A practice in the Lambeth area

4. Mr S complains that since August 2024 the Practice has:

• failed to provide him with relevant information or keep him updated regarding his individual funding request (IFR) • failed to take actions when directed to do so by the Integrated Care Board • caused delays in the IFR process by arranging unnecessary appointments • ignored his request for a copy of his medical records and failed to ensure the accuracy of his online records.

5. Mr S says the actions of the Practice have drained him in ‘every possible way’ as he finds having lack of clarity and lack of closure very challenging to live with.

6. He is seeking service improvements, a copy of his medical records and financial payment.

7. In mid-June 2024, the Practice had an appointment with Mr S. During this appointment the Practice and Mr S discussed the available options regarding autism assessment providers. The Practice made a referral to a local autism diagnostic and assessment centre (the Centre) the same day.

8. The Centre responded to the Practice in early August 2024. It confirmed the referral was appropriate, but it highlighted that in order for it to provide Mr S with an autism assessment, an individual funding request (IFR) would be required. IFR is a process where clinicians can ask NHS England to fund a treatment for a patient that is not normally available. The Centre does not hold a contract with South East London ICB (the ICB) to provide care, so an IFR was needed.

9. The Practice was unable to apply for the IFR online as it could not find Lambeth Clinical Commissioning Group (Lambeth CCG - the old name for what is now known as South East London ICB) on the system. The Practice emailed Lambeth CCG seeking assistance on how to make the application manually.

10. The Practice booked a telephone appointment for Mr S for late August 2024. However, due to an unexpected fire alarm, this appointment was rearranged for 48 hours later.

11. During the rearranged appointment, the Practice explained that the IFR process had changed and so it had been seeking information on how to proceed. It also explained that it was in the process of sending the IFR to the ICB and that it would take approximately a month to receive a response.

12. The Practice processed the IFR at the beginning of September 2024 and sent Mr S a text message to confirm this. It then received a response from the ICB the same day informing it that it needed to contact the local borough mental health team.

13. Mr S contacted the Practice on three occasions between mid to late October 2024, chasing an update on the IFR. Following his latter contact, the Practice sent Mr S a text message advising that it had been asked to contact a different funding service, which it was in the process of doing. This funding service was South East London Integrated Care System (SE London ICS).

14. In late October 2024, the Practice emailed SE London ICS, providing a completed Specialist Tertiary Panel form. A Specialist Tertiary Panel form generally refers to a specific type of referral document or an internal assessment template to manage and authorise access to highly specialized, complex medical care.

15. Mr S emailed the Practice in early November 2024. The Practice called Mr S the same day advising that it would obtain more information as to why SE London ICS had rejected the IFR.

16. The Practice sent Mr S a text message three days later. It advised the IFR had not been rejected but the previous funding pathway was no longer functional. It advised further that it had applied through a different funding portal and was now awaiting a response.

17. Mr S attended the Practice in mid-November 2024. During this consultation, Mr S expressed his frustration with slow progress of the IFR. The GP noted they would aim to keep him updated in a timely fashion.

18. At the end of November 2024 Mr S verbally complained to the Practice regarding missing documents from his patient record. The Practice asked him to send in an email of complaint, which he did. The Practice provided its final response the following day.

19. In mid December 2024, Mr S made an online appointment request in which he requested an update on the referral. The Practice sent him a text message advising it had sent an urgent task to the relevant GP. It also sent an email to the ICB requesting an update. The ICB responded the following day requesting the name on the referral, which the Practice provided the same day.

20. Mr S made another online appointment request the following week as he had not received any further information from the Practice. Upon receipt of his request, the Practice sent Mr S a text message advising him of the actions taken the previous week. It explained it was awaiting a response.

21. In early January 2025, Mr S made a further online appointment request. In this request, Mr S questioned why he was unable to see the referral document the Practice sent to SE London ICS in late October 2024 on his online record.

22. The Practice scanned the referral documents onto Mr S’s records the following day and sent him a text message confirming its actions. Mr S responded the same day confirming he was now able to see the referral, but he remained unhappy with the length of time the IFR was taking.

23. The Practice emailed Mr S in early February 2025 confirming the IFR had been approved, and this had been sent to his chosen assessment provider for urgent action.

Updates regarding IFR

26. Before we decide if we should conduct a detailed investigation of a complaint, we look at whether there are signs the events complained about had a negative effect which the organisation has not put right.

27. Mr S complains the Practice failed to provide him with relevant information or keep him updated regarding his IFR.

28. As detailed in paragraphs 7 to 23 above, we can see Mr S made numerous contacts with the Practice between September 2024 and January 2025.

29. The evidence available shows us that in October 2024, it took the Practice over two weeks to respond to Mr S’s email. However, the Practice’s automated acknowledgement response states that it will respond to email requests within two working days. We therefore consider the Practice did not adhere to its own timescale and took an unreasonable length of time to respond Mr S.

30. We can also see that on occasion, the Practice did proactively contact Mr S to advise him of the actions taken regarding his IFR. However, most of the information was provided due to Mr S chasing the Practice for updates.

31. It is clear from the level of contact Mr S made with Practice that he was concerned with the processing of his IFR and that he wanted regular updates regarding it. We acknowledge the delay in receiving updates, and needing to chase for these, caused Mr S challenges. We can see the Practice was taking action to process his IFR. However, we consider the Practice could have done more to communicate with Mr S about what was happening.

32. We note that Mr S is seeking service improvements and a financial remedy.

33. Our Principles state that good practice regarding remedies includes putting things right. Where maladministration or poor service has led to injustice or hardship, public bodies should try to offer a remedy that returns the complainant to the position they would have been in otherwise. If they are unable to do so, the remedy should compensate them appropriately. These remedies include:

• an apology, explanation, and acknowledgement of responsibility • remedial action, which may include reviewing or changing a decision on the service given to an individual complainant; revising published material; revising procedures to prevent the same thing happening again; training or supervising staff; or any combination of these • financial compensation for direct or indirect financial loss, loss of opportunity, inconvenience, distress, or any combination of these

34. Furthermore, they state that good practice includes seeking continuous improvements. This means organisations should use the lessons learned from complaints to ensure that maladministration or poor service is not repeated.

35. Regarding a financial remedy, we do not consider that in this instance, a financial remedy is required. This is because in cases where we expect the person to recover from the injustice quickly once the poor service comes to an end, we would generally consider this to sit at level one of our severity of injustice scale. For cases that sit at level one, we consider that a financial remedy is not appropriate.

36. We spoke to the Practice to discuss this part of Mr S’s complaint further. During this conversation we proposed a resolution which the Practice has agreed to. We have asked the Practice to ensure that, where it is needed, it agrees contact plans with patients. This includes circumstances where it contacts patients to provide an update even where there is no progress. This will ensure that patients receive timely updates that the Practice is able to accommodate.

37. We consider that the above is a fair and proportionate resolution to this element of Mr S’s complaint in line with Our Principles. Because the Practice has agreed to do further work here, we think this puts in place service improvements without the need for further investigation.

ICB instructions

38. Mr S complains the Practice failed to take actions when directed to do so by the ICB.

39. Section 6.1.4 of South East London ICB’s IFR Policy states that it is the responsibility of the clinician administering the treatment or intervention to complete the IFR application form. The clinician is also responsible for submitting all relevant clinical information and supporting evidence to make the case needed for the consideration of the application.

40. As detailed in paragraphs 7 to 23 above, we can see the Practice were initially unsure of how to process the IFR application and so contacted the ICB for information.

41. The evidence available shows us the Practice emailed the ICB at the beginning of September 2024, attaching the completed IFR form. We can see the ICB responded the same day advising that mental health and psychological referrals need to be directed to the local borough mental health team. The ICB provided the Practice with contact details for an individual to contact at SE London ICS.

42. The Practice sent the Specialist Tertiary Panel form for Mr S’s referral to SE London ICS at the end of October 2024. SE London ICS responded the same day acknowledging receipt of the referral.

43. Whilst we have no sight of the communication between the Practice and SE London ICS prior to the end of October 2024, we consider it reasonable to believe the Practice did contact it to obtain further information. Hence why it was then able to complete the Specialist Tertiary Panel form and emailed this at the end of October 2024.

44. We acknowledge that the Practice did cause some delays as it was unsure of how to process the IFR. However, we consider it was reasonable for it to seek assistance and information from relevant organisations. There is a gap in the information we have between the beginning of September, when the Practice was told to contact SE London ICS, and the end of October, when the completed form was submitted.

45. We consider the Practice did follow the instructions provided to it by the ICB. We are satisfied that it was acting in line with South East London’s IFR Policy as the responsible party for completing the IFR application.

46. We can see the Practice has apologised to Mr S for the delays encountered with his IFR application.

47. As detailed above, Our Principles state that an apology is considered a suitable remedy when putting things right for a complainant. As we have found that the Practice did follow the ICB’s instructions and contacted SE London ICS, we consider the delay by the Practice was minimal and therefore an apology is appropriate. It then confirmed to Mr S that it had processed the referral at the end of October 2024. Once the referral was sent, the responsibility for processing it fell to SE London ICS, which we note took until February 2025 to inform the Practice the IFR had been accepted.

48. We have therefore decided not to consider this part of Mr S’ complaint further. We acknowledge that Mr S found the Practice’s handling of his IFR application challenging. It is not our intention for our decision to dimmish this for him.

Unnecessary appointments

49. Before we decide if we should conduct a detailed investigation of a complaint, we look at whether there are signs the organisation has got something wrong. We do this by comparing what should have happened with what did happen. We have done this and have not seen any indications that something has gone wrong.

50. Mr S complains the Practice caused delays in the IFR process by arranging unnecessary appointments.

51. Section 24 of the GMC’s Good Medical Practice guidance states that all patients have the right to be involved in decisions about their care and be supported to make informed decisions if they can. Furthermore, it states that the exchange of information between medical professional and patients is central to good decision making.

52. We can see that upon receipt of the response from the Centre in early August 2024, the Practice booked a telephone appointment for late August 2024. This was after a multidisciplinary meeting in which it discussed Mr S’s case. However, due to a fire alarm incident, the telephone appointment was postponed by 48 hours.

53. During the telephone appointment, the Practice explained that is had been unable to apply for the IFR online but had obtained further information on how to proceed. It apologised to Mr S for any inconvenience caused and stated that it would send him updates via text message going forward.

54. We can see that the Practice arranged a further appointment for Mr S for mid November 2024. At this time, the Practice had processed the IFR and it was awaiting a response from SE London ICS. We are therefore satisfied this appointment did not have any bearing on the IFR and so did not cause any delays.

55. We appreciate that Mr S feels the Practice unnecessarily arranged the appointment for the end of August 2024. It is our view that the Practice acted in line with guidance in this instance, as it was sharing information with him regarding his referral, that he was previously unaware of. We consider this demonstrates the Practice was following GMC guidance as the information shared allowed Mr S to make an informed decision regarding his assessment.

56. With the above in mind, we have decided not to take this part of Mr S’s complaint further. We acknowledge Mr S has found the matter with the additional appointments challenging. Our decision regarding this element of his complaint is in no way meant to detract from this.

Requests for records

57. Before we decide if we should conduct a detailed investigation of a complaint, we look at whether there is an organisation that is better placed to deal with the concerns. Some complaints can be looked at by us, and also by other organisations. We consider whether another organisation is better suited to giving an answer to the complaint and whether it can provide the outcome Mr S seeks.

58. Mr S complains the Practice ignored his request for a copy of his medical records and that there are missing documents from his online records.

59. It is our view that the Information Commissioner’s Office (ICO) would be the most appropriate organisation to investigate this element of his complaint. This is because the ICO is the UK's independent body responsible for upholding information rights.

60. We acknowledge that we can ask the Practice to provide Mr S with a copy of his medical records. However, we consider the ICO is more appropriate to investigate his concerns regarding the accuracy of his online records and how the Practice has handled his subject access request. It can also recommend the Practice make service improvements, which is a further remedy Mr S is seeking.

61. With the above in mind, we have decided not to progress Mr S’ complaint further. We acknowledge that Mr S has found the Practice’s handling of his SAR challenging. It is not our intention to diminish this for him with our decision.

62. We would like to thank Mr S for providing us with the opportunity to investigate his concerns regarding the Practice.

1. We have carefully considered Mr S’s complaint about their GP practice (the Practice). We have, for the reasons we shall go on to explain, decided to take no further action.

2. We appreciate the cumulative nature of the points complained about have caused Mr S to experience stress and frustration, which he has found challenging to live with. We have contacted the Practice to negotiate a suitable remedy regarding the communication issue Mr S raised. We consider there is a more appropriate organisation available to investigate his concerns regarding the accuracy of his data and his subject access request.

3. We understand Mr S’s complaint is important to him. Our decision is no way meant to detract from the draining and challenging experience he has had.