line with the relevant guidance when issuing Mr B rescue packs and removing him from the Practice list.