A practice in the Derbyshire Dales area

6. Mr C complains about aspects of the care and treatment he received from the Practice between April and December 2022. Specifically, Mr C said the Practice:

• sent a letter to the court on 6 April 2022 which overturned a previous letter it sent to the court on 4 April 2022 - the 4 April letter said Mr C should not be forced to leave his family home following his separation from his wife • was late in sending a medical report the court • shared Mr C’s private medical records with his ex-wife which she used in court as evidence during their divorce • removed Mr C from the Practice’s list without justification on 12 December 2022 • failed to send a formal written response to his complaint dated 8 November 2022.

7. Mr C said he was made homeless for 18 months as a result of the letter sent by the Practice on 6 April 2022, and he could not see his daughter as a result of the medical report being sent late to the court by the Practice.

8. Mr C said his privacy was breached as the Practice shared his medical records with his ex-wife.

9. Mr C said he did not have access to a GP for a year and could not get his prescriptions due to being removed from the Practice’s list.

10. Mr C also said the Practice delayed him being able to access our services as it did not send a complaint response.

11. Mr C would like an apology and explanation of its actions from the Practice. He would also like the Practice to make service improvements, so other people do not experience the same care and treatment in the future.

12. In April 2022, the Practice sent a letter to the court which said that due to Mr C’s physical and mental health issues, he should not be made homeless or removed from his home. The Practice then sent another letter which overturned the previous letter.

13. Mr C said he then had to leave his martial home because of the second letter and became homeless, and this went on for 18 months.

14. In May 2022, Mr C said the Practice missed the deadline to send a medical report on Mr C’s capability to see his child to the court.

15. In November 2022, the Practice sent a warning letter to Mr C regarding his communication and behaviour. Mr C then made a formal complaint to the Practice in the same month regarding the issues outlined above.

16. In December 2022, Mr C attended a face-to-face meeting with two people from the Practice to discuss his formal complaint. The Practice then had a management meeting and decided to remove Mr C from the GP list due to further concerns with his communication and behaviour.

17. On 12 December 2022, the Practice sent Mr C a formal letter to notify him he was being removed from the GP list. It did not send him a response to his complaint from November 2022.

18. In October 2024, Mr C’s advocate emailed the Practice asking for a final response to his complaint.

19. In December 2024, the Practice emailed Mr C’s advocate saying there was no complaint to answer, and it considered the matter closed.

Letters the Practice sent to the court

23. Mr C said the Practice sent a letter to the court on 6 April 2022 which overturned a previous letter it sent to the court 4 April 2022, which said Mr C should not be forced to leave his family home following his separation from his wife.

24. Mr C also said the Practice was late in sending a medical report to the court which said he was capable of looking after his daughter which was due in May 2022.

25. We do not have the power to investigate these complaints. Our powers are largely limited to actions taken by staff providing NHS care or service. This means, for the reasons we explain below, we cannot consider these matters further.

26. The letter and the medical report were requested by the court. Therefore, the action of the Practice sending the court this information, and what it included in this documentation, does not fall under the NHS contract. The BMA Guidance explains doing so is non-NHS work for a GP.

27. As this is not NHS service, we do not have the power to investigate these matters.

Sharing private medical records

28. Mr C complained that he believed the Practice had shared his medical records with his ex-wife. He specifically said one of the GPs had some kind of relationship with his ex-wife, and he knew this GP had shared the information as Mr C’s daughter referred to them as her mother’s friend. He also said he suspected this as this GP had sent the letter to the court which overturned the previous letter, which resulted in him having to leave his marital home.

29. Mr C could not give us detail on specifically what the GP shared with his ex-wife and when.

30. In its complaint process, the Practice said it never shared his medical records with his ex-wife.

31. To reconcile these conflicting accounts and investigate this issue, we would need to request all the Practice’s communication with Mr C’s ex-wife in 2022. We would not be able to specify what communication, when and by whom from her records that we need.

32. We may decide not to do an investigation when it would not be practical, would not reach a satisfactory conclusion and there would be little value in providing a response through an investigation. We consider these circumstances apply on this part of Mr C’s complaint.

33. We would need to request a vast and unspecific array of information from the Practice relating to Mr C’s ex-wife. We also do not have her consent to access her information.

34. Therefore, it would not be appropriate and practical for us to investigate this issue. We cannot obtain the evidence that might help us reconcile the conflicting accounts we have.

35. This leaves us with the evidence we do have, which are the accounts from Mr C and the Practice. Given the conflict, and we consider both accounts potentially plausible explanations on what happened, they do not provide enough evidence, even on the balance of probability, for us to come to a view as to whether the Practice shared medical records with Mr C’s exwife.

36. For the above reasons, we have decided not to consider this part of Mr C’s complaint further.

37. We recognise this will come as a disappointment for Mr C. We hope we have clearly explained why it is not practical for us to investigate this part of his complaint and make robust conclusions on it.

Removal from the Practice’s list

38. Mr C said the Practice removed him from its list of patients without justification on 12 December 2022.

39. Our normal approach is to identify (using relevant standards) what should have happened, what did happen and then whether any gap between the two amounted to a service failing.

40. The Practice’s Removals Policy outlines circumstances in which it can remove a patient from its list. Section (1), removal of patients due to breakdown in GP/patient relationship says ‘the most common situation is where a patient exhibits unacceptable behaviour that may lead to a breakdown in GP/patient relationships. This may include persistent verbal abuse, unreasonable attitudes towards staff or advice/treatment given, persistent demands for unreasonable services that cannot be met, persistent failure to attend appointments, fraudulent or criminal behaviour, etc.’

41. It also says in (1.1) ‘the patient should be given the opportunity to moderate their behaviour, and the practice sends a written warning letter. This should explain the unacceptable behaviour/situation and advise that a repetition may result in removal from the practice list. If the unacceptable behaviour is repeated and a warning letter has been sent within the last 12 months the practice can remove the patient under the 8-day rule citing breakdown in GP/Patient relationship. The patient should be sent a further letter advising the reason for their removal and that the patient has 8 days to register with another GP.’

42. The Practice explained in its warning letter dated 7 November 2022 that Mr C’s behaviour was in breach of NHS guidance and its zero-tolerance policy on aggressive or abusive communication with the Practice’s staff. In its letter, the Practice explained ‘These [Mr C’s] emails have become progressively more aggressive and threatening in their undertone in recent months, and as a result the case has been discussed at the practice management meeting.’

43. The warning letter also said, ‘that any repeat of this or similar behaviour at any time in the next 12 months the practice, in line with our contract with the NHS, will give you 8 days' notice before removing you from the practice list of patients and you will need to find and register with another practice.’

44. The Practice sent Mr C a letter to notify him he was being removed from the GP list on 12 December 2022 and explained the reason. It said ‘on 8th December 2022 we received another email from you accusing us of not providing information to other agencies. This had been discussed in your face-to-face meeting on 2nd December, where you were advised that the information that was being requested was not information that we could comment on. Following an NHS England investigation, we have now been authorised to remove you from our patient list.’

45. Therefore, the Practice has evidenced it followed its Removals Policy when staff warned Mr C about his behaviour in November 2022. When he repeated this behaviour in December, it followed its policy in then removing him from its list.

46. We recognise Mr C told us he was removed from the Practice’s list without justification. The documentary evidence shows staff explained why they considered his behaviour unacceptable in their warning letter and removal from the list letter. Therefore, we do not see any indication of a service failing regarding the Practice removing Mr C from its list.

47. We recognise Mr C found the Practice’s decision very disappointing. We hope the explanations we have given assure Mr C we only reached our conclusions after carefully reviewing the available information and the policies the Practice needed to follow.

Complaint handling

48. Mr C made a formal complaint to the Practice on 8 November 2022. The Practice acknowledged it via email on 10 November 2022. The Practice had a face-to-face meeting with Mr C about his complaint on 2 December 2022.

49. The Practice removed Mr C from its list on 12 December 2022. The Practice then did not send Mr C a formal complaint response. Therefore, we saw indications of failings in the Practice’s handling of Mr C’s complaint. We explain this further below.

50. Mr C’s advocate emailed the Practice to ask for its final response on 28 October 2024. The Practice emailed Mr C’s advocate on 10 December 2024. It told his advocate there was no complaint to answer, and it considered the matter closed. It did not send a formal written response.

51. The Practice’s Complaint Policy says, ‘a full investigation should be carried out and the complainant responded to in writing as soon as reasonably practicable (bearing in mind the timescales), setting out how the complaint has been considered; the conclusions reached; what remedial action has been taken.’

52. We spoke to the Practice’s manager on 16 September 2025 to ask for further clarity as to why the Practice did not send Mr C a complaint response.

53. They explained staff did have a face-to-face meeting with Mr C and considered that the final response. However, staff should have made this clear in the meeting minutes they sent to Mr C. The Practice’s manager also explained it was a complex situation which had gone on for many months. They acknowledged this was not the correct procedure and they will ensure written complaint responses are completed in future. They considered Mr C’s situation was particularly complex, and this meant they missed sending him a complaint response at the time.

Resolution

54. We spoke to Mr C and his advocate on 28 October 2025 and explained we saw indications of failings regarding the complaint handling. We noted the Practice had failed to follow its policy and send him a written complaint response. Mr C confirmed he would like an apology and written response as an outcome about this.

55. The Practice sent us a written response to Mr C’s complaint to share with him on 6 November 2025. This response also contained the apology he told us he wanted. We find this is an appropriate remedy for the complaint handling part of Mr C’s complaint.

56. Our NHS Complaint Standards say an apology should always be by personal communication from a suitably senior person within the organisation. The apology should be specific in what it is addressing rather than general and should be for the injustice. We saw the Practice’s written response, and its apology to Mr C, provided these things.

57. We should have regard to the outcome the complainant seeks in determining remedy. As Mr C confirms he is satisfied with the actions the Practice has taken, including its commitment to respond to all complaints it receives in the future, and they are in line with our NHS Complaint Standards, we cannot see there is further action the Practice should take by way of remedy.

58. On the basis we have achieved an appropriate resolution, we decided not to consider this part of Mr C’s complaint further.

59. We were sorry to hear of Mr C’s experience and the ongoing impact this has had and thank him for bringing his concerns to our attention. We hope the explanations we have provided in our decision, and the resolution we agreed, help him in finding closure on his case.

1. We have carefully considered Mr C’s complaint about the Practice. We were sorry to hear of the events Mr C complains about and recognise the very difficult circumstances he went through.

2. Considering the letters and reports the Practice shared with the court, we have decided we cannot consider these matters. They are not within our power to investigate.

3. Considering the sharing of private medical records with a third party, we do not consider we can reach a satisfactory conclusion on his concerns. Therefore, we have decided it is not practical to look into this matter further.

4. Considering his removal from the Practice’s list of patients, we saw no indications the Practice got things wrong.

5. Considering the Practice’s complaint handling, we have decided there are indications of failings, and we have organised a resolution with the Practice.