Complaint about a General Practitioner
Jump to
Inadequate responses to a letter from a hospital Consultant about a patient’s medication and to a letter of complaint from the patient’s wife
Background to the complaint
Mrs Y’s late husband (Mr Y) was severely disabled with a chronic obstructive pulmonary disorder (a condition that results from damage to the breathing tubes and air sacs within the lungs). He was a patient of Dr Z at a GP Practice. In May 2005 a hospital Consultant (the Consultant) wrote to the Practice, suggesting changes to Mr Y’s medication. The Consultant’s Specialist Registrar saw Mr Y in August, when it transpired that Dr Z had not acted upon the Consultant’s letter. Mr Y’s prescription was changed after the Specialist Registrar wrote to the Practice.
Complaint to the Practice and to the Healthcare Commission
In September 2005 Mrs Y delivered a letter of complaint to the Practice about Dr Z’s failure to act upon the Consultant’s letter. Despite the intervention of the local Primary Care Trust, the Practice did not respond. In January 2006 Mrs Y referred her complaint to the Healthcare Commission, which was unable to complete its review due to the Practice’s lack of co-operation.
What we investigated
The Healthcare Commission referred Mrs Y’s complaint to the Ombudsman, who exercised her discretion to investigate the complaint as it stood. Sadly, Mr Y died in June 2006.
We investigated the Practice’s failure to take action on the Consultant’s letter and failure to respond to Mrs Y’s complaint about that. We examined the available documentation, and took clinical advice from a General Practitioner.
What our investigation found
Dr Z was responsible for ensuring that his Practice had effective procedures for dealing with correspondence. Although we could not establish the precise sequence of events, it appears that after receipt at the Practice, the Consultant’s letter was probably filed in Mr Y’s notes without being referred first to Dr Z. We concluded that the Practice did not have a robust procedure in place to record and respond to such letters.
Our clinical advice was that it would have been desirable for the Practice to have implemented the Consultant’s suggested changes, and if the Practice had done so without delay, then this could have helped Mr Y’s breathlessness, reduced the rate of exacerbations (a sustained worsening of the patient’s symptoms from their usual stable state, which is beyond normal day-to-day variations and is acute in onset) and improved his quality of life. It was unlikely, though, that the three-month delay in changing Mr Y’s prescription altered his long-term prognosis.
Since 1996 GP surgeries have been required to operate their own complaints procedures, in line with national guidelines. Dr Z had ultimate responsibility for ensuring the Practice had an acceptable procedure in place to handle and monitor complaints and that staff were trained to operate that procedure efficiently. We would have expected the Practice Manager to manage the complaints procedure for Dr Z (as she does now). The Practice initially said they had replied to Mrs Y’s letter, but could not produce a copy of their reply. However, the Practice later admitted that, essentially, they had ignored
Mrs Y’s complaint and did not reply. The Practice Manager’s evidence indicates that the letter was filed away without being date-stamped or seen by Dr Z. We criticised the Practice for not responding to Mrs Y’s complaint and condemned them for misrepresenting the truth by initially insisting they had replied to her complaint.
These failings left Mrs Y with little choice but to pursue her concerns through other routes. This prolonged her dissatisfaction and distress at a time when she was naturally concerned for her husband’s health. It also meant that she had to wait longer than necessary for an independent explanation about the impact of the delayed change to her husband’s medication on his health.
During our investigation, Dr Z told us that his own ‘lack of experience in the NHS Complaints Procedure’ led to his ‘totally inadequate and incorrect’ handling of Mrs Y’s complaint. He wrote to her, apologising unreservedly for the unacceptable handling of her complaint, and offered to meet her, to offer an honest and thorough account of his management of her husband. He apologised that an oversight had apparently delayed the start of Mr Y’s new medication and concluded that the Practice had learnt from their mistakes. Having considered Dr Z’s letter, Mrs Y told us that she felt that his apology was insincere and too late, and reiterated her view that her husband might have lived longer had Dr Z changed his prescription promptly. She declined the meeting offer, saying that she would prefer a written explanation of his management of her husband.
We upheld Mrs Y’s complaint and concluded our investigation in August 2007.
Outcome
We recommended that Dr Z:
- write to Mrs Y, offering her a full and honest explanation for the Practice’s failure to act on the Consultant’s letter and her complaint; and
- pay her £250 in recognition of the distress and inconvenience the Practice’s poor complaint handling had caused.
We noted the action that Dr Z had taken (and planned to take) as a result of Mrs Y’s complaint, in particular his intention to attend NHS complaint handling courses and to set up a Practice system to ensure that the same mistake cannot recur. In support of that, we recommended that Dr Z ask the Primary Care Trust to consider his proposed action plan, to help him to make any changes considered necessary in light of our findings, and to implement and monitor it.
Dr Z agreed to implement our recommendations.
Principles of Good Administration
The Principles of Good Administration were not referred to in our report but this case summary serves to illustrate the following Principles:
- ‘Being open and accountable’ (taking responsibility for actions).
- ‘Putting things right’ (acknowledging mistakes and apologising).
- ‘Seeking continuous improvement’ (learning lessons from complaints and using them to improve services and performance).
