My findings
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- In considering whether there has been maladministration by Dr Hampson, I have taken account of the Ombudsman’s Principles of ‘Getting it right’ and ‘Being customer focused’ (paragraph 17). In order to ‘get it right’ Dr Hampson should have followed the PMS Regulations agreement (paragraphs 19 to 23), the guidance provided by the RCGP (paragraphs 24 to 26), and the Practice’s own policy (paragraphs 27 to 29).
- The PMS Regulations agreement allows GPs to remove patients from their lists (assuming they have reasonable grounds) but they must have given a warning that the patient is at risk of removal within the previous 12 months and explained the reasons for this, apart from in exceptional circumstances (as set out in paragraphs 21 to 23). This is also stated in the Practice’s policy. The PMS Regulations agreement would only have allowed Dr Hampson to remove Mrs S without having first issued a warning if this would have been harmful to her physical or mental health, put at risk the safety of members of staff or patients at the Practice, or where in his opinion it would not otherwise have been reasonable or practical to give such a warning. I have seen no evidence to suggest that any of these exceptional circumstances applied in this case. Dr Hampson did not give Mrs S a warning before writing to tell her that she would be removed from the patient list. He said that his letter was not intended as a formal removal request and he apologised if the phraseology used was ‘poor, ambiguous or misunderstood’. I take a different view: the intention might not have been to remove Mrs S formally, but there is absolutely no ambiguity in the wording of the letter. Although, in the event, Dr Hampson did not remove Mrs S from the patient list, she was left in no doubt that if she did not apologise then she would be removed. He therefore did not act in line with the PMS Regulations agreement.
- In his response to our draft report Dr Hampson said that without any recognition by Mrs S that her behaviour had been unacceptable there appeared to have been an irretrievable breakdown of the patient-Practice relationship. However, had Dr Hampson been ‘Getting it right’ and acting in line with the PMS Regulations agreement and RCGP Guidance, he would have discussed the incident with Mrs S, given consideration to whether the Practice had contributed to the breakdown and, in the light of what came out of that discussion, considered issuing a warning. He did not even follow the Practice’s own policy because Mrs S was not given an opportunity to respond; and although Dr Hampson considers his letter to have been ‘more as a warning and opening for a response’, I do not regard his demand for an apology to be an opportunity for Mrs S to respond. It seems to me that the letter sent by Dr Hampson played a significant part in the breakdown of the relationship, a fact that he has failed to fully acknowledge. In not acting in line with the relevant guidance, Dr Hampson was not ‘Getting it right’.
- Dr Hampson’s actions fell significantly below the applicable standards and guidance. This was maladministration.
- Mrs S also complained that the Practice lied to both her and to my Office when they said that there were no entries in her records regarding the incident.
- The Practice saved a copy of the letter it had sent Mrs S about the incident in her administrative records. This administrative record is separate from the records of clinical contact between Mrs S and the Practice’s clinical staff, but forms part of the overall medical record that was forwarded to her new GP. It seems to me that Dr Hampson and the Practice Manager interpreted Mrs S’s and our enquiries as referring only to whether an account of the incident had been recorded in her clinical records: they did not consider the entry relating to the letter in the administrative record to be relevant. Had they considered the purpose of Mrs S’s enquiry a little more they might have understood that she was concerned that her new GP would learn of the incident from her records, and have considered whether the administrative record would be of concern to Mrs S also.
- I do not concur with Mrs S’s view that Dr Hampson and the Practice Manager lied to her and to us about her records; in my view they misunderstood her concerns and the reason she wanted to know whether or not there was an entry anywhere in her records. In doing so they lacked customer focus, by failing to consider the purpose of Mrs S’s request for that information. Further, the choice of words used to record the letter sent about the incident was insensitive and unnecessary. No consideration appears to have been given to how the heading ‘letter RE ATTITUDE AND OFFENSIVE LANGUAGE’ could be interpreted by anyone who was not in possession of the facts of the incident. As the entry was made for administrative purposes only, I cannot see that it was necessary to include such details in the letter title.
- I have identified shortcomings in Dr Hampson’s recording of the letter and the subsequent responses to Mrs S’s and our enquiries. However, the entry, although insensitive, was an accurate description of the letter sent to Mrs S and I am satisfied that Dr Hampson did not intend to mislead either Mrs S or my Office. Therefore, although these actions demonstrated a lack of customer focus, I do not find that they amount to maladministration.
Injustice
- Mrs S said that she had felt ‘bullied’ into leaving the Practice and that this had been very stressful for her and her daughter. She said that she felt let down by the Practice. She said that she now has to travel by car to her new GP practice.
- Contrary to Dr Hampson’s view, the letter sent to Mrs S made it clear that she would be removed from the Practice list if she did not apologise and so I can understand why Mrs S felt bullied into leaving. Further, I can fully appreciate why this was so distressing for her, given that the reason for her becoming frustrated and emotional in the first place was because of her daughter’s condition at the time. This was made all the more distressing by the knowledge that Dr Hampson was aware of her daughter’s ongoing condition but had not appeared to have given any consideration to this in his decision-making. There was also an added inconvenience for her in having to find a new GP practice with which to register after she had been happily registered for so long at the Practice. She now has to travel further to visit her new GP too.
Conclusions
- I therefore uphold Mrs S’s complaint about Dr Hampson.
Recommendations
- When deciding on recommendations for Dr Hampson, I have taken into account my Principles for Remedy. Three of the Principles particularly relevant to this complaint are:
- ‘Being customer focused’ – which includes apologising for and explaining the poor service;
- ‘Putting things right’ – which includes, if possible, returning the complainant to the position they would have been in if the maladministration had not occurred. If that is not possible, compensating the complainant appropriately; and
- ‘Seeking continuous improvement’ – which includes using the lessons learnt from complaints to ensure that maladministration is not repeated.
- With these Principles in mind, I recommend that within one month of the issue of this investigation report, Dr Hampson should:
- provide Mrs S with a full written acknowledgement of the maladministration identified in our investigation report and give her a sincere apology for the injustice we have identified. A copy of that letter should be sent to my Office;
- provide financial redress of £500 to Mrs S for the distress and inconvenience resulting from his actions; and
- prepare an action plan to describe what he has done to ensure that he has learnt the lessons from the maladministration identified by this upheld complaint. He should also detail what he has done and/or plans to do, including timescales, to ensure that Practice staff are made aware of, and follow, the relevant standards and guidance in relation to removing patients from the Practice list. Copies of the action plan should be sent to my Office, Mrs S, and to NHS Dudley. Dr Hampson should also ensure that Mrs S and NHS Dudley are updated regularly on progress against the action plan.
