The Investigation

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  1. We visited Mrs S on 27 January 2011 to discuss the nature of her concerns and the way in which we would investigate her complaint. We also visited the Practice on the same day to discuss Mrs S’s complaint.
  2. During this investigation we have examined all the relevant documentation.  This includes papers provided by Mrs S, documentation provided by Dr Hampson, and the papers relating to the attempted resolution of the complaint at local level.  We have taken account of comments made by Mrs S and by the Practice.
  3. In this report I have not referred to all the information examined in the course of the investigation, but I am satisfied that nothing significant to the complaint or my findings has been omitted.

Key events

  1. Mrs S had been registered as a patient at the Practice for 24 years. Her children were also registered there. Over the past few years her daughter has been suffering from poor health and has had frequent episodes of passing out. The cause of these episodes has not been diagnosed and she continues to pass out periodically.
  2. Mrs S attended the Practice at about 6pm on the evening of 23 August 2010 and asked what time the Practice was open until. The receptionist told her that it was open until 6.30pm but that the last appointments were at 6pm. Mrs S asked if there was a possibility of seeing a doctor but was advised that there were no free appointments. The receptionist informed Mrs S that she could attend a nearby walk‑in centre or could call the out-of-hours doctors who were available from 6.30pm. Mrs S became frustrated at this point and stormed out of the Practice, pushing the door open with force as she did so. The receptionist said that as Mrs S was leaving she said: ‘This surgery is shit, I can’t believe I can’t get an appointment’.
  3. When Dr Hampson was told of what had happened he decided that he should write to Mrs S about the incident. In a letter sent the following day he wrote:
    ‘I am sorry that we were unable to offer you an appointment last night but understand that you were informed of the alternative services available to you for your daughter. 
      ‘Your attitude to our reception staff and offensive language is not acceptable.
    ‘If we do not receive a written apology from yourself in the next 14 days we will be unable to offer you medical care at the practice and so will require you to register elsewhere.’
  4. After receiving the letter from Dr Hampson Mrs S registered herself with another practice.

Local resolution

  1. Mrs S wrote back to Dr Hampson and said that she had decided to register with another GP practice. She explained that she had become so frustrated and emotional because of the ongoing problems with her daughter’s health. She gave her account of events and acknowledged that her frustration had led to an emotional outburst but not ‘attitude’ as had been described by him. She said that she certainly did not use offensive language during the conversation with the receptionist. She said she wanted to receive a letter from Dr Hampson apologising for this error and the slur on her character. She also asked for any mention of the incident to be removed from her records. She said that his letter was a knee-jerk reaction and that it had not taken into account the full facts of what had happened.
  2. On 17 September the Practice Manager wrote to Mrs S. She said that the letter from Dr Hampson concerning Mrs S’s behaviour was not a knee-jerk response to the incident. The Practice Manager said Dr Hampson had received an ‘immediate full report from the experienced receptionist on duty, whom we have no reason to doubt’ and that offensive language would not be tolerated. The Practice Manager advised Mrs S that there was no entry in her medical record to amend with regard to this incident.
  3. On 25 September Mrs S wrote to the Practice Manager. She asked to see a copy of the full report made by the receptionist concerning the incident involving her.  She wanted to know what offensive language she had been accused of using. She wrote that the effect of the Practice Manager’s letter was to make her a ‘branded liar’.
  4. In a letter dated 28 October 2010 the Practice told Mrs S that ‘a copy of the initial correspondence is included in [her] notes’.

Mrs S’s recollections and comments

  1. Mrs S said that her daughter had been ill for many years and therefore had had many visits to the Practice, including one a few days before 23 August. She said that her daughter kept passing out and had knocked herself unconscious on a number of occasions. She said that on 23 August her daughter had again passed out at work and she went to collect her. Mrs S said that she was obviously quite upset about the situation. She said that she knew that the Practice closed at 6pm, but wanted a GP to see her daughter in her semi-conscious state as previously she had only been seen once she had recovered. Mrs S asked the receptionist what the point was of going to the walk-in centre when they did not know her daughter and did not have her medical records. She said that she told the receptionist that her daughter was unconscious in the car. Mrs S said that when the receptionist would not give her an appointment she ‘stormed out’ because she was angry and upset. However, she said that she did not swear.
  2. Mrs S said that they went to the walk-in centre who said that they did not know her daughter and suggested that she see her GP the following day.
  3. Mrs S said that being ‘kicked out’ of the Practice where her family had been registered for 24 years had been ‘mega-stressful’ for her and her daughter, given her daughter’s ongoing illness. She said that she felt ‘bullied’ into leaving and finding another practice because she was given an ultimatum to apologise or face being removed from the Practice list. She said that she felt very let down by the Practice. She said that even when she explained the reason for her reaction Dr Hampson did not reconsider his decision. She said that she would have felt better about things if he had invited her in for a discussion about what had happened.
  4. Mrs S said that it had also been stressful finding a new GP, which was now around three to four miles from her home. She also said that she was worried about the new GP seeing the entry in her records and that this had greatly upset her. She said that, unfortunately, people do judge based on such things. She said that she was also concerned that Dr Hampson and the Practice Manager had told her and this Office that there were no entries in her records relating to this, and felt that the Practice had lied to her and to us.

The receptionist’s comments

  1. The receptionist told us that when she told Mrs S that she could not have an appointment, Mrs S became quite frustrated and was gesturing with her hands, saying that there was an ongoing problem with her daughter. Mrs S said that her daughter needed to be seen. She said this with a raised voice and was quite angry. The receptionist said that she was trying to be quite calm. Mrs S then walked out and pushed the door open with force, which made the receptionist jump, and as she did so Mrs S said: ‘This surgery is shit’. The receptionist said that she was a bit scared that Mrs S might come back in as she had been quite angry.

Dr Hampson’s comments

  1. Dr Hampson said that he sees patients by appointment only and that the walk-in centre was there for these situations. He said that the last patient appointments are at 6pm and so when Mrs S had come in, he was with a patient. When he had finished with the patient he saw that the receptionist was ‘disturbed’ and on the verge of crying. He said that she is very experienced and does not complain needlessly. The receptionist told him what had happened. He told us that Mrs S had been ‘bullying, in‑your‑face, demanding an appointment and aggressive’. He said that she had sworn when she left, although she may have not meant it to be overheard.
  2. Dr Hampson said that the receptionists have to deal with difficult patients all of the time and that he has a duty to protect his staff. He said that, given the receptionist’s state, on the balance of probabilities he was persuaded that Mrs S had acted as the receptionist had described. He said that he was aware of the ongoing situation with Mrs S’s daughter’s health, but that this did not excuse her actions. He said that he had to decide what an appropriate response to Mrs S’s actions should be. He said that it would not have been appropriate to take no action but neither would it have been appropriate to have removed her straight away. Therefore, he decided that her actions needed a ‘fairly strong letter’. He said that the local Primary Care Trust (NHS Dudley) has a strict ‘zero tolerance’ policy which the Practice employs and, therefore, he felt that he had to demand an apology from Mrs S for her actions.
  3. Dr Hampson said that in the 24 years that Mrs S had been a patient at the Practice there had never previously been a problem.
  4. In reference to Mrs S’s concern about there being an entry in her medical records about what had happened, Dr Hampson said that they were a paper-free Practice and so all letters are stored electronically. He said that the letter asking her to apologise had been recorded in Mrs S’s medical records, which contain all correspondence and clinical treatment details. However, he said that no details of the incident had been recorded in her clinical records themselves. He explained that this was why there had been a misunderstanding about what had been recorded. He said that these records were forwarded on to her new GP.
  5. We contacted the Practice on 21 October 2010 and the Practice Manager told us that there was nothing recorded in Mrs S’s medical records about the incident. The Practice sent us a screen print of the summary of the entries in Mrs S’s medical records, which included the following entry for 24 August: ‘letter RE ATTITUDE AND OFFENSIVE LANGUAGE’.

Dr Hampson’s comments on our draft report

  1. In response to our draft report Dr Hampson requested that my Office reconsider our findings. He said that Mrs S had voluntarily changed doctors and had not been removed from the patient list by the Practice. He said that without any recognition by Mrs S that her behaviour had been unacceptable there appeared to be an irretrievable breakdown of the patient-Practice relationship, which would indicate that a ‘parting of the ways’ was imminent.
  2. In a further letter to my Office, Dr Hampson said that the letter to Mrs S was not intended as a formal removal request or even an indirect removal request, but was meant ‘more as a warning and opening for a response’. He apologised for the misunderstanding if the phraseology in the letter was ‘poor, ambiguous or misunderstood’. He said that at the time of the initial letter it had not been his intention or understanding that he had started a formal removal request procedure and therefore he found it difficult to accept our finding of maladministration.
  3. Dr Hampson said that although he did not accept our finding of maladministration, the Practice was intending to provide training to staff on the PMS guidelines for the removal of patients from the patient list. However, he was not prepared to offer a financial remedy to Mrs S.

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