Practice not offering reasonable adjustments
25. Mr E complains the Practice did not offer reasonable adjustments for his disability and provide him with an evening appointment for over a year and has not yet done so. He says he is unable to attend daytime appointments and feels least unwell later at night.
26. Mr E says he requires appointments to be in the evening, in order to increase the chances of him feeling well enough to attend these. He complains the Practice has not facilitated this for him and has therefore not made reasonable adjustments to allow him to have evening appointments.
27. The ICB provided Mr E with complaint responses dated 11 November 2024 and 1 April 2025. Within these responses, the ICB explains the Practice’s operating hours are from 8am until 6.30pm.
28. It also explains the Practice is part of Gloucester Inner City Primary Care Network and does offer some extended access appointments outside of those hours. The first complaint response notes the Practice had previously helped Mr E’s wife book one of these appointments, however he was not well enough to attend.
29. The initial response goes on to say the Practice would be happy to offer Mr E an appointment between its opening hours and that appointments can also be booked in advance.
30. It also provides clarification surrounding the non-registered service in explaining this service is available for the entire population of Gloucestershire and not just patients at the Practice. It advises this is a separate service which is available until 8pm on weekdays and weekends and is primarily commissioned for acute conditions.
31. Before we decide if we should conduct a detailed investigation of a complaint, we look at whether we can achieve the outcomes that a complainant is asking to achieve and would resolve their complaint for them.
32. In his complaint form and further correspondence with us Mr E states he wishes for the ICB to make arrangements for him to be provided with a permanent solution to obtaining GP appointments, prescriptions and vaccinations in a way that fits in with his disability.
33. We are unable to make recommendations relating to a patient’s access to care and treatment. This is because we are a lay led organisation, so we do not make decisions about what treatment a person should or should not have access too.
34. Section 3.10 of PHSO’s service model guidance also says:
‘There will be occasions when we decide that there are other reasons why we should not investigate a complaint made to us. These include, but are not limited to:
• If the outcome sought is not achievable • That an investigation would not be practical, would not reach a satisfactory conclusion and there would be no value in providing that response through an investigation.
35. We have reviewed the detailed responses the ICB has provided Mr E which also included input from the Practice and detailed the adjustments the Practice has already offered to him.
36. We thank Mr E for being clear with us regarding the only outcome which would resolve his complaint for him.
37. If we decide to investigate and find failings that have led to an unremedied injustice, we are not rigid or instructive about the recommendations we make. We would usually ask an organisation to draw up an action plan based on where we found it had not done what it should have done.
38. This means that we would never reach a point where we would be able to compel the Practice to offer Mr E access to care and treatment in the way he wants, extend its operational hours or change the way it resources its service.
39. It should also be noted that Mr E alleges the Practice breached the Equality Act 2010. This would be a legal matter, and we would not be able to reach a decision on whether the ICB has breached equality rights.
40. We have determined we will not be able to consider this element of Mr E’s complaint further as a satisfactory outcome could not be achieved and further investigation would not lead to us making recommendations that he seeks.
41. We can appreciate Mr E’s frustration in not being able to obtain an evening appointment at the Practice as he so wishes. We do not wish to downplay how this will have impacted him in seeking treatment for his chest infection and hope he can receive the care he requires.
ICB not addressing issue of Mr E having no GP or allowing him access to one
42. Mr E complains that following receipt of his complaint, the ICB did not address within its responses the fundamental issue of him having no GP or take steps to allow him access to an alternative one.
43. He says the ICB failed to suitably answer his complaint as it did not look to remedy the situation by making arrangements for him to have access to a GP, repeat prescriptions and vaccinations.
44. We have determined as above we would not investigate the facilitation of Mr E’s ongoing access to appointments and prescriptions as we are unable to make recommendations to the ICB regarding ongoing treatment or care. We have therefore considered the ICB’s handling of Mr E’s complaint.
45. The ICB provided response letters to Mr E on 11 November 2024 and 28 March 2025. Within each of these letters the ICB included responses from the Practice which addressed the concerns Mr E had raised.
46. The initial response dated 11 November 2024 from the ICB and Practice explain the non-registered service, the Practice’s own opening hours and processes, along with addressing Mr E’s care and the Practice’s communication with him. The further concerns Mr E raised were then also addressed within the second response letter dated 28 March 2025.
47. The NHS complaint standards say organisations should give fair and accountable responses. We deem the ICB has acted in line with this standard in providing Mr E with detailed responses to consider each element of his complaint.
48. Within its first response letter the ICB apologises information on how to access appointments has been unclear. It also says feedback about the Practice website will be taken forward to ensure information displayed is clear and accurate.
49. The response letter dated 11 November 2024 also says the Practice would discuss the complaint at a Clinical and Board meeting to ensure that any further learning that can be taken from Mr E’s complaint can be identified. It also gives an apology to Mr E for the delay in providing a response.
50. NHS complaint standards say organisations should promote a learning culture and use learning to improve their services and make sure every member of staff knows their role in promoting a learning culture.
51. We appreciate Mr E is disappointed the ICB has not been able to resolve his complaint, by providing an alternative arrangement to give him access to appointments and prescriptions.
52. We hope that the explanations given by the ICB and Practice along with the information surrounding learning they will look to take provides Mr E with reassurance that his complaint has been considered thoroughly and prompted learning to be taken.
ICB allowing the Practice to investigate his complaint
53. Mr E complains the ICB breached regulation seven of the Local Authority Social Services and National Health Service Complaints (England) Regulations 2009 by allowing the Practice to investigate the complaint after the ICB failed two legal tests which should have been completed before the Practice investigated.
54. Mr E says the Trust did not adhere to the above regulations as the first test says it should be more appropriate for the provider to investigate, and the second says the complainant should provide consent for it to do so.
55. In considering the ICB’s response letters dated 11 November 2024 and 28 March 2025, we can see that each of these also included an attached letter directly from the Practice addressing the concerns Mr E had raised.
56. The ICB’s response dated 28 March 2025 says it was explained via email on 10 May 2024 that as a commissioner, the ICB asks the NHS provider named in the complaint to provide it with a response which the ICB would then review.
57. The ICB response letter also says Mr E responded on 11 May 2024 to advise he was ‘happy for the complaint letter to be sent to the Practice as part of the ICB investigation’. The ICB further confirms it was responsible for the handling of the complaint itself.
58. The ICB’s Complaints and Feedback Policy, August 2023 states:
5.11. From 1 July 2023 the South E Complaints Team is responsible for handling the complaints investigation process relating to GP services and Pharmacy, Optometry and Dental (POD) services. From 1 July 2023 the ICB PALS and Complaints Team is responsible for administering the GP services and POD complaints process, ensuring comprehensive responses are provided to the complainant within the required timescales.
59. We can see the ICB has acted in line with its own guidance when carrying out its investigation and providing Mr E with its complaint responses and have therefore not identified any failings regarding its handling of Mr E’s complaint.
60. As the complaint was made to the ICB about the Practice, we deem it to be entirely reasonable that the ICB would need to contact the Practice in order to conduct its internal investigations.
61. PHSO’s Principles of Good Complaint Handling also states:
2 Being customer focused
• Responding flexibly, including co-ordinating responses with any other bodies involved in the same complaint, where appropriate.
62. We are satisfied the Trust has acted in line with our Principles of Good Complaint Handling in also consulting with the Practice and providing responses from it as part of its investigation into Mr E’s complaint.
63. We appreciate Mr E’s comments regarding the above regulations however can see the ICB did carry out the complaints investigation and provide responses themselves. It consulted the Practice for its comments and response which was necessary as the complaint was made about the Practice itself.
64. Mr E also says there was a conflict of interest as the ICB relied solely on a member of its board, who is also a director and CEO of the Practice to conduct its complaint investigations.
65. The Local Authority Social Services and NHS Complaints Regulations 2009 set out the NHS complaints process. In it there are two stages for dealing with complaints:
• Stage 1 - Local Resolution • Stage 2 - Parliamentary and Health Service Ombudsman (PHSO)
66. This highlights the first stage of the complaints process is local resolution. Local resolution allows the organisation responsible an opportunity to formally respond and resolve the complaint before it would be considered by PHSO.
67. The local resolution process is an internal investigation and so it is not unreasonable for the complaint responses to be provided by a member of staff at the organisation. We can see the ICB’s response letters were sent by its Chief Executive Office which is also in line with its own Complaints and Feedback policy which states:
68. We have seen satisfactory evidence that this has been done and therefore deem the ICB carried out its complaint investigation in line with its own guidance.
69. We have identified no failings regarding this element of Mr E’s complaint. We are sorry for any disappointment this may cause for Mr E as we understand his concerns that his complaint was not handled in the way it should have been in line with relevant guidance. We hope the above provides assurance that his complaint was handled suitably by the ICB.
Conclusion
70. We are unable to make recommendations to the ICB or Practice with regards to ongoing access to care or treatment. It would therefore not be proportionate for us to investigate whether the ICB should have arranged for Mr E to have permanent access to a GP as we would not be able to reach a satisfactory conclusion regarding this.
71. We have also identified no failings in the way the ICB investigated or responded to Mr E’s complaint. We deem it adequately investigated and responded to each element of the complaint and also suitably acted in line with relevant guidance when consulting the Practice for its input.
72. We can appreciate how distressing it has been for Mr E not having access to regularly available appointments for over a year, meaning he has not been able to receive the care he seeks regarding his chest infection. We understand how this has affected his physical health and also his daily life in general.
73. We hope the above explains the thorough consideration we have given his complaint and hope that our decision not to consider his complaint further does not cause any further upset as this is not our intention.