A practice in the Fenland area

3. Mr E complains about the conduct of a GP at the Practice between 2015 and 2018 in relation to his ongoing health needs. He complains the GP: • ignored correspondence, including a letter relating to a referral for private tests • failed to transfer him to a different NHS Trust when he was unhappy with his care • accused him of fabricating his symptoms in correspondence with an NHS Trust • failed to intervene or refer him to endocrinology, and declined routine investigations • diagnosed him with ‘constitutionally short stature’ when not qualified to make this determination • failed to communicate the results of a bone age X-ray • discharged him from an NHS Trust without communicating this to him • provided false and misleading explanations for discrepancies in his medical records.

4. Mr E also complains that when a solicitor made a request for his medical records in 2020, the GP deliberately concealed documents that reflected poorly on the Practice’s care and was dishonest about why this happened.

5. He says the GP’s actions impacted on his ongoing treatment at the Trust and his growth suffered as a result. He adds this has caused social and emotional challenges.

6. Mr E would like the GP to take responsibility for what they did and explain the reasons for their conduct.

7. Mr E was a teenager when, in 2015, he became unwell and received treatment with steroid medications for proctitis (inflammation of the rectum that can be caused by inflammatory bowel disease). Shortly afterwards, he began to experience unsatisfactory growth as a side effect of this medication.

8. He was seen by a consultant at a local NHS Trust, and he is also dissatisfied with the care provided by the Trust.

9. Mr E says he was dismissed by his GP when he was experiencing severe abdominal pain between September 2015 and April 2016. He was referred to a specialist in April 2016.

10. He remained under the care of this Trust until July 2016, when he was referred to a different NHS Trust. He was prescribed steroids and experienced severe side effects from this. At times he was unable to walk and collapsed on more than one occasion. He visited his GP several times during this period.

11. In August 2016 Mr E was diagnosed with inflammatory bowel disease, which is a chronic condition involving inflammation of the digestive tract. He was also hospitalised due to rectal bleeding in September 2016.

12. Mr E says despite this diagnosis the consultant did not believe him and diagnosed him with a somatic illness, which is where a person experiences physical symptoms without any clear medical cause. He asked his GP repeatedly to refer him to a different consultant, but says the GP refused to help.

13. In August 2017 the GP saw Mr E on a number of occasions. Mr E says the GP prescribed a drug he had previously had a bad reaction to. He also says the GP was aware of abnormal test results but failed to communicate these to him. In addition, Mr E says the GP received a number of clinic letters from different practitioners in 2017 and 2018, but failed to act on these.

14. Mr E commenced legal action against the NHS Trust and, in 2020, his solicitors made a request for evidence from his GP. He explains that he discovered, in late 2023, that the GP had been ‘meddling’ in his care and had accused him of fabricating his illness. He also says that when this request was made, the GP deliberately concealed/deleted documents that reflected anything ‘negative’ about his care from the Practice. He says the GP was also dishonest about this, claiming his records were a paper record when this was not true.

15. He raised a complaint with the GP Practice and received responses on 12 and 27 February 2024. The responses noted that due to the passage of time, it was unable to comment on correspondence and why this was not replied to at the time. It also stated that there had been a change in management and processes since this time that would prevent similar problems happening again.

17. When we receive a complaint, we must consider whether we can and should undertake a detailed investigation into that complaint. In doing so, we must consider whether: • an investigation would be practical and proportionate • we can reach a robust conclusion about the matters raised • we can achieve the outcome(s) sought • another organisation is better suited to consider the matters raised.

18. A number of issues raised by Mr E relate to the ethical conduct of the GP, rather than being a complaint about service failure. This includes:

• ignoring correspondence • accusing him of fabricating his symptoms • providing false and misleading explanations for discrepancies in his medical records • deliberately concealing evidence requested by his solicitors.

19. Our remit is to investigate service failure within a health service body, including actions arising from a person employed by that body. We do not have the power to investigate individual practitioners outside of this context.

20. The General Medical Council (GMC) is responsible for regulating the ethical conduct of doctors in England, including their fitness to practise. The GMC has the power to investigate:

• serious or repeated mistakes in patient care • abuse of a professional position • fraud or dishonesty.

21. We consider the GMC is best suited to considering Mr E’s concerns about the GP’s ethical conduct. For this reason, we are not taking further action on these issues.

22. We understand Mr E has already approached the GMC about the matters raised and it has not taken further action. This does not change our decision that the GMC is the correct organisation with which to raise these concerns.

23. We also understand that Mr E has approached the Information Commissioner’s Office regarding his complaint about the provision of medical records to his solicitor in 2020. We have seen evidence of this in Mr E’s correspondence with the Practice.

24. We are satisfied that the Information Commissioner’s Office is the most appropriate organisation to consider this issue, and that Mr E has already approached its service.

25. With regards to the clinical matters raised by Mr E, we must consider whether an investigation would be practical and proportionate, and whether there is a reasonable prospect achieving the outcome(s) to person is looking for.

26. The clinical matters in this case took place between seven and ten years ago. Although we recognise Mr E says he was not aware of these issues until late 2023, the passage of time creates a significant barrier to investigating these matters and reaching a robust conclusion and outcome.

27. It is unlikely that we could achieve the outcomes sought by Mr E. He would like the GP to explain why they took the actions they did and take responsibility for this.

28. According to the Royal College of General Practitioners, the average GP Practice in England currently has more than 10,000 patients registered, with each full-time GP caring for, on average, 2,257 patients.

29. Given the volume of patients registered at a GP Practice and the passage of time being up to 10 years, we consider it highly unlikely that the GP would be able to accurately remember the rationale for actions taken this long ago. Because of this, we do not consider we can achieve the outcome sought by Mr E.

30. Furthermore, given the claim that the GP has acted dishonestly, this casts additional doubt on the ability to be able to achieve the outcome sought. This is because whilst we could ask the GP to provide an explanation, we have no control over whether the explanation provided would be candid.

31. Given we are unlikely to be able to achieve the outcome sought, we do not consider an investigation would be practical or proportionate. For this reason, we are not taking further action on this complaint.

32. We recognise that these events caused serious distress to Mr E, and our decision in no way comments on or detracts from his experience.

1. We have carefully considered Mr E’s complaint about the Practice and have decided: • aspects of this complaint are best suited to consideration by the General Medical Council and the Information Commissioner’s Office • we are unlikely to be able to achieve the outcomes sought by Mr E, and an investigation would not be proportionate or practical.

2. This decision makes no comment on the appropriateness of the GP’s actions, and we recognise Mr E had a very difficult experience during this time.