April
14. Ms N complains about an appointment with a locum doctor in April 2024. She says the doctor challenged a plan agreed in February, to prescribe isotretinoin, without examining her and whilst making assumptions that conflicted with her medical history. She says that once the doctor did agree to the prescription, they did not provide the consent form, which delayed the process unnecessarily. She also complains about inaccurate information that the locum sent in a letter to her GP, following this appointment.
15. The Trust confirmed Ms N’s treatment plan but also explained the use of this medication, in this was considered ‘off licence,’ which means Ms N would be using the treatment for a different purpose than it was approved for. As the clinician who would ultimately prescribe isotretinoin for off licence use, the Trust said the locum was correct to conduct their own due diligence.
16. The Trust accepted the locum had not provided the consent form that they should have and recognised this would have saved time before she met with the pharmacist. It apologised and noted staff had also apologised by telephone in the week following the incident.
17. The Trust accepted the doctor had sent the wrong information to Ms N’s GP and apologised again. It said this had been rectified in a follow up letter in June, and that the doctor was to conduct professional reflection regarding this error ahead of their yearly appraisal.
18. Below we have considered each of Ms N’s concerns about this April appointment.
Consultation
19. The records reflect both the proposed plan in February, and the consultation in April. The events Ms N complains about must have caused her frustration and she says she felt she had to persuade the doctor to give her the prescription. Whilst we can recognise this concern, we also have to recognise that the consultation did ultimately result in a prescription for isotretinoin. The records show Ms N also completed a medication risk awareness form on the same day.
20. This means that even in the event the doctor did not examine Ms N and did make assumptions contradictory to her history, the outcome of the appointment was the same as the plan, and her expectation that she would obtain a prescription for isotretinoin. The appointment may not have gone as Ms N hoped, but without any discernible injustice outside of annoyance, there is no reason for us to take any further action on this matter.
Consent form
21. The records show that Ms N completed the consent form or isotretinoin during her pharmacy appointment on 15 May. This caused her a very slight delay, because if Ms N had received this form in April, her pharmacy appointment would have been shorter.
22. The Trust accepted this and apologised. The amount of time Ms N was set back by this step was thankfully minimal, and the delay did not change nor delay the course of her treatment plan. The records show this continued as expected. Given this, we think that the apology the Trust has offered is sufficient remedy for the inconvenience caused, and we do not need to take any further action.
Clinic letter
23. The records reflect both the letter of 15 April, and its revision on 14 June, that a doctor sent to Ms N’s GP. We can recognise Ms N’s concern, so we considered whether the doctor misdirected the GP, and whether this resulted in any actions it should not have.
24. All clinic letters appear to be for information purposes. It is standard practice for secondary care to provide summaries to a patient’s primary care provider. Both the April and June letters are detailed, with some minor amendments, but neither contain any onward directions for her GP.
25. The Trust has apologised for the oversight and taken steps to ensure the doctor involved learns from their error. Without significant clinical impact as a result of the first letter, we think these actions are sufficient to ensure the problem does not repeat. We will therefore take no further action.
September
26. Ms N says that at the end of an appointment in September, staff told her to wait for five minutes whilst they moved an October 2024 appointment to November and created a follow up appointment for January 2025. She complains that after 10 minutes, the timescale changed to the end of the day. She complains staff then only booked the January appointment, with no update or explanation regarding the earlier November appointment.
27. The Trust said reception had asked her to sit whilst they arranged the appointment change and follow up. It explained the system classed the November appointment as short notice, and system constraints meant this took time to appear. The Trust said whilst Ms N received her January appointment later that day, it was sorry that staff had not been clearer in explaining the November appointment would take longer to confirm. It said the outstanding appointment was confirmed the following morning, but going forward, it had asked staff to ensure patients in this scenario receive clear communication about the timescales involved.
28. We know from Ms N’s correspondence with the Trust that she was advised of a five-minute wait on the day, which turned into 10. We can appreciate Ms N found this frustrating, but the time difference is so negligible that we think the apology the Trust provided is more than sufficient to address this issue.
29. She sent an email about the November appointment just after midnight on the day of the appointment in September, and the Trust booked the appointment just after the start of the same day. This means the appointment booking was delayed by less than one day. The appointment was for November, so whilst this must have added to her existing frustration, Ms N thankfully did not miss it, or any other related appointments as a result.
30. The Trust has taken action to ensure better communication about short notice appointments in dermatology. We again think these actions and its apology are sufficient to remedy what went wrong.
Complaint Handling
31. Ms N says the events she complains about represent a pattern of issues within the dermatology department. She believes this should have prompted escalation of her complaint, which should have been investigated at a senior level as a result.
32. She says the Trust did not respond to her concerns in full, and in March 2025 when she raised new concerns, she complains that it refused to respond.
33. The Trust said that it would consider any new clinical complaints that Ms N made, but it would no longer respond to administrative matters. It said a high-level investigation of her concerns was disproportionate because of the limited impact of the issues. It felt staff had taken proportionate action to remedy her concerns and noted it had changed her clinician to the clinical lead of dermatology too.
34. We think the Trust had taken sufficient steps to remedy any identified mistakes. Any delays in this case were very short, and any miscommunication very minor.
35. We have not seen any indication of maladministration so serious that they would warrant further consideration, which highlights that the Trust’s decision not to investigate this further was both appropriate, and proportionate.
36. The records show Ms N did raise new complaints in February and March 2025. She sent an email an hour after staff gave her a 10-minute timescale for call back, once they had rearranged an appointment. The records show staff did acknowledge this and remedied the problem within half a business day. Ms N also complained about a letter she was still waiting for a copy of.
37. The records show the Trust responded to all other complaints.
38. We considered the outstanding concerns. Regarding Ms N’s missing GP letter, it is open to her to make a Subject Access Request with the Trust if this has not been resolved.
39. Regarding her appointment in February, we think the Trust could have responded to this, because it is a new complaint. However, when we consider how quickly she complained, and how soon this was resolved, then we can see the impact was limited to frustration. In other words, no real problems arose as a result.
40. If Ms N still requires an answer to this concern, we do recommend that she returns to the Trust for a formal response. However, we want to manage her expectations in saying that the limited impact means that we may not consider the complaint, should she return to our office with a final response from the Trust.
41. Ms N’s frustration with the Trust is clear, and we do not wish to detract from the stress that has caused her, but we cannot see a good reason to take any further action when we consider the limited impact, and the steps the Trust had already taken to remedy her concerns at each juncture.