A practice in the Shropshire area

3. Dr A complains about aspects of care and treatment a GP Practice in Shropshire (the Practice) provided to his 11 year old daughter, H from October 2024 to April 2025. Specifically, he says the Practice:

• did not pick up on the fact his daughter was being bullied at school. He states whilst the bullying was taking place, H showed both emotional and physical symptoms of bullying, including stomach issues. He states H’s physical manifestation was emotional and she was clearly presenting herself as vulnerable • Missed the opportunity to identify that H was being bullied as she was seen by several nurses and GPs at the Practice, rather than one GP for consistency.

4. Dr A explained H’s long-term health and wellbeing has been severely impacted. She is seeing a counsellor and has left the school system and may never return to school. He states she has lost trust in adults, especially those who are in a safeguarding role. He states she no longer enjoys doing the activities she used to enjoy.

5. Dr A states in terms of safeguarding, the Practice failed to protect his daughter, he states her condition has been described as life changing, and she is a less confident, insular and traumatised child.

6. By bringing his complaint to us, D A would like to know why safeguarding legislation failed in his daughter’s case. He states safeguarding needs to be more than a ‘tick boxing’ system. Dr A wants to ensure the Practice does not miss bullying in other children in future. He is also seeking financial remedy.

7. On 11 October 2024, H attended an appointment at the Practice as she had been experiencing abdominal discomfort. Her mother expressed concern that this could be linked to the anxiety of starting a new school. Blood and stool tests were arranged.

8. On 7 November, the Practice contacted H’s parents to inform them her blood and stool tests had come back normal. The GP advised them to keep a symptom diary alongside a lifestyle and diet diary, and this would be reviewed in two to three months if she was no better.

9. On 11 November Dr A contacted the Practice as H had been experiencing ongoing stomach aches for around six weeks. The Practice had previously tested her for irritable bowel syndrome (IBS) and celiac disease (a condition where your immune system attacks your own tissues when you eat gluten) but both tests came back negative.

10. On 12 November, Dr A complained to the Practice that he had discovered H had been being bullied for months. He felt this could have been spotted sooner if she had one allocated GP.

11. On 10 February Dr A had a telephone consultation with a GP to discuss H’s wellbeing. Dr A expressed concern that the Practice, and H’s school had missed signs of bullying.

15. Dr A states the Practice should have picked up on the fact his daughter was being bullied at school, as she was presenting with both emotional and physical symptoms of bullying, including stomach issues.

16. In its response, the Practice explained H had presented with proven acute infections, such as tonsillitis, eczema and chest infections on each occasion she attended the Practice, which are common symptoms in children. It says H’s presentation with these specific illnesses would not alert staff members to underlying stress, anxiety or psychosomatic illness, even if an experienced doctor had seen her.

17. The medical records show on 11 October H attended an appointment at the Practice as she had tonsillitis and a longer history of abdominal pain. There is a note in the records to show her mother wondered if this could be anxiety related.

18. The Practice arranged for some tests and investigations in line with GMC good medical practice which states:

• ‘15 You must provide a good standard of practice and care. If you assess,diagnose or treat patients, you must:a adequately assess the patient’s conditions, taking account of theirhistory (including the symptoms and psychological, spiritual, socialand cultural factors), their views and values; where necessary,examine the patientb promptly provide or arrange suitable advice, investigations ortreatment where necessaryc refer a patient to another practitioner when this serves the patient’s needs.’

19. By 12 November, Dr A informed the Practice they had found out H had been being bullied.

20. Our adviser explained at the one appointment prior to this point, it would not have been appropriate to ask H if she was being bullied when she presented with abdominal pain and tonsillitis, and this would not have been in line with GMC guidance. It would have been wrong to attribute the abdominal pain to bullying during the first consultation. This is because the GP needed to rule out physical issues in the first instance, which they did by ordering the relevant tests in line with GMC guidance.

21. This was the only consultation in the time period complained about regarding abdominal pain where they were not aware of the bullying.

22. We appreciate it must have been very distressing for Dr A to find out his daughter was being bullied. We have not found any indications of failing here, the Practice assessed H in line with GMC guidance and could not have attributed her symptoms on 11 October to bullying.

23. Dr A also complains the Practice missed the opportunity to identify that H was being bullied as she was seen by several nurses and GPs at the Practice, rather than one GP for consistency. The medical records show in the time period complained about, H was seen by five different staff members at the Practice.

24. In its response, the Practice explained there had been no specific reason to indicate a specific point of contact was required during the acute illness presentations it saw H for. It also explained it is not always possible for a patient to be able to see the same GP at each appointment due to time demands.

25. Our adviser explained it would be ideal if a patient could see the same GP at each appointment for continuity, but this would be practically impossible, especially when requesting a same day emergency appointment which Dr A did for his daughter on numerous occasions.

26. NHS choice framework guidance states:

• “You can: • choose which GP practice you register with • ask to see a particular doctor, nurse or other healthcare professional at the GP practice”

27. This guidance then goes on to say:

• “You should be provided with a choice of doctor, nurse or other healthcare professional you see for an appointment unless:

- the particular doctor, nurse or other healthcare professional is on leave, or at full capacity with no available appointments you need an urgent appointment and your choice of doctor, nurse or healthcare professional is not immediately available”

28. Our adviser explained when requesting a same day appointment, it would be very difficult to be able to see the same clinician each time in line with the above guidance. In addition to this, there is no evidence in the medical records to show that Dr A contacted the Practice and requested for H to be seen by the same clinician at each appointment.

29. In considering the above, there are no indications of failings in the Practice not assigning H the same clinician at each appointment she attended. We understand why Dr A feels it would have been better if H was seen by the same GP for consistency.

30. We hope Dr A is reassured we have taken his concerns seriously.

1. We have carefully considered Dr A’s complaint regarding aspects of the care and treatment a GP Practice in Shropshire (the Practice) provided to his daughter, H. We are very sorry to hear of H’s experience of being bullied and the impact this had on both her physical and mental health. We recognise how strongly Dr A feels about his complaint.

2. We have seen no indication that anything went wrong with the way the Practice assessed H’s symptoms. We have not found any indications of failings in the Practice assigning H different clinicians at different GP appointments.