A practice in the Camden area

5. Mr R complains about the care and service he received the Practice between 29 October and 23 December 2024. Specifically, Mr R complains on 29 October, a doctor at the Practice dismissed his mental health issues and failed to make suitable recommendations, and the Practice failed to fully investigate his complaint.

6. Mr R also says the complaint response is generic and does not detail any learning taken from his complaint.

7. Mr R says because of the failings he felt undervalued as a patient and unsupported at a particularly vulnerable time when he was suffering with post-traumatic stress disorder (PTSD) from workplace bullying.

8. Mr R says the complaint handling felt robotic, impersonable, and incomplete. He explains he raised a complaint previously and received a similar response. He says this made him feel dismissed and frustrated that his concerns were not fully investigated.

9. Mr R is seeking a thorough investigation into his concerns, service improvements and financial remedy.

10. On 29 October 2024, Mr R attended an appointment at the Practice and was seen by the named doctor for concerns regarding his mental health.

11. On 19 December 2024, Mr R attended the Practice with similar concerns and was seen by a different doctor.

GP Appointments

16. Before we decide if we should conduct a detailed investigation of a complaint, we look at whether there are signs the organisation has got something wrong. We do this by comparing what should have happened with what did happen. We have done this and have not found any indications that something has gone wrong.

17. Mr R says he attended an appointment at the Practice on 29 October 2024 for concerns regarding his mental health. Mr R explained he had been experiencing workplace bullying for nine years which resulted in his resignation and later pursuing an employment claim. He said because of workplace bullying he often experienced panic attacks in public, post-traumatic stress disorder (PTSD) and severe anxiety.

18. Mr R says during this appointment the doctor told him that bullying could not result in PTSD, dismissed his concerns and did not discuss other options such as a referral for cognitive behavioural therapy (CBT).

19. We were sorry to hear how this experience made Mr R feel unsupported and undervalued at difficult time in his personal and professional life.

20. Mr R says he returned to the Practice on 19 December 2024 where he was seen by a second doctor. Mr R explains at this appointment the second doctor provided a treatment plan which included CBT.

21. In its response dated 23 December 2024, the Practice apologised if Mr R was unhappy and said it takes patient safety very seriously. It said it apologised if the named doctor made Mr R feel uncomfortable as this was not the intention. The Practice reminded Mr R that it is committed to actively promoting equality and reflecting the diversity of the local community.

22. We recognise Mr R had concerns about the comments made by the doctor at this appointment. We have considered Mr R’s account and the medical records. We think it is not possible for us to reach a view on this as it is unlikely the specific detail of this interaction will be documented.

23. Whilst we do not doubt Mr R’s recollection, it is not possible to reach a view on what the doctor intended to communicate during the appointment and how this was received. That is not to say we do not believe him. It means this evidence is not enough for us to make a definitive decision.

24. In making our decision, we have considered the advice given at this appointment.

25. On 29 October, Mr R attended an appointment at the Practice. This is noted as a review appointment for a previously diagnosed anxiety disorder. Our adviser was unable to comment on how the doctor at this appointment had assessed Mr R’s symptoms as this was a review and not an assessment.

26. We note that Mr R was prescribed citalopram (an antidepressant) used for the management of several mood disorders including anxiety disorders. The records from this appointment indicate the doctor reviewed the prescription with Mr R following a previously increased dose.

27. The records indicate the doctor also discussed Mr R’s personal circumstances. The records document Mr R was bullied at work, his travels, his job search and increase in anxiety symptoms. It notes Mr R had experienced a panic attack the day before the appointment in a local pharmacy.

28. We have seen the doctor noted ‘graded exposure discussed on a daily basis’ and to continue medication to ensure management of mood. The notes indicate that the doctor discussed talking therapy and signposted Mr R to a local talking therapy service for a selfreferral.

29. Our adviser says the discussion during the appointment on 29 October 2024 is in line with the NICE Anxiety Guidance for the management of anxiety disorders.

30. NICE Anxiety Guidance sets out the steps for clinicians in managing GAD. Step one is:

• communication of GAD diagnosis as early as possible to help people understand the disorder and start effective treatment promptly • provide information about the nature of GAD and treatment options and • arrange active monitoring of the person's symptoms and functioning at intervals based on clinical judgement

31. As this is a review appointment we cannot comment on previous communication of anxiety disorder diagnosis. We have included this for context and completeness of guidance content. As we do not have records earlier than October 2024 and it is outside of the scope being considered, on balance, we consider it is likely this step was completed at an earlier appointment.

32. Step two of the NICE Anxiety Guidance says for patients with GAD whose symptoms have not improved a clinician should offer one of the following interventions, guided by the patient’s preference:

• Individual non-facilitated self-help — based on cognitive behavioural therapy (CBT) principles that the patient works over a period of at least six weeks. It usually involves minimal therapist contact.

• Individual guided self-help — should include suitable written or electronic materials and support from a trained practitioner who facilitates the programme and reviews progress and outcomes. This usually consists of five to seven weekly or fortnightly face-to-face or telephone sessions.

• Psychoeducational groups — based on CBT principles, this should have an interactive design and encourage observational learning through presentations and self-help manuals. Conducted by trained practitioners, there should be a ratio of one therapist to 12 participants.

33. Our adviser explained the discussion of gradual exposure and a signposting for a selfreferral to a local talking therapy service is in line with guidance. Our adviser explained the discussion of gradual exposure is part of the self-help CBT content. Our adviser explained it is likely the doctor provided this as a self-help tool whilst Mr R waited for his self-referral to be processed.

34. We are satisfied the advice provided by the doctor at the appointment in October 2024 was in line with NICE Anxiety Guidance.

35. We have listened when Mr R described the difference between the first appointment at the Practice in October and the second appointment in December. We understand Mr R felt the second appointment was more supportive of his concerns and symptoms.

36. Our adviser noted at the second appointment, with a different doctor, there is a more detail in the history here which suggests the second doctor had a more complete understanding of Mr R’s history. Our adviser explained this was likely obtained through previous appointments.

37. The records from this appointment indicate Mr R had self-referred to a local talking therapy service following the signpost in the October appointment. There is no indication a referral was completed by the Practice.

38. In summary, we consider the Practice acted in line with NICE Anxiety Guidance and professional standards when consdiering Mr R concerns and have seen no indication anything went wrong in this part of his complaint. We hope our explanation provides Mr R with reassurance the Practice provided appropriate care.

Complaint Handling

39. Before we decide if we should investigate a complaint, we should consider attempting a resolution where it appears that, with minimal intervention, we could achieve a satisfactory result for the complainant.

40. Mr R says the Practice’s complaint response was generic. He says it did not detail any learning from his complaint. He explains this made the complaint response feel generic and incomplete.

41. We recognise this was frustrating for Mr R who felt that his concerns about his care at the Practice were not acknowledged or fully investigated.

42. Mr R says the complaint handling felt robotic, impersonable, and incomplete. He explains he raised a complaint previously and received a similar response. He says this made him feel dismissed and frustrated that his concerns were not fully investigated. We can appreciate this was difficult for Mr R to read.

43. In its response, the Practice apologised if Mr R was unhappy and said it takes patient safety very seriously. It said it apologised if the named doctor made Mr R feel uncomfortable as this was not the intention. The Practice reminded Mr R that it is committed to actively promoting equality and reflecting the diversity of the local community.

44. The apology in the final response is not in line with the standards we would expect. Our NHS Complaint Standards say organisations should be open and accountable when responding to complaints, acknowledge mistakes and apologise where appropriate to put things right. It provides clearer guidance for NHS organisations who want to resolve complaints. Our NHS Complaint Standards explains an apology should demonstrate sincere regret, an explanation and be tailored to the individual’s needs.

45. We contacted the Practice to discuss its final response and what we look for in sincere apologies from organisations. The Practice reflected on its response and said it understood our concerns and would take into consideration our comments with any future complaints.

46. On 3 November 2025, the Practice provided us with an amended apology which we will forward to Mr R alongside with our decision. On 27 November, we contacted Mr R and discussed the revised apology. Mr R agreed he was happy with our resolution and recognition the Practice’s complaint handling fell below the expected standard.

47. The Practice apologised for its previous response, recognised the impact this had on Mr R and noted it has reflected on Mr R’s complaint and would take learning from this improve its complaint handling and prevent this from recurring.

48. We would expect organisations to acknowledge mistakes and apologise for the impact these mistakes had. We would also expect organisations to take action to learn and improve from its mistakes. This is in line with our NHS complaint standards.

49. Based on what we have seen we are now satisfied the Practice has done this and has given Mr R the outcome he was seeking regarding this part of his complaint. We consider this action has resolved this part of his complaint and we hope this gives Mr R some reassurance the Practice has taken learning from his experience.

1. We have carefully considered Mr R’s complaint about the care and service he received at a GP Practice (the Practice) in the London Borough of Camden between 29 October and 23 December 2024.

2. We have considered Mr R’s complaint about the Practice’s handling of his mental health concerns, and we have seen no indication that anything went seriously wrong. We recognise how Mr R struggled with his mental health and felt paralysed without support. We are sorry for any distress our decision may cause.

3. We have carefully considered Mr R’s concerns about the handling of his complaint. Mr R told us that he was seeking a thorough investigation into his concerns and service improvements as primary outcomes to his complaint. The Practice has agreed to take action and issue an improved complaint response and has taken learning on how to improve its complaint responses to prevent this from happening again.

4. We have therefore agreed action with the Practice to resolve Mr R’s complaint and are satisfied Mr R’s complaint is resolved. We hope that Mr R gets the reassurances he wanted from this additional information.