A practice in the Barnet area

8. Mr B complains about aspects of his care and treatment provided by the Practice between October 2024 and March 2025. Specifically, he complains the Practice:

• did not make a referral to dermatology about his ongoing skin condition/rash the earliest opportunity • did not action and follow up a referral to gastroenterology appropriately • reception staff were unprofessional and gave inaccurate information.

9. Mr B also complains about aspects of the complaint handling by the Practice between March 2025 and May 2025. Specifically, he complains:

• his initial complaint was responded to by a doctor and not the practice manager, and this was in breach of NHS complaints handling protocol • the doctor’s response to his complaint was ‘dismissive’ and ‘inaccurate’ • the final response does not acknowledge any harm caused and does not take accountability.

10. Mr B says the delay in referrals has caused physical harm as it has worsened his medical conditions. Mr B explains he has a pre-existing autoimmune condition (where the immune system attacks healthy tissues by mistake) so is more prone to gastrointestinal related issues. He explains he may now have irritable bowel syndrome (a common condition that affects the digestive system) due to the lack of follow up after referral to gastroenterology, and this has prolonged his suffering.

11. Mr B says he has had to rearrange his personal, social and professional commitments to cope with the pain he is in. He says the delays and poor complaint handling have caused him emotional distress and he feels ‘neglected, vulnerable and anxious’ due to this and due to the attitudes of the reception staff.

12. Mr B would like acknowledgement of failings. Should failings be found in the referral aspect of his complaint, he would like referral action to be taken by the Practice to dermatology and gastroenterology. He is also seeking service improvements and financial remedy.

13. Mr B attended the Practice again multiple occasions throughout October 2024 with stomach issues including pain and being bloated. He had repeated tests for H. pylori (a type of bacteria that infects the stomach - it can cause sores and inflammation in the lining of the stomach or the upper part of the small intestine). Some of these tests were positive.

14. The GP therefore prescribed antibiotics and a proton pump inhibitor (PPI - medicine to reduce how much acid the stomach produces) to treat the infection, referred Mr B to gastroenterology, and carried out allergy testing.

15. Mr B says he told the Practice about an ongoing skin rash during this time, and says the GP told him he would be referred to dermatology.

16. On 28 November 2024, the gastroenterology department wrote to the Practice and Mr B closing the referral and advising the Practice treat Mr B for H. pylori using PPI medication and a re-test following a month of this.

17. The department advised that if Mr B’s symptoms remained after this time, the GP should refer Mr B for an ultrasound or endoscopy. An ultrasound is a procedure that uses high-frequency sound waves to create an image of part of the inside of the body. An endoscopy is a procedure that uses a tube with a camera to look inside the body.

18. The Practice did not order the re-test or follow this up and Mr B did not provide a further sample.

19. In February 2025, Mr B contacted the hospital he believed he had a dermatology referral with, who informed him there was no referral.

20. Mr B contacted the Practice about his referrals on 17 February 2025, and reception staff at the Practice advised him the dermatology and gastroenterology referrals were still active and to chase the hospital. The Practice also advised Mr B he needed a re-test for H. pylori.

21. The Practice messaged Mr B later in February 2025 to advise it had not referred him to dermatology. It asked Mr B to send pictures of his ongoing skin condition so it could arrange this. Mr B did not provide these.

22. Mr B attended the Practice on 26 March 2025 with further stomach concerns. The GP referred Mr B for an abdominal ultrasound scan and a repeat H. pylori test. The GP told Mr B they would refer him for a gastroscope (a flexible tube with a camera and light at its tip that is passed down the throat to examine the gullet, stomach, and the upper part of the small intestine) if the repeat H. pylori test was negative and his symptoms carried on.

23. Mr B complained to the Practice on 31 March 2025 about the dermatology and gastroenterology referrals, and about unprofessional conduct of Practice staff.

24. A GP from the Practice responded on 8 April 2025. Mr B replied to this response expressing he was unhappy it was not the practice manager responding.

25. Mr B attended the Practice again in May 2025 for his ongoing stomach issues and skin condition. The GP gave him advice about the skin condition and referred him to gastroenterology again.

26. The Practice manager made a final response to Mr B’s complaint on 14 May 2025.

27. Mr B brought his complaint to us on 19 May 2025.

Dermatology referral

31. Mr B complains the Practice did not refer him to dermatology at the earliest opportunity for his ongoing skin condition. Mr B says there was opportunity for the Practice to refer him in October 2024, and this was not done. He explains this prolonged his suffering and delayed any treatment.

32. We have considered Mr B’s medical records for the Practice for his appointments in October 2024. There are not indications from the records that an ongoing skin complaint was discussed at these appointments or that the GP discussed referring Mr B to dermatology for the ongoing skin condition.

33. There is mention of allergy testing at these appointments, but this was in the context of Mr B’s ongoing stomach related symptoms.

34. We therefore have two conflicting accounts of the October 2024 appointment. We have carefully considered this to see if we can reach a view on what was likely discussed. Sadly, in the absence of any further third-party evidence, we are unlikely to be able to say what was said and if a skin condition was discussed during this appointment.

35. In light of this, we are unlikely to be able to be able to say if Mr B should have been referred following this appointment and therefore are unlikely to be able to say there were delays from this time.

36. We are reassured the Practice offered Mr B an appointment about his ongoing skin condition in February 2025 and referred him to dermatology in July 2025. We hope this leads to Mr B getting the assistance he is seeking with his ongoing skin condition.

Gastroenterology referral

37. Mr B complains the Practice did not action or follow up his gastroenterology referral appropriately and this delay has prolonged his suffering and worsened his condition which has impacted his personal, social and professional commitments due to pain.

38. In October 2024 Mr B attended the Practice multiple times with ongoing stomach pain and bloating. A number of H. pylori tests were completed, some of which were positive. The Practice prescribed Mr B antibiotics and PPI medication, completed allergy testing, and referred Mr B to gastroenterology.

39. The NICE guidelines ‘Gastro-oesophageal reflux disease and dyspepsia in adults: investigation and management’ says to offer H. pylori testing to people experiencing stomach pain and heartburn, with or without bloating, nausea or vomiting, and to treat this with a PPI medication. The guidelines also say to refer to a specialist service for ‘people of any age with gastro-oesophageal symptoms that are non-responsive to treatment or unexplained.’

40. The GMC guidelines ‘Good medical practice’ says doctors should ‘consult colleagues or seek advice from your supervising clinician, where appropriate’ and ‘refer a patient to another suitably qualified practitioner when this serves their needs.’

41. We consider the evidence shows the Practice appropriately considered Mr B’s symptoms in line with standards and guidance and actioned his referral to a specialist at the appropriate time.

42. Mr B also complains the Practice did not follow up his referral appropriately.

43. The records show gastroenterology wrote to the Practice and Mr B at the end of November 2024 advising the next steps. These included a repeat H. pylori test, and a referral ultrasound or endoscopy if his symptoms continued. A copy of this letter was also sent to Mr B, so he was aware of the next steps should his symptoms continue.

44. We cannot see Mr B contacted the Practice again until March 2025. We also cannot see the Practice contacted Mr B to arrange the repeat H. pylori test.

45. The GMC guidelines say doctors must ‘provide a good standard of practice and care’ and ‘promptly provide suitable advice, investigation or treatment where necessary’.

46. In line with this, we consider the Practice should have contacted Mr B to arrange the further H. pylori test. The remainder of the gastroenterology actions relied on information from Mr B, to understand if he had ongoing symptoms. We cannot see Mr B contacted the Practice again until March 2025 about these.

47. We therefore consider there is an indication of a failing as there was a four-month delay in arranging the repeat H. pylori test with Mr B. We consider the likely impact of this below.

Impact

48. Mr B says the delays in the Practice’s care prolonged his suffering and if he has irritable bowel syndrome as he thinks he may (he is not diagnosed with this at the time of this complaint), any delay will have worsened this. We recognise how concerning this will be for him in light of his distressing symptoms.

49. We have considered what happened following the March 2025 appointment, to see if there was a delay in care or diagnosis for Mr B due to the delayed H. pylori test.

50. We can see the GP sent a text message to Mr B in March 2025 to ask him to pick up a stool sample pot from the Practice’s reception. It noted if the test was negative, Mr B would need to book an appointment and a referral to gastrology would be made.

51. Sadly, we cannot see Mr B completed the further H. pylori test at this time.

52. Mr B’s next contact with the Practice was in May 2025 and he was again asked to complete a repeat H. pylori test and was referred to gastroenterology. At this time, we cannot see Mr B has received a specific diagnosis for his symptoms. We can see the ultrasound was completed in June 2025, but the results of this did not indicate any specific gastrointestinal concerns.

53. Overall, we are unlikely to be able to link the impact Mr B claims to the indicated failing we have seen. This is because there are a number of other factors involved in this, some of which fall outside of the Practice’s responsibilities.

54. We can see Mr B was also aware of the need for a further H. pylori test in November 2024, and he did not contact the Practice until March 2025. We cannot see Mr B completed the requested further H. pylori test at this time. We therefore are unlikely to be able to say if Mr B would have completed the H. pylori test in October 2024 (the recommended time after the gastroenterology advice), had the Practice contacted him about this.

55. We also cannot see the further referrals from May 2025 have led to a specific diagnosis, such as irritable bowel syndrome. We are therefore unlikely to be able to say there has been a clinical impact to the delay in arranging a further H. pylori test after the November 2024 letter.

56. Overall, we consider the likely impact of the four-month delay to be distress and concern to Mr B.

57. We have next considered the actions the Practice has taken to address the impact of the indicated failing.

The Practice’s actions

58. We have the actions the Practice has taken to address the above concerns in line with our ‘Complaint standards’. These say organisations should acknowledge any failings and impact, then provide an appropriate remedy to these and take on board any learning.

59. We can see the Practice’s complaint response acknowledges it should have arranged the further H. pylori test after the gastroenterology letter in November 2024. The Practice apologised and acknowledged that this contributed to a delay in Mr B’s referral and treatment for his ongoing stomach symptoms.

60. The GP who originally made the gastroenterology referral has explained, acknowledged and apologised to Mr B directly. We consider these actions are appropriate to recognise the Practice’s delayed actions.

61. The Practice also raised and shared learning from this incident at its GP meeting on 28 April 2025, to ensure referrals are followed up on promptly in the future.

62. We consider the Practice has done enough to remedy this situation, in line with our ‘Complaints standards’, and we do not consider it needs to take further action. We consider the impact that can be linked to this failing (distress and concern) is appropriately remedied with acknowledgement, apology and learning.

63. This does not detract from the distress and concern Mr B has felt knowing more could have been done to action his referral, but we hope the action that has been taken since moves him towards treatment for his ongoing discomfort.

Professionalism and accuracy of Practice staff

64. Mr B says he rang the Practice in February 2025 to chase his referrals to dermatology and gastroenterology. He says the reception staff were unprofessional and gave inaccurate information which made him feel neglected and anxious.

65. Mr B says the reception staff told him the referrals to both departments were active and to ring the Trust about them. Mr B then did so but was told there were no relevant active referrals for either department.

66. We have considered the information given about the dermatology referral first. Mr B had two dermatology conditions ongoing at the time of these events. The records show an active dermatology referral for a forehead concern (not complained about) at the time of his interaction with the Practice’s reception staff. The records do not show a referral for Mr B’s ongoing skin rash.

67. On the balance of probabilities, it is likely the reception staff gave information to Mr B based on the active dermatology referral for Mr B’s forehead concern, and it is reasonable reception staff were confused by this.

68. We have next considered the information the reception staff gave Mr B about his gastroenterology referral. The Practice records and Mr B’s recollection does suggest he was given information that his referral was active which was not the case. We cannot see any reason to suggest how this mistake occurred. We therefore can see an indication of a failing in relation to this aspect of Mr B’s complaint.

69. We consider the likely impact of this below.

Impact

70. Mr B says the inaccurate information made him feel neglected and anxious, especially at a time when he was experiencing a number of distressing symptoms. We agree the incorrect information will have added to Mr B’s distress. We recognise it will have been very concerning to have contacted the Trust, only to be told he did not have an active referral.

71. We have next considered the actions the Practice has taken to address the impact of the indicated failing.

The Practice’s actions

72. Although the Practice’s complaint response provides information about the handling of the follow up tests for Mr B, we cannot see this acknowledges the incorrect information he was given by the reception staff and the impact this caused.

73. Our ‘Complaints standards’ say organisations should ‘give fair and accountable responses’ and ‘promote a learning culture’. The Practice’s final response did not meet the standards.

74. We contacted the Practice to discuss its final response and our ‘Complaints standards.’ The Practice agreed its response fell below standard and agreed to take further action to put this right.

75. The Practice has since offered a further response to Mr B about this part of the complaint, which acknowledges the incorrect information he was given by the reception staff. It describes service improvements made since Mr B was given incorrect information, including processes being reiterated to staff.

76. We consider the further actions the Practice has taken are appropriate, in line with our ‘Complaint standards’. We consider these acknowledge and address the impact of these events on Mr B. We therefore do not see indications to suggest further action is needed and we consider this part of the complaint resolved.

Complaint handling

77. Mr B complains his initial complaint was responded to by the GP, and not the practice manager.

78. Mr B’s initial complaint to the Practice in March 2025 was responded to by a GP from the Practice in April 2025. When Mr B explained he was unhappy about this, the practice manager responded in May 2025 advising they had been on leave which is why the GP had replied. This response also noted the GP’s expertise qualified them to respond to Mr B’s complaint.

79. The complaints regulations say to respond to complaints promptly and that they ‘allow the responsible body to authorise any person to perform the functions of its responsible person and complaints manager on its behalf.’

80. When balancing the responses from the Practice, it appears proportionate that the GP responded to Mr B’s initial complaint in the practice manager’s absence, to give a timely response in line with standards. We do not find indications of failings in this part of the complaint.

Complaint responses

81. Mr B also says the complaint response from the GP was ‘dismissive’ and ‘inaccurate’.

82. Our ‘Complaints standards’ say complaints should be welcomed, any learning taken from them and to acknowledge impact with a view to remedying any wrong-doing. The Practice’s initial response in April 2025 does not appear to welcome Mr B’s complaint positively or from a learning perspective, as it does not acknowledge any areas for improvement or explain how any improvements have or will be made.

83. We therefore consider the Practice’s initial response was not in line with the ‘Complaint standards’ and we understand how Mr B felt dismissed by this response.

84. We contacted the Practice to discuss this further. The Practice acknowledged its response was not in line with standards and took opportunity to issue a further response in January 2026 to put this right. Mr B made it clear to us he was not looking for apology as an outcome, but for acknowledgment and service improvements, and we relayed this to the Practice.

85. The further response acknowledges the GP’s initial response was not in line with the complaints standards and explains it has taken the feedback on board to improve complaints communication with patients in future.

86. We consider these actions are appropriate and we do not see indications to suggest further action is needed in relation to this aspect.

87. We have next considered the Practice’s final response, sent in May 2025. Mr B says this does not take accountability or acknowledge any impact on him. We have considered this further in the above sections and noted where we consider the Practice has taken appropriate action to address the concerns Mr B has raised.

88. We therefore do not reach any further view on this aspect of Mr B’s complaint. This does not detract from how the responses made Mr B feel at the time and we can see how they fell short of standards.

89. We hope Mr B can see how the Practice have now met standards to address his concerns and take on board learning for the future.

Conclusion

90. We thank Mr B for bringing his complaint to us. While this may not be the outcome he was hoping for, we hope he can see how we have balanced our decision in line with standards and guidance.

1. Mr B complains about the actions of a medical centre in London (the Practice). He complains the Practice did not make appropriate and prompt referrals for his stomach and skin concerns and provided misleading advice in relation to this. Mr B also says the Practice did not handle his complaint appropriately.

2. We are sorry to learn of Mr B’s experiences with the Practice. We can see how frustrating and worrying these aspects of complaint will have been for him, particularly with his concerns that delays in referrals have caused him to suffer unnecessarily and fearing his conditions will have worsened without treatment.

3. We are unlikely to be able to reach a view about the referral for skin concerns. This is because we have two conflicting accounts of the appointment for this, and do not have further evidence to reach a view.

4. We saw indications of failings in the Practice’s actions following a gastroenterology referral, as we consider it did not act on the instructions in the clinic letter. We can however see the Practice has taken action to apologise for this and take learning. We therefore consider the Practice has done enough to put this right.

5. We can also see the Practice has taken Mr B’s concerns about the misleading information seriously and has taken appropriate action to apologise and take learning from this. We therefore again consider the Practice has done enough to put this right.

6. We also saw indications of failings in the Practice’s complaint handling. We have spoken with the Practice about this. It has agreed to take action to address this and apologise to Mr B. We consider these actions are appropriate to resolve these concerns.

7. We recognise some of our decision may be disappointing to Mr B, but hope our explanations below reassure him that his complaint has been considered fairly and impartially, considering all relevant evidence and in line with standards and guidance.