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Misunderstanding of patient choice legislation led to delay in diagnosing and treating PTSD

Organisation we investigated: A GP Practice in Suffolk; Ipswich and East Suffolk Clinical Commissioning Group

Date investigation closed: 01 May 2019

The complaint 

Complainant V complained that their GP Practice and CCG did not allow them to choose the first available outpatient appointment for mental health treatment. 

Complainant V also complained that the CCG wrongly interpreted patient choice law when rejecting their Individual Funding Request (IFR — a process for people to apply for special funding for treatment that might otherwise be unavailable) and that neither the CCG nor the Practice sought clarity on the law.
Complainant V also complained about the GP Practice’s complaint handling.

Complainant V said this caused a two-year delay in getting treatment from the healthcare provider of their choice, which had a major impact on their mental health. Complainant V also said they had been unable to continue with their career until they received treatment.

What we found 

Although the GP Practice was trying to help Complainant V, it did not follow the IFR process properly. It did not discuss patient choice or the process for referring to an NHS provider. This contributed to a delay in Complainant V’s diagnosis and treatment of PTSD.

The GP Practice also handled the complaint poorly and did not answer all of Complainant V’s questions.
The CCG misinterpreted the patient choice legislation and incorrectly told Complainant V about the limitations of patient choice in a mental health setting. This further contributed to the delay in the diagnosis and treatment of Complainant V’s PTSD.

Background 

Complainant V worked for an NHS mental health trust. Complainant V raised concerns about poor care, after which they experienced bullying from colleagues in management. Complainant V left their job having reached a compromise agreement with the trust.

After this, Complainant V suffered from a deterioration in their mental health, experiencing mild to moderate depression, thoughts of self-harm, paranoia, obsessive behaviour and social withdrawal. Complainant V was also recently diagnosed as being on the autistic spectrum and having Asperger syndrome. 

Complainant V’s health declined further. They attended an appointment at their GP Practice, which agreed to refer them to an NHS trust that was not the Trust they had previously worked for. Complainant V was seen at this trust and was referred for treatment through the Improving Access to Psychological Therapies programme. However, this service discharged Complainant V as it was unable to meet their needs. They had a further assessment at the trust. It recommended Complainant V’s GP referred them to a private psychiatrist.

The GP Practice submitted an IFR to the CCG seeking funding for a referral to a private psychiatrist.   

Complainant V subsequently agreed to a referral to an alternative trust. The CCG rejected the IFR but did not inform Complainant V. Complainant V then asked the GP Practice to refer them again to a private psychiatrist as they had found enough money to pay for one appointment. 

The GP Practice contacted the CCG in relation to Complainant V’s case, and then made a further IFR. The CCG wrote to the Practice to say they could refer Complainant V to any NHS provider without any need for funding approval.

Putting it right 

We recommended the Practice apologise for the mistakes it made and set out how it has learnt from the complaint. We recommended the Practice pay Complainant V £500.

We also recommended the CCG apologise and set out the learning from the complaint. We also recommended the CCG pay Complainant V £500.

Both the Practice and the CCG have complied with our recommendations.

This case summary is featured in the Ombudsman's Casework Report 2019.