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Selected Investigations Completed October 1997 - March 1998 > Foreword
This report contains a selection of 16 reports from the 75 reports of investigations completed between September 1997 and March 1998. It also containts two reports which were completed very shortly after the end of March 1998, and which I have included in this report in the hope that doing so will enable lessons to be learned from them sooner than if I held back their publication to my next report. In my last report I said that my office received more complaints in the first half of 1997-98 than in any 6-monthly period before. The total received in the second half of the year (1488) was higher still. I completed - and started - more investigations in the second half of 1997-98 than in the first, but fewer than in earlier six-month periods before that. In many cases the most appropriate response from my office was an intervention which prompted the NHS body concerned to take further action on the complaint, without a full investigation by me.
This volume includes, for the first time, reports of investigations against general practitioners (GPs). My jurisdiction was extended from April 1996 to cover the actions of GPs and other family health services providers after that date and I have now completed sufficient investigations of complaints against GPs to enable me to draw some initial lessons from them.
Of the eight reports which I have selected of investigations against GPs, four involved complaints that the GP had removed a patient from his or her list. In some cases, the complaint was that the removal was unreasonable; in others, that the GP did not explain why he or she had removed the patient from the list. In my Annual Report for 1997-98 I say more about the approach I have taken to such complaints. I do not question the current statutory provisions in GPs' terms of service which allow a GP at any time to request the health authority (health board in Scotland) to remove a patient from his or her list and do not require the GP to give reasons.
However, my perspective is wider. I have to consider whether any action taken by a GP (or other family health service provider) has caused hardship or injustice. I take the view that, as providers of public services, GPs implicitly accept an obligation to adhere to certain standards. These include that they should, in the absence of special circumstances, try to make the doctor-patient relationship work, and if that cannot be achieved, they should normally be willing to explain why to the patient. I believe that these views are broadly in line with those of GPs' representative and professional bodies.
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Other investigations involving GPs reported here involved alleged failures to make a home visit, communications with patients (including a GP's manner at a home visit) and poor handling of complaints.
I do not find every complaint to be justified. In this report I have included one case (E.290/97-98) in which I did not uphold a complaint about a GP's diagnosis of the condition of a woman who later died of a heart attack. I was advised by independent professional assessors that the GP's actions were sufficient and reasonable in view of the history and the signs and symptoms evident at the time of his visits.
This volume includes my first report (E.1803/97-98) of a complaint by a NHS practitioner who felt that he had been unfairly treated in the operation of the NHS complaints procedure. I upheld a complaint by the GP that he had been unfairly treated by an independent review panel which gave insufficient consideration to his evidence and failed to take evidence from a key witness.
As in previous reports I have named health authorities, health boards and NHS Trusts against whom the complaints were made. I have maintained the anonymity of those who put their complaints to me, and of individual members of staff. In the case of complaints against GPs, I have in this volume identified the health authority (or health board) area in which the GP practised, but not the individual GP or practice. I consider that the more personal nature of the relationship between patients and the individual GP or GP practice makes this generally appropriate. However, I reserve the right to identify individual GPs or GP practices if the circumstances warrant it - for example, if the failings revealed by my investigation are particularly serious, or the body concerned is a 'repeat offender'.
The reports do not include an exhaustive recital of every event that has been investigated by my officers; but I am satisfied that in their compilation no matter of significance has been omitted or overlooked.
In this volume, I have followed the practice established in my last report of including short summaries of all investigations which I completed during the period and which are not reproduced earlier in the volume.
The text of this report has again been made available through the Internet (www.ombudsman.org.uk). I hope that this will enable more people to study the texts of my reports and to learn from them.
The Annex gives the dates on which the investigations of each of the published cases began and finished.
MICHAEL BUCKLEY
Health Service Commissioner
(Ombudsman)
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