Doctors can’t delist patients for complaining

[holyshedballs]

I understand that this is a fear of many people using this forum.

It is important to understand that the NHS, the Care Quality Commission and the General Medical Council expect patients to give feedback both positive and negative. For the sake of brevity I’ll just write about giving negative feedback in the form of a complaint.

As the CQC says if they don’t what is going wrong they can’t put it right.

The NHS expects patients to complain in the NHS Constitution

Each surgery has to seek both positive and negative feedback from its service users (patients). In other words a complaints system. This is a legal duty that is monitored by the CQC.

The GMC make it very clear that a doctor must not “de list” a patient just for making a complaint in their ethical guidance “Ending your professional relationship”.

By making it explicitly clear that delisting is not appropriate when a patient makes a complaint the GMC also make it clear that a complaint is not the same as a break down of a doctor/patient relationship.

Being abusive or violent are good reasons to support the break down of the doctor/patient relationship

But complaining isn’t.

The GMC also expects doctors to apologise when they make mistakes.

Patients must not be afraid of doctors. The law and the GMC say that doctors must work in partnership with patients and patients have every right to complain when doctors do not meet the standards expected of them by the law and the GMC. In fact the NHS expects patients to complain.

Hopefully armed with information that complaining should be a normal part of a relationship with a doctor patients will feel more confident in making complaints.

My view is that complaining is not about punishing a doctor. Complaining is about highlighting deficiencies and facilitating change for the better.

Complaining is about

detailing the thing that the patient feels is wrong,

Detailing the harm caused by the thing that went wrong

providing some form of evidence to support the complaint

and where possible proving a reasonable solution that will rectify the thing that went wrong.

I also put what will happen if the thing that went wrong and caused harm isn’t put right in my work letters. At work I have to let the people I regulate know what the possible consequences for non compliance are as a legal requirement.

The best complaints, in my view, are those that keep to the facts of what went wrong what the harm was backed up by evidence, written in fairly clear and unemotional terms.

[Sleepybunny]

Hi,

I was never rude and never went through formal complaint procedure although did speak to/write a polite letter explaining I was upset but not wanting to complain formally, to practice manager after being shouted at by a doctor yet pressure was put on me to leave the practice. I was written a letter signed by GPs suggesting I should change practices.

I was a persistent patient, kept asking (politely) for tests/referrals etc as I knew something was physically wrong with me and they didn't like this and one openly said I was too expensive.

I was certainly never violent or verbally or physically abusive eg never shouted, never swore etc. I regularly left an appointment in tears but stayed for years as it was the easiest one to get to. The way I was treated brought me to the brink of mental collapse.

Thankfully, when I finally realised I needed to leave or I was going to end up severely disabled , I found GPs in other practices were much kinder.

I agree that complaining is not a good enough reason to delist a patient but GPs have much subtler ways of getting rid of people.

[holyshedballs in reply to Sleepybunny]

I agree and that needs to be addressed too.

[holyshedballs in reply to holyshedballs]

and sometimes changing surgeries is best out come. However, no doctor should shout at a patient no matter how persistent they are. I'm not in your shoes but I would complain about the doctor who shouted at you. It is totally not acceptable.

[Hidden in reply to Sleepybunny]

The thing is either you are born with an assertive manner or not, it can be learnt and with practice is a valuable asset to cultivate.

It would be hard at first but with practice can prove to be a valuable asset.

Nobody should shout at you anyway it's bullying. Taking someone like myself to your

appointments would be good I never cry and stay calm but assertive in all circumstances.

It works for me and for others that I have helped along the way.

[holyshedballs in reply to Hidden]

I couldn't agree more!! it is particularly hard for hypothyroid patients to muster the energy to get all the resources together. it is hard and daunting, but knowing the facts of what is expected and what can be done helps the process a great deal. Complaining effectively is a skill. It can be learned and can be relatively easy to take on.

[Hidden in reply to holyshedballs]

With your useful information we can only forge ahead, thank you for the post.

[endomad]

The complaint process is a fallacy, the truth is all GP surgeries are self employed individual companies, they are not really governed by anyone, they have codes of practice but how they run their practice and who they have as customers are entirely up to them. This was explained to me by NHS England, CCG, and my MP shadow health minister Jon Ashworth.

They can indeed make it difficult for customers, refuse to treat, accuse customers of non compliant or vexatious, all of which you often read on this forum. One lady has it on her notes that she is part of a lobbying group and is trouble! not something you want on your notes.

I complained to my practice manager in the politest way that my monthly prescription was always late and was in fact running at one point 6 weeks in arrears, he said they have 3,500 prescriptions to do every month and there would always be odd error! there was no one who seemed able to sort it and it was starting to stress me out, so i had long talk with my dr and refused to leave appt till it was sorted, he gave me an extra prescription for 2 months worth to take up the slack, which is great but doesnt stop my chemist and me having to chase them every month. My dr told me that it weeds out the people who are not actually taking their meds properly. The practice manager said i could change surgeries if i didnt like it and that is the bottom line, if your gp is a bit crap you can change but there is no guarantee the next one will be any better. Just my experience x

[WildDeer in reply to endomad]

If you live in a rural area though, it's not possible to change surgeries. I'd very much like to change but there are red boundary lines around the one I'd like to move to, outside of which you can't be accepted.

[Hillwoman in reply to WildDeer]

That's also the case where I live.

[holyshedballs in reply to WildDeer]

All the more reason to be aware of you rights and the legal obligations your surgery has so that if things go wrong, you will know what to do.

[holyshedballs in reply to endomad]

I have to disagree with you that the complaint process is a fallacy. I personally have complained and achieved my intended result. I know of others who also have complained and achieved a positive change. patients need to know that they can complain and need to know how to complain successfully.

Most GPs are either self employed or in partnerships that are contracted to the NHS.

But, in England they have to conform to the NHS England Standard Contract england.nhs.uk/nhs-standard...

in the Standard Contract, Service Condition 16 is about Complaints. Point 5 in Schedule 6 requires the contract holder to submit a complaints monitoring report, setting out numbers of complaints received and including analysis of key themes in content of complaints. england.nhs.uk/publication/...

Regulation 17(2)(e) of Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 requires service providers to seek and act on feedback from relevant persons and other persons on the services provided in the carrying on of the regulated activity, for the purposes of continually evaluating and improving such services;

the guidance to the regulations goes further and says:

Providers should actively encourage feedback about the quality of care and overall involvement with them. The feedback may be informal or formal, written or verbal. It may be from people using the service, those lawfully acting on their behalf, their carers and others such as staff or other relevant bodies.

All feedback should be listened to, recorded and responded to as appropriate. It should be analysed and used to drive improvements to the quality and safety of services and the experience of engaging with the provider.

Improvements should be made without delay once they are identified, and the provider should have systems in place to communicate how feedback has led to improvements.

Where relevant, the provider should also seek and act on the views of external bodies such as fire, environmental health, royal colleges and other bodies who provide best practice guidance relevant to the service provided.

I am sorry to hear of your experience with your surgery. It does read like your surgery is staffed by arrogant unhelpful people. I would support you in the things you expect from your surgery and if it happened at my surgery I would complain about that. It is not in the letter and spirit of the law and Standard Contract for a GP to "weed out" those who don't take their medicine.

the practice manager should have informed you of the their legally required complaints process instead of telling you to change surgeries. Such appalling behaviour needs to addressed and complaining is the best way tot do so. That way patients can "weed out" doctors who are not actually meeting their patients needs

[WildDeer in reply to holyshedballs]

Thanks for providing that positive information.

[endomad in reply to holyshedballs]

what a coincidence we were talking about this 2 weeks ago. Yesterday i was told by my gp surgery that i had been removed off their patient list and would not be providing any further prescriptions. I have started a formal complaint thro NHS England but they said it is the surgeries prerogative and down to their discretion who they treat. I was given a bogus reason which i challenged and now practice mngr cited patient dr relationship breakdown which is untrue i get on with my dr but not the practice manager. This is the get out of jail card for surgeries as they only have to say break down on their side.

Altho the complaint will be looked at i have no alternative but to sign with a different surgery further away and hope they havent put anything defamatory on my notes for being assertive.

Having checked local social media there are quite a few of us being de listed and all have long term health conditions (i.e cost them money) my chemist said they are asking for info on who and when prescriptions are collected for many elderly, which he told the surgery was none of their business. There is no recourse but move either when or before being pushed. On another thyroid forum one lady has been told she has to use their in house pharmacy or will be removed off list, she wants to choose where she gets her meds dispensed but apparently they can veto that.

The NHS is not what is was with checks and balances and fair play, we do as we are told or face the consequence.

[holyshedballs in reply to endomad]

I don't have all the information but none of the reasons you quote seem legitimate to me. However, I don't have any experience in the type of scenario to help you further. it seem pretty bad for you personally and worrying for the rest of us.

Re your notes, you have a right to examine them under the Data Protection Act and GDPR, and can get them to rectify any errors.

You can also ask to see any correspondence about you not just your patients notes.

[endomad in reply to holyshedballs]

The practice manager doesnt like me because i won my case for t3, he then refused it on cost, i got individual funding. My complaint was upheld regarding prescriptions late every month last year, all done politely but firmly. I refused a smear test last month as it was done last october at the ladies clinic, he then said i needed thyroid blood tests done, i said no i have them done at hospital by consultant, he said he should be controlling my tests (i suspect the word controlling is big in his life). He then got the receptionist to call me and say iv been removed as not a uk citizen i emailed proof of residence, with HMRC and NI contributions. I called an spoke to him and he said i would have to have a gp surgery review every 3 months and i said annually was sufficient as per guidelines and the last 10 years. He then lost his temper saying he wasnt going to discuss it any further and i had been removed. Of course 'they cant' but he has, no letters from them of dissatisfaction from surgery, no mediation to sort any problems they had, no notice given as per guidelines, no procedure followed but as NHS England said, that doesnt actually help me as it is at his discretion, they will investigate the complaint but asked why i bothered as i would still have to register elsewhere.....lol because i am a stickler for procedure and if everyone just rolls over, he gets to be a misogynistic little Hitler.

So anyone not prepared to be struck off needs to tread carefully.

[holyshedballs in reply to endomad]

it sounds very much like the practice manager is acting out side his remit and interfering in clinical decisions unless he is both practice manager and your doctor. If this happened to me I would be pulling all the stops out to complain about this behaviour. (Its easy for me to say, I know) If he is your doctor as well as your practice manager, his behaviour is against Good Medical Practice and I would complain to the GMC.

I would also complain to the Care Quality Commission as well. They won't act immediately but will discuss this on their next inspection.

Its a lot of work and you may not be up to it but if he's like that with you he is probably like that with other patients. Could you find out if others have had similar treatment?

I'm very surprised the NHS England have said that but i have no information on these types of procedures, yet.

[endomad in reply to holyshedballs]

The complaint is already in with NHS England, local CCG and my wonderful MP Jon Ashworth but had forgotten about Care Quality Commission will cc them in to MP's stuff. Yes there are others iv seen on local social media but its up to them to complain and the truth is most dont. My husband went in this afternoon and my dr was not there, instead someone new which is odd, I will do some digging but im wondering if he has been moved on and they are culling his more expensive patients. The practice manager has no clinical or medical position, he is admin/cost cutting only. He is a bully and i am not a push over which he does not like, women should be seen and not heard, he actually told me last year to do as i was told or he would put 'non compliant' on my notes, i asked if he was threatening me and dared him to do it, i said i would take that to CCG. He is an arrogant twit, its not often i meet my match!

[holyshedballs in reply to endomad]

Well good luck with the process. I have to say I haven't come across anybody as bad as that. I hope he is an anomaly. if he isn't a doctor he certainly has no influence in clinical matters. for one an interested in how the complaint proceeds so we can all learn from it - both good and bad.

if you have the time and energy could you keeps us informed?

[Hidden]

With thyroid and related problems there is an extra layer of hindrance to getting what you need, which even the best of doctors has difficulty with. Wasn't there a recent report of a doctor being threatened with legal action or even with being struck off, for prescribing T3?

And of course there is the iniquitous cost of what should be available to all that need it.

Any suggestions on how (if by some miracle we do find a doctor who will listen) we can work together with the doctors to do something about it? I know something IS being done already, but such a slow process. And money talks!

[holyshedballs in reply to Hidden]

HI jnetti

I am not aware of any doctor being or threatened to be disciplined or struck off solely for prescribing T3. However, there is a dispute between the CCGs and patients regarding the CCGs interpretation of guidance from PrescQIPP and NHS England. The CCGs have mostly interpreted the guidance to mean a ban. However, NHS England allowed T3 for those patients who need it. Further, a blanket ban is unlawful.

Lynne Mynott and other patient group leaders are speaking to NHS England to ensure that T3 is available for those who need it.

Some poor Endos and GPs sometimes tell patients that doctors have been struck off the medical register for prescribing thyroid hormones. I sent a Freedom of Information request to the GMC to see if this was true. the replied that NO doctor has been struck off or prescribing thyroid hormones.

2 GMC cases spring to mind - Dr Gordon Skinner and Dr Sarah Myhill.

In Dr S cases, the GMC never struck him off. The worst they did was put conditions on his license. when he was summoned for yet another hearing the GMC removed his conditions and congratulated him on his work.

In Dr M cases, she has never been struck off. In her last thyroid hearing (I think) the GMC asked a leading barrister to review the evidence provided to the GMC by Dr Skinner in his hearings. the Barrister concluded that the way that Dr Skinner and Dr Myhill worked was supported by a responsible body of medical opinion. I think that case was dropped because of Dr Skinners evidence and that provided by Dr Myhill.

I don't have the details to hand but I believe that Dr M GMC placed some sanctions on her license. She appealed to the High Court but the GMC withdrew the sanctions before they got to the High Court.

Both Dr S and Dr M have endured many hearings with regard to prescribing thyroid hormones with no significant action taken against them. Dr Skinner died during his last hearing. none of the complaints to the GMC have been made by patients but by other Endos.

I think but don't know for certain that the specific complaints to the GMC about prescribing thyroid hormones have stopped.

[SilverAvocado]

Hi Holyshedballs, Sorry to bother you. I'm sure I saw you say somewhere that doctors are now not allowed to charge to give out records, but I can't find it?

I just had a huge number of blood tests done after a hospital appointment, and have just received a letter saying 'normal' to everything. I'm determined to get copies, but don't even have much of a lead for who to phone. I've got a leg injury at the moment (actually caused by the tiring day in hospital!!) so am not going to be able to walk in and collect the copies, and I think I'm going to have a hard time persuading anyone to post them or email me.

I'm armed with knowing I can make a subject access request, and having a template letter that looks good: ico.org.uk/your-data-matter... But I expect most people I try to call will act dumb and not even know how to print out the results.

[holyshedballs in reply to SilverAvocado]

HI

on the same link but at the bottom is the ICOs advice on fees. It says:

Can the organisation charge a fee for this?

A copy of your personal data should be provided free. An organisation may charge for additional copies. It can only charge a fee if it thinks the request is ‘manifestly unfounded or excessive’. If so, it may ask for a reasonable fee for administrative costs associated with the request

I have asked for copies of all my test results.

My first GP surgery was pretty obstructive and demanded £10 per page. I wrote to them advising them of the law at that time, which was that charges should be reasonable not punitive. the suggestion at that time was 10p per page. They gave copies of the test results for free in the end.

The other GPs have been good but the hospitals have not been so good. initially they said that the GP can provide them. I told them that the blood tests were taken at the hospital so the hospital should provide me with copies. They procrastinated until I suggested that they were in breach of the Data Protection Act and then provided the results.

It shouldn't be hard to get copies. They should be getting used to it by now.

[SilverAvocado in reply to holyshedballs]

Thanks so much! Just as I got a notification of your reply, my very first call paid off. I had a call back from someome who seems to be the secretary to consultants in the department. She cheerfully said she could put them in the post for me. Only wrinkle is she says she will check with the consultant first, so might hit a barrier there.

Thanks so much for all you post on the forum! In the past I've struggled to get printouts from the hospital and have just given up, but you're giving me the confidence to push for it.

[holyshedballs in reply to SilverAvocado]

Puzzling that!! My hospital said that to me. The consultant has no jurisdiction over release of personal data. I am hoping its to ensure that there are no anomalies that have been missed before they results are sent out.

[SilverAvocado in reply to holyshedballs]

The argument I've heard is that the consultant should see them first and discuss any serious issues with the patient.

I suspect the bigger issue is that they are in charge of anything and can make things difficult for other staff if they don't get to sign off on everything

[holyshedballs in reply to SilverAvocado]

Highly likely!!