ADHD referral
20. 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. Having done so we think the Practice has already done enough to put right the impact of these events. We have explained our decision below.
21. Miss A complains about the lack of action the Practice took when she requested an ADHD referral for her son, Y. She complains the Practice advised her of the wrong process when submitting for the relevant documentation for the referral. Miss A also complains the Practice provided no updates on Y’s ADHD referral.
22. Our Principles say organisations should ‘get it right’ and act in accordance with its policies and guidance. Organisations should be open and clear about policies and procedures and ensure that information and any advice provided is clear, accurate and complete.
23. The Practice reviewed what happened with Y’s referral. Upon its review, it explained that it did not take any further action after Miss A submitted the completed ‘Right to Choose’ forms. This was despite Miss A correctly following the advice the GP gave her during appointment on 4 July 2024.
24. The Practice explained that after filling in the relevant forms regarding her preferred provider, it should have advised Miss A to make another appointment with the GP. This would so the Miss A and the GP could discuss the referral, and the GP would complete the rest of the referral. It is at this point that the GP would have referred Y to the provider.
25. From the records, and from Miss A’s account, we can see that after submitting the ‘Right to Choose’ form, Y did not receive any follow-up appointment with the GP to discuss and complete the referral. This is not in line with what the Practice says should have happened, and it does not demonstrate the Practice ‘got it right’, in line with Our Principles.
26. In terms of receiving any updates, we understand Miss A contacted the Practice on a couple of occasions to ask about the status of the referral. The Practice advised Miss A that the forms were with the GP, or that it had completed the referral. This was not accurate, as the Practice had not completed the referral.
27. The Practice also advised Miss A that due to long waiting times to receive an ADHD referral, it would be a long time to hear anything back. We recognise this advice was accurate, as the waiting lists for ADHD assessments are long. However, the advice failed to recognise it had not submitted the referral, and the assessment would not take place until the Practice had done this.
28. On another occasion, the Practice advised Miss A to start the process again as it had not advised Miss A of the right process for an ADHD referral.
29. The Practice’s actions here do not appear to be in line with Our Principles. It did not provide Miss A with clear, accurate and complete updates.
30. There are indications of failings here. The Practice appears to have failed to act in line with Our Principles when it did not follow its own process for arranging the ADHD referral, and in providing inaccurate updates.
31. Miss A says the delay and lack of action by the Practice has delayed Y’s ADHD referral to the relevant provider. We understand Y remains unassessed for ADHD and is on an inactive waiting list. Miss A has told us Y is not receiving the support he requires in school and his education is suffering as a result. Overall, Miss A says the Practice’s actions have had a negative impact on Miss A and Y’s wellbeing.
32. The ADHD assessment provider confirmed with the Practice that it received Y’s referral for an ADHD assessment. Unfortunately, Miss A received an email from the provider in late November advising her that it had paused NHS assessment. This is a decision by the provider, and the Integrated Care Board (ICB), and is not a decision the Practice can influence.
33. The Practice contacted Miss A a week or so later. It confirmed that Y is still on the ADHD assessment provider’s list for an assessment. However, all assessments are on hold, both for new referrals and for patients already on the list who have not yet been offered assessment dates. It advised Miss A that it would send the provider an expedite letter in the hope that Y could be seen sooner.
34. The ADHD assessment provider responded to the Practice’s expedite letter in December, a week or so after the Practice sent the expedite letter. It advised the Practice that it was unable to prioritise booking a patient due to an ‘external administrative error’.
35. In January 2026, the ADHD assessment provider provided an update to the Practice. The provider explained that as Y was within one of the paused ICB areas (until at least April 2026), it was unable to give an exact timeframe. It said that in April, once the ICB had provided it with further information, it could inform the Practice further.
36. We can understand how the administrative delays on the part of the Practice have had a negative impact on Miss A and Y. Especially in Y not receiving the support Miss A believes he requires in school. We do not underestimate the effect this has had on both Miss A’s and Y’s wellbeing.
37. The Complaint Standards say organisations should explain why things went wrong and identify suitable ways to put things right for people.
38. As outlined previously, the Practice had explained what went wrong in Y’s case. When the ADHD assessment provider had received the referral, the evidence we have shows the Practice was actively chasing the status of this referral. It is unfortunate that the provider had paused assessments two months after it received Y’s referral, but this is outside of the Practice’s control.
39. The Practice also requested the provider expedite the referral. It is unfortunate that the provider decided it was unable to expedite Y’s referral, but we recognise this is outside of the Practice’s control.
40. In its response to Miss A’s complaint, the Practice apologised for what happened and the upset and distress this caused Miss A and Y.
41. The Practice’s actions are in line with the Complaint Standards. It has explained why things went wrong, and has taken action to try and put things right for Miss A. In terms of Y’s place on the list for an assessment, as the provider as paused all assessments, Y’s position on the list is irrelevant.
42. Similarly, even if the Practice had referred Y when it should have done, we do not know whether Y would have already received an assessment before this pause. This is because we do not know how long the waiting times are, as these can fluctuate depending on demand on the relevant service.
43. Furthermore, we cannot ask the Practice to provide Miss A with a financial remedy towards a private ADHD assessment. We understand why Miss A would want this, as it may provide a quicker ADHD assessment for Y. Y can receive an ADHD assessment on the NHS, albeit there are delays (even in the absence of issues) in assessments. It would be Miss A’s choice whether to seek a private assessment or not.
44. We appreciate this may not provide much, if any, comfort to Miss A. We recognise this has been a difficult and frustrating time for Miss A and Y, and that there is an ongoing impact for them from waiting for the assessment.
45. While we think there are indications of failings in the Practice’s actions, we think Practice has taken the steps needed to put things right. Because of this, we will not consider this part of Miss A’s complaint further. We apologise if our decision here causes Miss A and Y any further distress.
Confidential documents
46. Miss A complains the Practice has not informed her of the whereabouts of the confidential documents she submitted to the Practice for the ADHD referral.
47. Our Principles say organisations should handle and process information properly and appropriately. In this situation, we think this means the Practice should have accurately recorded the referral, and accompanying information, in Y’s medical record. Or it should have stored the information safely where it could be found.
48. In its response to Miss A’s complaint, the Practice advised it had been unsuccessful in locating the documents supporting Y’s referral. This was despite it investigating the matter, and having spoken with receptionists, secretaries, administrators and doctors as to where these documents may be.
49. The Practice’s actions here are not in line with Our Principles as it does not appear to have handled Miss A’s information properly. For example, the Practice noted it had received the documents, but it cannot advise Miss A if it was scanned into its system incorrectly, or if it had noted that the document had been destroyed because they were duplicates of information it already had.
50. There are indications of failings here.
51. Miss A says not knowing where the confidential documents are is very worrying for her. We can understand how worrying it would be for Miss A not knowing where these documents are.
52. As part of our investigation, we asked the Practice if it had been able to establish what happened with these documents.
53. The Practice confirmed that it could not locate the documents. It explained that it thinks ‘it is possible that the doctor or staff member who received the form may have inadvertently placed it in the confidential waste bin with other documents … On this occasion, although the receptionist recorded that the form had been received, the record did not specify which member of staff the form was subsequently passed to’.
54. The Practice explained what it has done because of these events. This has included introducing a protocol for assessment forms, and accurately recording what action has been taken with the form. The Practice also provided reassurance to us that it takes patient confidentiality very seriously and always aims to keep patient information secure.
55. We asked the Practice if it would be willing to explain to Miss A what is has said to us regarding the documentation. The Practice has said it is willing to do this. We will ask the Practice to write to Miss A with these explanations within four weeks of the date of this statement.
GP appointment
56. Miss A also complains the GP at an appointment in July 2024 was dismissive, offered little empathy and reluctantly explained the ‘Right to Choose’ process.
57. In the record of this appointment, there is only a brief note: ‘History - concerned about ADHD fidgeting, can’t stay still, poor concentration, poor behaviour at school, can be impulsive. Plan – explained right to choose – will look into it’.
58. We understand an appointment note would not include how the GP was during the appointment, and this is something that would be subjective. In terms of the ‘Right to Choose’ process, the note only says the GP explained this, not how much they explained, or the way the GP explained it.
59. In the response to Miss A’s complaint, the Practice explained all clinicians are expected to treat patients and their families with empathy, understanding and respect. The GP apologised for the upsetting experience Miss A and Y had during the appointment. The Practice were deeply concerned that Miss A felt dismissed and unsupported, and how Y left confused.
60. Miss A says the appointment with the GP left her and Y distressed and feeling unsupported. We acknowledge Miss A and Y felt like this.
61. The Complaint Standards say organisations should support and encourage staff to be open and honest when things have gone wrong or where improvements can be made. Staff recognise the need to be accountable for their actions and identify what learning can be taken from a complaint.
62. The Practice recognises Miss A’s poor experience at that appointment, apologised for what had happened and acknowledged the impact it had on her and Y. It also advised Miss A of the learning it has taken from her complaint, and that it would review the appointment to ensure high standards are upheld to make sure this does not happen again.
63. The Practice’s response to this part of Miss A’s complaint is in line with the Complaint Standards. It has acknowledged the appointment could have been better and has apologised for the impact of its actions. Because of this, no further action will be taken on this part of Miss A’s complaint.