Foreword
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This is a report of my investigation of a complaint that a GP ‘bullied’ a patient, Mrs S, into leaving the GP Practice that her family had been with for 24 years. Following the investigation, I upheld the complaint but the GP has not accepted all my recommendations to remedy the injustice arising from his mistake. Therefore, I am laying this report before Parliament under section 14 (3) of the Health Service Commissioners Act as I have found injustice arising from maladministration which has not and, it appears, will not be remedied.
Mrs S’s story begins with her concern about her daughter’s health. Mrs S’s daughter had been suffering from poor health for a few years and had frequent episodes of passing out. The cause of these episodes was undiagnosed. Mrs S attended her GP Practice with her daughter in August 2010 after her daughter had collapsed at work. The Practice’s receptionist told Mrs S that as it was after 6pm there were no more appointments and so she would have to go to the walk-in centre or wait for an out-of-hours GP. Mrs S said that she told the receptionist that her daughter was unconscious in the car. Mrs S added that when she could not get an appointment she ‘stormed out’ of the Practice because she was upset and angry. The receptionist said that Mrs S swore as she was leaving. Mrs S said that she did not swear.
When the GP was told of what had happened he decided that he should write to Mrs S. In his letter he wrote that her attitude towards reception staff and the offensive language she used was not acceptable. He said that if the Practice did not receive a written apology from Mrs S within 14 days he would be unable to offer her medical care at the Practice and would require her to register elsewhere. Mrs S considered this an ultimatum and registered herself with another GP.
Mrs S complained to the Practice. She was dissatisfied with the outcome of the local resolution process so she complained to my Office. We investigated her complaint. We found that although the GP did not remove Mrs S from the Practice’s patient list, Mrs S was left in no doubt that if she did not apologise then she would be removed. The GP had not acted in line with national and local guidance about removing patients from a GP list. His actions fell so far below the applicable standard in the circumstances as to amount to maladministration which resulted in injustice for Mrs S as she felt ‘bullied’, was distressed and was inconvenienced. Mrs S’s distress was exacerbated by the knowledge that the GP was aware of Mrs S’s daughter’s on-going undiagnosed condition but the GP had not appeared to have given any consideration to this in his decision-making.
In September 2011 I issued the final report of the investigation of Mrs S’s complaint. I recommended that within one month of the report the GP should:
- provide Mrs S with a full written acknowledgement of the maladministration identified, giving her a sincere apology;
- provide financial redress of £500 for the distress and inconvenience resulting from his actions;
- prepare an action plan to describe what he had done to ensure that he had learnt the lessons from the maladministration identified. He should also detail what he had done and/or planned to do, including timescales, to ensure that the Practice staff are made aware of, and follow, the relevant standards and guidance in relation to removing patients from the Practice list.
In response the GP said that his Practice were planning to organise in-house training regarding guidelines concerning patient behaviour and removal requests. He did not consider his communication with Mrs S was a direct removal request but he was willing to apologise if that was how it was interpreted. He refused compensation saying that his Practice ‘will not sanction or condone the payment of monies rewarding such poor behaviour.’ This was a reiteration of the GP’s response to the draft investigation report.
Unfortunately, by refusing to accept my recommendations in full the GP has missed the point. He may consider that his letter was misinterpreted by Mrs S as an ultimatum. But this is not an issue of the GP’s intention versus Mrs S’s interpretation. Following my independent investigation, I have found that, whatever the intention of the letter, its wording was unambiguous. I do not regard the GP’s demand for an apology to be an opportunity to respond. I found that the GP’s letter played a significant part in the breakdown in the relationship between the GP and the patient.
Furthermore, the GP has misunderstood my recommendations for remedy. Like the GP and his colleagues at his Practice, I would not sanction or condone the payment of monies for poor behaviour. Aggression and abuse are never acceptable and GP Practice staff have a challenging job when they are on the receiving end of such behaviour by patients. Whatever precisely happened when Mrs S stormed out of the Practice on an August day in 2010, I have not investigated Mrs S’s actions. What I have investigated is Mrs S’s complaint about the GP and his actions. My independent investigation found that, following the incident when Mrs S stormed out, the GP got things wrong. As a result of his mistake and his significant part in the breakdown in the relationship with his patient, Mrs S moved to a different GP practice. I found that the GP’s actions therefore resulted in Mrs S experiencing injustice in the form of distress and inconvenience alongside feeling ‘bullied’. My recommendations are to remedy that injustice experienced by Mrs S.
I have no doubt that having a patient storm out was an unpleasant experience for the Practice’s staff. That does not remove the injustice experienced by Mrs S arising from the GP’s actions. In Mrs S’s words she was ‘bullied’ into finding a new GP practice after 24 years as she was given an ultimatum to apologise or be removed from the patient list. Mrs S’s injustice remains unremedied.
My investigation report was copied to NHS Dudley, the local Primary Care Trust. They have urged the GP to comply with my recommendations and are considering what further action to take.
In October 2011 I considered that the GP’s unwillingness to comply with my recommendations raised questions about his fitness to practise, sufficient to constitute a threat to the health and safety of patients. Therefore, I shared the report of my investigation with the General Medical Council. The General Medical Council is considering what action to take.
This is only the second time I have laid a report under section 14 (3) of the Health Service Commissioners Act since I became Health Service Ombudsman for England in 2002. By laying this report I am able to put into the public domain my investigation report, naming the doctor. I am also able to reinforce a theme in my recent report Listening and Learning: the Ombudsman’s review of complaint handling by the NHS in England 2010-11. In the latter report I said that in a small but increasing number of cases a failure to resolve an issue led to a patient being removed unfairly from the GP’s patient list and that my Office’s casework shows that some GPs are not following clear guidance available to them. As I said in Listening and Learning, as GPs prepare for the increased commissioning responsibilities outlined in the Government’s health reforms, it is essential that they get the basics of communication right. Finally, I hope that making this story public encourages the GP to provide the long overdue remedy to Mrs S.
Ann Abraham
Parliamentary and Health Service Ombudsman
