5. Mrs R complains that in June 2024, the Surgery removed her family from its patient register. Mrs R says this left the family without access to primary care services or prescription medication while they were moving house.
6. By bringing her complaint to us, Mrs R seeks acknowledgment of failings, an apology, and improvements to the Surgery’s out-of-area procedures. Mrs R also seeks a financial remedy.
7. Mrs R lived outside the Surgery’s catchment area. She registered at the Surgery as out-of-area patient in or around 2017.
8. The Surgery agreed Mrs R could remain registered as an out‑of‑area patient, subject to certain limitations. We have not seen a copy of the written agreement, and the Surgery’s and Mrs R’s descriptions of the terms differ slightly. However, both accounts indicate that the arrangement restricted access to some services and that the registration might be reconsidered if the Surgery considered continuity of care to be compromised.
9. Mrs R says the problem started in June 2024. Around this time, she phoned the Surgery to make an emergency phone appointment for her young child, who had been unwell for five days.
10. The Surgery decided a physical examination was required and asked Mrs R to come in. Mrs R was unable to come to the Surgery the same day. The Surgery told Mrs R that her child should be seen the following day if they were still unwell.
11. The next day, Mrs R took advice from NHS 111 and then accessed an urgent treatment centre, rather than visit the Surgery, although this was during the Surgery’s normal operating hours.
12. Mrs R says she received a letter in June 2024 from the Surgery asking her to register with a practice closer to home.
13. After Mrs R complained, the Surgery provided a written response explaining its position.
14. The Surgery said it removed Mrs R from its patient register because continuity of care for her child was compromised.
15. The Surgery also said Mrs R was never formally removed. Rather, Mrs R left the Surgery on 7 October 2024.
18. Before we decide if we should investigate a complaint in more detail, we look at a few different factors. We consider whether there are signs the organisation concerned has got something wrong. We do this by comparing what should have happened with what did happen. If what happened fell far short of what should have happened, we call this a failing. We also look at whether what happened had a negative impact on the person in question. If we think it did, we will go on to consider what, if anything, the organisation has done to try to put things right.
19. If we think there was a failing, and that this had an impact that has not been put right, we will usually investigate in more detail.
20. In this instance, we did not see any indication of a failing on the part of the Surgery.
21. The NHS England guidance explains that practices decide whether outofarea registration is clinically appropriate and practical for an individual patient, and notes that registration without home visits may not be suitable where this would compromise clinical care. The guidance also says a trigger for review includes exceptional use of homearea urgent care services when the patient is unwell and unable to attend the registered practice.
22. Both Mrs R and the Surgery describe the outofarea registration as being subject to limitations and periodic review. Although we have not seen a copy of the written agreement and the parties’ descriptions of the terms differ slightly, both accounts indicate that the registration might be reconsidered if continuity of care was considered to be compromised.
23. The Surgery says that the sequence of events in June 2024 raised concerns about continuity of care and prompted it to reconsider the outofarea registration. In its complaint response letter, the Surgery explained that it felt clinical care was compromised when, after five days of illness, Mrs R’s child was not brought in for a physical examination despite the GP’s advice. It also explained that it considered the family’s use of local urgent care services during its normal opening hours to affect continuity of care, prompting a review of the family’s outofarea registration.
24. We accept that Mrs R disagrees with the Surgery’s position on this matter and that it may well be the case that normally, she is able to get to the Surgery when needed. The Surgery, on the other hand, must be sure it can provide safe, effective care for its patients. It was in line with the NHS Egland guidance for the Surgery to review the arrangement after the events in June 2024. Whether or not that review should have led to removal from the patient list is discretionary – and we do not think it would be appropriate for us to criticise the Surgery for prioritising patient safety over patient convenience. We have, therefore, decided not to look into this further.
25. We appreciate it may have been upsetting when the Surgery asked Mrs R to register with another GP practice closer to home. We also understand it could feel daunting to find a new GP in the middle of moving house, especially given that Mrs R’s young child was experiencing frequent illness.
26. Under complex circumstances like these, continuity of care is important to ensure every member of the family can access safe and effective primary care with an appropriate provider, rather than needing to rely on urgent care services for ongoing needs. The Surgery’s complaint response letter indicates that it considered ending the outofarea registration would support more consistent access to primary care for the family. We hope that Mrs R finds our analysis useful in understanding these events and is reassured that the Surgery acted in line with applicable guidance.
1. We have carefully considered Mrs R’s complaint about a GP surgery in the Herefordshire Area (the Surgery).
2. We have seen no indication that anything went wrong when the Surgery decided that Mrs R should register with a GP practice closer to home.
3. We have, therefore, decided not to investigate in more detail or take any further action.
4. We recognise Mrs R had a difficult time when the Surgery decided to remove her from its patient register. We realise it was inconvenient to register with a new GP practice and that this occurred at a challenging time for her family.