A practice in the Tonbridge and Malling area

3. Mr K complains about the service he received from the Practice in May and June 2025. Mr K says the Practice provided him with an inappropriate fit note and it refused to amend it when asked. Mr K says this affected his ability to take necessary time off work. He says was ongoing for several weeks and continues to impact his daily life and wellbeing.

4. Mr K complains the Practice failed to cater to his reasonable adjustment request. Mr K is also unhappy with the length of time it took the Practice to respond to his complaints.

5. Mr K says failings at the Practice have significantly worsened his mental health. The delays in complaint handling, poor communication, and lack of understanding of autism and his mental health needs, have caused ongoing stress, anxiety and emotional exhaustion.

6. Mr K would like the Practice to acknowledge the impact of the failings, provide a written apology and a financial remedy.

7. Mr K had a telephone consultation with the Practice in late April 2025 to request a fit note for two weeks.

8. Mr K had a further telephone consultation with the Practice in mid-May and requested an extension to his fit note for a further two weeks. Mr K also asked for advice on how to access NHS services in relation to his recent autism diagnosis.

9. Mr K called the Practice a couple of days later to ask about his recent fit note enquiry that he made online that morning.

10. The following day Practice provided Mr K with his fit note by email. On the same day Mr K sent the Practice two emails asking for the fit note to be amended. Later that day, Mr K raised a complaint about his fit note. The Practice provided its response to the complaint on the same day. Mr K was unhappy with the response and sent the Practice a further complaint.

11. The following day Mr K sent the Practice a further email to reconfirm his concerns in the complaint he sent the previous day. Later that day Mr K sent the Practice a further email to advise he was not happy his previous emails had not been acknowledged, and he raised further concerns he wanted the Practice to investigate. On the same day the Practice acknowledged all Mr K’s emails of complaint and asked him to allow it time to respond to all of his concerns.

12. Later in May Mr K emailed the Practice asking for an update on his complaint. On the same day Mr K emailed the Practice to share information in relation to his assessment that he had with NHS Talking Therapies that morning. He also provided the Practice with a copy of the assessment letter that he received from the Senior Psychological Wellbeing Practitioner at NHS Talking Therapies.

13. A couple of days later Mr K had a face-to-face appointment at the Practice to discuss the fit note process. Later that day the Practice Manager emailed Mr K to confirm all the issues raised in his complaints had now been addressed by the doctor he had seen that morning. The Practice Manager also asked Mr K if he had any further concerns outstanding.

14. Mr K emailed the Practice in early June to say some of the concerns were discussed during his recent face-to-face appointment, but he did not feel all the concerns he raised in his formal complaint have been fully or adequately addressed. On the same day the Practice provided its final response to Mr K’s the complaint.

18. At the primary investigation stage of any 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 we have not seen any indications that something has gone wrong. We have explained why below.

Fit note

19. Mr K says he asked the Practice to extend his current fit note for a further two weeks. However, when he received the fit note the reason documented for being unable to work had changed from ‘Side effects from coming off medication’ to ‘Poor concentration’ and was only for a period of one week. He complains about the details of the fit note, and that the Practice refused to amend this when asked.

20. We have first considered the details contained in the fit note.

21. Our adviser said healthcare professional should follow the GOV.UK guidance when issuing a fit note.

22. The GOV.UK guidance says a fit note is based on an assessment by a healthcare professional about their patient’s fitness for work. In order to complete a fit note, the healthcare professional can undertake an assessment through a face-to-face appointment, video call, telephone consultation. It also says the length of a fit note will depend on healthcare professional’s clinical judgement.

23. The GOV.UK guidance also says the person requesting the fit note should discuss anything that they think would help them stay in or return to work with their employer. For example, arranging for an occupational health assessment.

24. The records show Mr K had a telephone consultation with the Practice at the end of April 2025. Mr K requested a fit note for two weeks and said the reason he was unable to work was due to side effects due to coming off medication. The GP agreed to his request and confirmed the fit note was available to pick up from the Practice on that day.

25. The records show Mr K contacted the Practice via its online service in mid-May and asked for an extension of his previous sick note for two weeks due to ‘autism burnout’. On the same day a GP at the Practice contacted Mr K by telephone to carry out a consultation.

26. The records show the GP looked at the previous consultation in late April, the problem recorded in the medical records was ‘poor concentration’. The GP produced a computer-generated fit note, the condition for being unable to work was automatically populated as ‘poor concentration’. The records show the GP confirmed to Mr K the fit note would be for one week only.

27. The records show the GP explained the fit note process to Mr K and advised him if he was going to be off work longer that a week due to autism burnout, then he should engage with his employer and ask them to do an occupational health assessment.

28. The Practice’s actions here appear to be in line with the GOV.UK guidance set out in paragraphs 22 and 23. In mid-May the Practice carried out a telephone assessment and produced a computer-generated fit note based on the problem recorded during the April consultation. The Practice confirmed to Mr K the fit note would only be for one week and gave advice on an occupational health assessment if he felt he was going to be off work longer.

29. We understand Mr K is concerned the reason documented on the May fit note had changed and was only for a period of one week. We acknowledge this caused him distress.

30. Based on the evidence we have considered, we have not seen any indication of a failing in the Practice’s actions when completing the fit note. The fit note produced was valid based on the problem recorded at the April consultation, and the fit note period of time was based on the GP’s clinical judgement.

31. We have also considered the Practice’s refusal to amend the fit note.

32. The records show Mr K contacted the Practice by email in mid-May to request an amendment of his current fit note that reflected his clinical needs. He also requested the fit note be for a period of two weeks.

33. The records show the Practice emailed Mr K on the same day to confirm the fit note issued in May was an extension of the previous fit note issued in April. The Practice explained to Mr K if he wanted the fit note reviewed then he would need to have a further GP consultation. It said only then could the reason for being off work be changed.

34. The Practice also informed Mr K it would not be changing the period of time on the current fit note. The Practice advised Mr K to contact it back after the current fit note had expired, if he wanted it extended further.

35. Again, the Practice’s actions here appear to be in line with the GOV.UK guidance set out in paragraphs 22 and 23. The Practice informed Mr K he would need to have a GP consultation to have the reason for being off work changed. The Practice also advised him to contact it again if he needed the fit note extended.

36. We understand Mr K is upset because the Practice would not change the reason why he is off work or extend the fit note further. We acknowledge this caused him further distress.

37. Based on the evidence we have considered, we have not seen any indication of a failing in the Practice’s actions here. The Practice offered Mr K a further GP consultation to change details within the fit note. It confirmed he could call the Practice back if he wanted the fit note extended. These actions appear to be in line with GOV.UK guidance.

38. We have therefore decided not to consider this part of Mr K’s complaint any further. We realise our decision here will cause further upset for Mr K and we are sorry for any upset or distress our decision may cause.

Reasonable adjustment

39. Mr K was recently diagnosed with autism. He complains the Practice refused to make reasonable adjustments to help support his needs, such as avoiding telephone or face-to-face appointments and to only communicate in writing instead.

40. The NHS England guidance sets out how to support someone with a mental impairment that has a substantial and long-term adverse effect on their ability to do normal daily activities. It says healthcare professionals should ensure they have good access to healthcare. Healthcare professionals can do this by making changes, often quite small, to the way that they care for people. These changes are called reasonable adjustments.

41. The NHS England guidance says reasonable adjustments can be things like a digital flag. A digital flag is a national, visible marker on a person’s record, which indicates any reasonable adjustments needed by a person with a disability whenever and wherever they are seen or treated by any publicly-funded health and social care service.

42. It is important to note that if making an adjustment would increase the risk to health and safety, this should be considered when making a decision about whether the adjustment is reasonable.

43. The records show Mr K wrote to the Practice in late May to confirm he no longer wished to have telephone or face-to-face contact with it. He said moving forward, he only wanted to communicate with the Practice in writing, and he asked the Practice to make these reasonable adjustments in light of his recent autism diagnosis.

44. The records show the Practice wrote to Mr K in early June to say it would try its best to cater to his reasonable adjustments. The Practice went on to say there may be situations where written communication is appropriate. However, it said GPs will generally communicate with patients on a face-to-face or telephone basis. It explained his request for written communication only could cause clinical issues and is potentially unsafe for his ongoing care.

45. Our advisor said Mr K’s request for written communication only, could mean clinical safety is compromised.

46. The records show the Practice explained to Mr K there may be times where a clinician would need to examine him. It also explained he may be requested to provide a blood test where he would need to come into the Practice. It said it could look at making GP appointments via telephone to avoid him having to come into the Practice and his records could be marked to this effect if he wished.

47. The Practice’s actions here appear to be in line with the NHS England guidance as set out in paragraphs 40 and 41. The Practice offered GP appointments via telephone only to avoid Mr K having to visit the Practice. It has also offered to add a reasonable adjustment digital flag to Mr K’s records. It explained how communication in writing only could cause clinical issues and his ongoing care could be compromised.

48. We understand why Mr K is upset that the Practice would not agree to all his reasonable adjustments. We acknowledge this will cause him further distress due to his neurodevelopmental condition.

49. Based on the evidence we have considered, we have not seen any indication of a failing in the Practice’s actions here. The Practice offered to make reasonable adjustments where possible and safe to do so. It has explained why written communication may not always be appropriate.

50. We have therefore decided not to consider this part of Mr K’s complaint any further. We realise our decision here will cause further frustration for Mr K and we are sorry for any upset or distress our decision may cause.

Complaint handling

51. Mr K complains about the length of time it took the Practice to respond to his complaints. He says the delays caused him ongoing stress and anxiety.

52. The Regulations say NHS organisations should respond to a complaint within six months.

53. The records show Mr K raised his first complaint to the Practice in mid-May. The Practice provided its response to Mr K’s complaint on the same day.

54. We can see Mr K raised a second complaint with the Practice later the same day. Mr K had a consultation at the Practice eight days later and his complaint was addressed on that day. The Practice also emailed Mr K on that day to ask if his complaint was now resolved.

55. The records show Mr K emailed the Practice in early June to say his complaint was not fully addressed at the consultation in May and he outlined his outstanding concerns. Later that day, the Practice provided its response to Mr K’s concerns.

56. The Practice’s actions here are in line with the Regulations. In total the Practice took just over three weeks to respond to all Mr K’s complaints. The time taken from Mr K’s first complaint to the Practice, to the Practice’s final response, was clearly inside of the six-month timescale set out in the Regulations.

57. We understand Mr K found the length of time it took the Practice to respond to his complaints difficult. We acknowledge this was a frustrating time for him.

58. Based on the evidence we have considered, we have not seen any indication of a failing in the Practice’s actions. The total time taken to respond to the complaints was in line with the Regulations. We hope our decision here provides Mr K with some reassurance about the time taken by the Practice to respond to his complaint.

Summary

59. In summary, based on the evidence we have considered, including the clinical advice we have received, we have not seen any indications of failings in the actions of the Practice. In reaching our decision, we must consider relevant guidance and if it appears the guidance was followed. In this instance we have seen the Practice have acted in line with all the guidance as set out above.

60. We acknowledge this has been a very difficult time for Mr K. We understand these events have caused him ongoing stress and anxiety, and continue to impact his wellbeing. As we have seen nothing to indicate the Practice got anything wrong, we will not be taking any further action on this complaint. We hope our work will being some reassurance to Mr K about his concerns.

1. We have carefully considered Mr K’s complaint about a GP Practice in Kent (the Practice). We were sorry to hear Mr K’s concerns about the service he received from the Practice. We recognise he has been through a difficult and distressing time and that these events have impacted his mental health.

2. We have reviewed all the relevant evidence. We have seen no indication that anything went wrong. We recognise Mr K may be disappointed by this decision. We hope this statement will help him understand how we reached our decision.