Extraction, handing over treatment, recording that treatment was complete
11. Mr J complains the Practice:
• refused to extract the tooth that was not aligned • did not hand over treatment to another orthodontist after his own orthodontist had retired • recorded the treatment to align his teeth as complete in 2022.
12. The HSC Act 1993 (Section 9(4)), says we cannot accept a complaint if it is made more than a year after the day on which the person aggrieved first had notice of the matters in the complaint, unless we consider it reasonable to do so.
13. During our introductory call in mid-June 2025, Mr J’s father said he was aware the Practice refused to extract his son’s tooth, when he had his braces removed at the end of June 2022. In relation to the completion of treatment, Mr A said in early 2024, he and his son attended the Practice and staff told him the orthodontist had written in the records that treatment was completed in June 2022.
14. Mr A said his wife asked the orthodontist, during the appointment in June 2022 (removal of braces), to remove the tooth that was causing the problem (overlapping). He said they refused saying it would leave a gap between his teeth. Mr A said they asked the orthodontist this multiple times at different times, but they just refused.
15. Following removal of his son’s braces, Mr A said he raised concerns his son’s teeth had not yet properly aligned, the orthodontist assured him retainers would be provided to complete the remaining corrections. Mr A said his son initially agreed to follow the orthodontist’s advice. However, near the end of the treatment, Mr A said his son told him several times to tell the orthodontist the teeth needed to be removed as soon as possible which the orthodontist ignored.
16. The consultation notes at the end of June 2022, record that Mr J attended the Practice with his mother. The orthodontist removed his braces and gave retainers. The orthodontist explained that to keep the teeth aligned, Mr J must wear the retainers permanently (first six months full time and then every night permanently).
17. In 2023, Mr A said their orthodontist began attending only twice a week to complete the cases of ongoing patients before retiring. He said he and his family specifically asked the orthodontist who would continue the treatment after their departure. However, he said they never received a clear or satisfactory response from him or the Practice.
18. The Practice said the orthodontist retired from the Practice in March 2023. He assisted for two days a week until the end of July 2023 to complete treatments. The dental notes show Mr J’s last consultation with this orthodontist was at the end of March 2023.
19. During the appointment at the end of March 2023, the orthodontist recorded that one of Mr J’s upper teeth had moved as Mr J had not worn the retainers for several months. The orthodontist recorded he informed him and his parents that if he wanted his teeth straightened again, he would have to pay as the NHS would not cover the cost.
20. We recognise Mr A and his family said they wanted to follow the advice from the orthodontist about the extraction. By the time Mr J attended the dental appointment at the end of March 2023, his teeth were not aligned. As the problem still persisted, we consider Mr J and his family – at the latest - became aware of the problem relating to the tooth extraction request by the end of March.
21. In relation to recording treatment to align Mr J’s teeth was complete, based on the dental records, we consider Mr A and his family were aware after the braces were removed at the end of June 2022 and at the latest by the end of March 2023. This is because this was the last appointment with Mr J’s orthodontist at the Practice, before he retired and before he told Mr J and his family that if he wanted his teeth straightened again, they would have to pay.
22. Regarding handing over treatment, Mr J and his family were aware of the problem sometime between end of March 2023 to the end of July.
23. Mr J’s father raised an issue about the tooth extraction and the treatment in an email to the Practice on 10 April 2024 – one year and 12 days after their date of knowledge.
24. Mr J brought his complaints to us on 29 January 2025 – between 18 and 22 months from the date of knowledge. This is between six months to ten months outside the statutory time limit.
25. For us to move the time limit to one side we must be satisfied the explanation given for the delay is reasonable.
26. We explained to Mr A that by law we can only investigate complaints that are brought to us within 12 months of the person being aware of the problem, unless there is a justifiable reason for the delay. We asked Mr A why he or his son did not complain at the time.
27. Mr A said he had been aware there was the option of removing the tooth from when the whole procedure started in 2019. He said they were told it would be a painful procedure and his son’s teeth would be fixed with retainers and braces. He said he took the orthodontist’s word and continued with the procedure.
28. Mr A said he continuously expressed to the orthodontist that he, his wife and son were not satisfied with the alignment, and that extraction might be necessary.
29. In relation to handing over the treatment, Mr A believed the treatment was still ongoing until the orthodontist retired in 2023. After being told by the Practice in 2023 that the orthodontist would no longer be coming in, Mr A said he expressed concerns to the management, saying his son's treatment was still incomplete. However, he said he was constantly given vague or delayed responses.
30. We have carefully listened to Mr A’s and his son’s explanation for the delay in complaining to the Practice and then us. We are sorry to learn of their experiences.
31. We have taken into account the length of time Mr J’s complaint was in local resolution. We do not consider there was any undue delay – on behalf of the Practice - in responding to his complaint.
32. There are several free independent NHS advocacy services that could have assisted Mr A and his son in raising a complaint with the Practice and bringing the matter to us, as well as explaining about the legal time limits.
33. The Practice’s website provides details of advocacy services to help someone making a complaint. If the person is not happy with how the Practice has dealt with their complaint, it explains how they can bring their complaint to us.
34. Our website explains there is a 12-month time limit for making a complaint to us.
35. The onus is on the complainant to make enquiries (with the organisation – in this case the Practice) when they are unhappy with the care and treatment they receive or think they should be receiving. Raising this as a complaint brings it to the attention of the organisation. It allows it the opportunity to address the issue and if appropriate offer a suitable resolution.
36. We are of the view Mr A had the ability and opportunity to raise a complaint – on behalf of his son - with the Practice and us sooner than he did.
37. We recognise the difficulties he faced. We are not persuaded there was any significant barrier during the majority of the time between the date of knowledge and the point he came to us. Although we acknowledge the experiences he and his son were going through may cause a delay, we are not satisfied the total length of time taken in bringing the complaint to us is reasonable for us to move the statutory time limit to one side. We cannot investigate these complaints any further.
38. Based on the information we have seen, there is no indication Mr A or his son raised a complaint - about handing over treatment - with the Practice. Emails indicate Mr A raised concerns with the Practice in early April 2024. In a subsequent email from Mr A to the Practice at the end of April, he referred to his initial email of complaint and made no reference about handing over treatment.
39. The Practice’s complaint response does not comment about the handing over of treatment. Within the MP’s email to the Practice in October 2024, there is no reference to handing over treatment.
40. Therefore, it is more than likely Mr A and his son have not complained about this to the Practice.
41. In health cases, section 4(4) and (5) of the HSC Act 1993 prevents us from conducting an investigation unless we are satisfied the complaints process has been used and exhausted, or it was not reasonable to expect the complainant to have done so.
42. We consider Mr A had opportunity to raise this with the Practice during the complaint process and before bringing the complaint to us.
43. In line with the HSC Act, we cannot investigate this aspect of Mr J’s complaint. This is because there is no evidence he or his father raised this with the Practice and gave it opportunity to respond.
44. Even if Mr M A or his son raised this with the Practice now, and then brought his complaint to us, it would be outside of the statutory time limit time for us to investigate, in line the HSC Act 1993.
45. We cannot investigate this complaint any further.
Continue treatment
46. Mr J complains the Practice refused to continue treatment to align his teeth.
47. NHS Overview: Orthodontics website explains that:
‘Orthodontic treatment (usually with braces) is most often used to improve the appearance and alignment of crooked, protruding or crowded teeth, and to correct problems with the bite of the teeth.’
48. GDC: Standards, 2013 says:
‘You should refer patients on if the treatment required is outside your scope or practice or competence.’
49. Mr A said when he asked the Practice to continue treatment to align his son’s teeth in early 2024, it explained it no longer has an orthodontist at the Practice (as Mr J’s orthodontist retired in early 2023). It explained as it has no orthodontic contract at the Practice, its only option was to refer Mr J to another suitable dental practice. It referred him to an orthodontist at a different dental practice for an NHS assessment.
50. The dental records show this dental practice carried out an assessment. It explained it could not offer treatment under NHS contract as the severity of the teeth was not at a level to access NHS funding. This dental practice offered to carry out treatment privately but Mr J’s family refused. The Practice made a further referral to another dental practice, but they also refused.
51. There is no evidence it was the Practice that refused to continue treatment to align Mr J’s teeth. Because it has no orthodontic contract at the Practice, it referred Mr J to other dental practices, in line with the above guidance. It was these dental practices that refused, not the Practice. Therefore, Mr J’s complaint needs to be directed to these dental practices if he wants to pursue his complaint.
52. We consider Mr A or his son had opportunity to raise this with the relevant dental practices during the complaint process and before bringing the complaint to us.
53. In line with the HSC Act, we cannot investigate this aspect of Mr J’s complaint. This is because there is no evidence he raised this with the relevant dental practices and given them opportunity to respond.
54. Even if Mr A or his son raised this with the dental practices now, and then brought his complaint to us, it is more than likely we could not investigate as the complaint is outside of the statutory time limit time for us to investigate, in line with the HSC Act 1993.
Dental records
55. Mr J said the Practice did not provide a copy of his dental records until his father got his MP involved. He complains the Practice refused to receive his father’s last letter.
56. This letter was not a complaint but sought confirmation from the Practice on whether he had received all his dental records.
57. During our introductory call, Mr A said he asked the Practice for his son’s dental records in about April/May 2024 time. He said he filled out the correct forms but heard nothing back from the Practice. It was only when he contacted his MP and his MP requested them on his behalf, that they were then sent in October 2024.
58. In mid-July 2024, Mr A sent a letter to Practice thanking it for the recent correspondence (dental records). He believed there should be more entries and asked the Practice to confirm. This letter was marked as refused and sent back to Mr A.
59. Based on the information we have seen, there is no indication Mr A or his son raised this complaint with the Practice.
60. Within the MP’s email to the Practice in October 2024, there is no reference to the delay in dental records being received.
61. The Practice’s complaint response (November) does not indicate Mr A raised these issues either.
62. We consider Mr A and/or his son had opportunity to raise this with the Practice during the complaint process and before bringing the complaint to us.
63. In line with the HSC Act, we cannot investigate this aspect of Mr J’s complaint.
64. We are sorry the delay in sending Mr J’s dental records to him and not responding to his father’s last letter caused them upset. Even if Mr A or his son raised this with the Practice now, we cannot investigate this complaint any further.
65. This is because we consider the impact for the delay to be low or of no impact. At the most it would be level one on our severity of injustice scale. This is where we consider there is a low impact, such as annoyance, frustration or inconvenience for a short duration and was a one-off event.
66. As an organisation we focus on the more serious complaints that people bring to us, where they may have faced a big impact. These types of complaints are where we can often make the biggest difference. This will allow us to provide the right level of service to those people, as quickly as possible.
67. This means we are not looking into complaints where we can see there has been a low or no impact. Based on the impact Mr A and Mr J told us about, we consider this applies to Mr J’s dental records complaint.
68. We acknowledge the ongoing difficulty for Mr J and his family. Our primary investigation decision is not made without recognition of the impact this had on them and we are sorry if our decision causes any further upset to Mr J and his family. We hope we have explained the thorough consideration we have given to our decision and clearly outlined the reasons for it.