17. Before we decide if we should conduct a detailed investigation of a complaint, we look at whether there are signs of service failings or maladministration which has caused an impact the organisation has not put right. Having done so we consider that Dr A communicated appropriately with Mr O and that the Trust handled his complaint well.
Agreement in January 2025
18. From Mr O’s account of the consultation on 7 January and the Trust’s response, there is a conflict about what was agreed during the appointment. Mr O recalls that he would remain under Dr A’s care while she sought guidance from other specialists, whereas both Dr A and the Senior Respiratory Nurse state that it was agreed he would be discharged from her care.
19. Where accounts differ, our findings are made on the balance of probabilities, taking into account the reliability of the evidence available. Section 69 of GMC guidelines states that doctors must ensure that formal records of their work, including patient records, are ‘clear, accurate, contemporaneous and legible’.
20. Given that further discussion around any dispute did not take place until around two months after the consultation, allowing time for memories to fade or alter, the contemporaneous notes recorded by Dr A and issued the following day provide the most reliable evidence of what was discussed. Those notes clearly state that Dr A would not arrange a further appointment.
21. Taking this into account, it is more likely than not that Dr A explained during the consultation that she would not be arranging further review and that Mr O was discharged from her care. The fact that this was documented at the time, in accordance with the requirement that records be ‘accurate, complete, contemporaneous and legible’, supports the conclusion that Dr A acted appropriately. In addition, given the subsequent breakdown of the doctor patient relationship, Mr O would not have had the opportunity to continue under Dr A’s care in any event. Accordingly, any misunderstanding about whether he was to remain under her care had a limited impact.
22. The way in which Dr A has dealt with this matter is consistent with the GMC guidelines that require timely, and complete record keeping to ensure continuity and safe referral of care. As the contemporaneous notes align with Dr A’s account and meet the standards set out by the GMC there is no indication of maladministration in how Dr A dealt with this matter.
Referral for further treatment
23. From our review of the medical records, we can see that the consultation notes from 7 January 2025 were forwarded to the Sleep Clinic for review. There is no evidence to suggest that the Sleep Clinic failed to receive these notes. The records also show that Mr O attended an appointment at the Sleep Clinic on 30 January, which demonstrates that the information provided by Dr A was sufficient for the Sleep Clinic to progress his care. There was no significant break or delay in treatment arising from the way the referral was made.
24. The GMC’s guidelines make it clear that clinicians must ensure patients are not put at risk by poor communication and that continuity of care is maintained. The evidence shows that the Trust referred Mr O appropriately and in line with these expectations.
25. During the discussion on 19 March, Mr O expressed concern that the notes sent to the Sleep Clinic might not have been treated as a new referral. In response, Dr A issued a further letter to the Sleep Clinic, acknowledging Mr O’s concern and reiterating that the purpose of her correspondence was to refer him for a formal outpatient review. This was a reasonable step to address any potential misunderstanding and ensure that Mr O’s care was not affected.
26. The records show that Mr O attended the Sleep Clinic again in May 2025, confirming that his care continued without interruption. While there may have been some confusion about the referral process, Dr A acted promptly to clarify the situation and minimise any possible impact by issuing a further referral letter.
27. Whilst the GMC guidelines do not prescribe a single format for referrals, they do require that referrals are clear, that relevant information is shared, and that patient care is properly coordinated. In this case, Dr A made the referral decision, communicated it to the Sleep Clinic, ensured that Mr O was informed, and followed up when concerns were raised. The fact that Mr O was seen by the Sleep Clinic and experienced no disruption to his care supports the conclusion that the referral was made appropriately and in line with guidance.
28. Our Principles of Good Administration also state that public organisations should behave helpfully and deal with people promptly and within reasonable timescales. Dr A’s actions both in making the initial referral and in issuing a further letter when concerns were raised reflect these principles.
29. The evidence shows that the Trust acted in accordance with the relevant GMC guidelines on continuity and coordination of care, and our Principles of Good Administration regarding prompt and helpful action.
30. In light of this, we do not consider there is evidence of maladministration or service failure that has caused a significant impact requiring further action from us.
Complaint handling
31. From a review of the evidence provided we can see that the Trust responded to Mr O’s complaint promptly and thoroughly. Dr A took proactive steps early on, personally telephoned him to discuss the issues and followed this up with written notes. She provided clear explanations about his blood test results, making it clear why she did not believe they were contributing to his breathlessness.
32. Although Mr O became dissatisfied with the consultation, Dr A documented the discussion and explained her view that the patient and doctor relationship had broken down. When Mr O then raised a formal complaint and submitted twelve detailed questions, the Trust issued a response, breaking down his complaint into twelve points addressing each point.
33. After issuing this response, the Trust continued to engage with Mr O providing a further letter on 8 May, signposting him to our service, and reiterated its position in subsequent communications in May and June 2025.
34. In August, Mr O submitted a further set of thirteen questions. The Trust replied a few days later confirming that it had nothing further to add to its previous responses. While this meant that some of Mr O’s later questions were not answered individually, by this stage the Trust had already explained that the complaint process had been exhausted. Its position was that all issues had been addressed, and no new matters remained outstanding within the scope of the complaints procedure.
35. The Trust confirmed that it had exhausted all reasonable efforts to resolve the matter, yet still signposted Mr O to our service for independent review to ensure fairness.
36. Our Principles of Good Complaint Handling emphasise fairness and proportionality. They state that organisations should deal with complaints in a way that is proportionate to the issues raised meaning they are not expected to engage in unnecessary or repetitive correspondence once a complaint has been properly addressed.
37. Whilst we have seen there was an instance where additional questions raised by Mr O were not answered, by this point the Trust had issued its final response and had signposted him to our service.
38. Having reviewed all the correspondence, we consider that the Trust answered the substance of Mr O’s concerns in its initial and subsequent responses. The questions it did not respond to individually had already been addressed in earlier replies, and the Trust was entitled to conclude its role in the complaint once it had provided its final response and signposted Mr O to our service. It would not be proportionate or fair to require the Trust to continue responding when it had already provided clear explanations and indicated it had exhausted its complaints process.
39. After consideration of this, we are satisfied that the Trust acted in line with Our Principles of Good Complaint Handling. The Trust addressed the key issues, acted proportionately, and brought the complaint to a reasonable conclusion. We therefore do not consider that the Trust’s actions amount to maladministration or service failure.
Conclusion
40. For the reasons outlined above, we will not be taking any further action on Mr O’s complaint about the Trust.
41. We understand this decision may be disappointing for Mr O, especially given the time and effort he has invested. We thank Mr O for bringing his complaint to us and appreciate the opportunity to consider it.