A practice in the City of Leicester area

4. Ms L complains an educational psychologist at the Trust did not reassess her son (Mr S) every six months in line with their recommendation in 2017.

5. Ms L says this meant her son’s attention deficit hyperactivity disorder (ADHD) was not identified as a barrier to his education as early as it could have been.

6. She also complains the Practice did not follow a shared care agreement (SCA) to fund her son’s medication trial. She says she had to privately fund a medication trial for her son at a cost of between £2,000 and £3,000.

7. Further, Ms L complains the Practice did not refer her son to the Trust’s Child and Adolescent Mental Health Services (CAMHS) in 2022. Ms L says the delayed referral means her son did not get the care he needed sooner.

8. Ms L says she has spent a long time trying to resolve these issues which has caused a significant amount of distress.

9. Ms L says as an outcome to her complaint she would like to recover the money she has spent on private medication. She would also like service improvements to stop the same problems happening again.

10. The Trust diagnosed Mr S with ADHD in early 2017. Symptoms of ADHD include impulsive behaviours and difficulty concentrating. Mr S started at a new school in 2021. An educational psychologist there believed Mr S’s ADHD was a barrier to his learning. They prescribed some medication to help with this.

11. Ms L asked her GP to agree to an SCA. An SCA is a formal arrangement between a private healthcare provider and a GP. In this instance, it would mean the GP would share responsibility for managing Mr S’s ADHD with the private provider. Specifically, his medication needs and ongoing monitoring of his condition.

12. Ms L also asked the GP to refer her son back to CAMHS. CAMHS is a set of services designed to support young people with behavioural or mental health difficulties.

The Trust Re-assessment

15. The law says a person needs to make their complaint to us within a year of becoming aware of the problem. We cannot investigate complaints brought to us after one year, unless we consider there is a good reason to do so.

16. We have discussed this with Ms L to understand the reasons why she could not do so. We have also considered the time the organisation has taken to respond to her.

17. Ms L says when the Trust diagnosed Mr S with ADHD they planned to reassess him periodically to monitor how his ADHD was affecting his education. Ms L complains this reassessment did not happen. She says the barrier his ADHD presented to his education was not identified earlier and his education has been affected as a result.

18. Ms L says she only learned about the impact this had on her son’s education in 2021. She says Mr S’s new school asked for an assessment of his ADHD to understand how it was impacting his learning. However, we consider Ms L knew about the problem much earlier.

19. The educational psychologist at the Trust decided to assess Mr S’s ADHD periodically at the time of his diagnosis. This is demonstrated in the Trust’s letter to Ms L’s GP dated 6 March 2017. The Trust also sent a copy of the letter directly to Ms L.

20. The letter set out ‘Following an ADHD assessment, it was found that [Mr S] displayed symptoms of ADHD within the moderate range. It was decided that [Mr S] would not commence any medication at the moment but that if symptoms were to cause a significant impairment, then [Ms L] will contact ourselves to discuss treatment options. This will be reviewed in the next six months.’

21. It appears the reviews happened twice in 2017 when Trust staff visited Mr S at school to assess how his ADHD impacted his education.

22. The educational psychologist wrote to Mrs L and her son’s GP in a letter dated 15 January 2018. The letter set out the Trust would discharge Mr S from the service and would not organise another care review.

23. The letter also agreed Ms L and his school will continue to monitor Mr S’s ADHD and the impact on his learning. If they felt his ADHD was affecting his learning or if the school expressed concerns then she could request a referral to the Trust.

24. Therefore, Ms L would have known at this point the Trust would not be reassessing her son given she agreed with the decision to discharge him at the time. We therefore consider Ms L reasonably knew the Trust would not be reviewing her son every six months at this point.

25. As Ms L knew something went wrong in January 2018 we would expect her to have brought her complaint to us by January 2019 to be within our time limit. However, she only complained to us in January 2025.

26. We have considered the reason for this delay to understand whether it was reasonable.

27. Ms L took her complaint to the Trust on 21 August 2024 and it responded on 24 December. Ms L was unable to actively pursue her complaint during this time. She complained to us promptly after the Trust’s final response and we are willing to set this time aside.

28. We also acknowledge Ms L has caring responsibilities that account for a significant amount her time. We understand this would reasonably explain some delays.

29. However, Ms L says the primary delay in complaining was how long it took her to find out about what happened. Given our view of the date of Ms L learned something went wrong we cannot agree this is a reasonable explanation for the delay. With this in mind, we consider this part of Ms L’s complaint falls outside of our time limit without a reasonable explanation.

30. This does not take away from her frustrating experience and how she feels this has impacted her son. We understand how much this issue means to Ms L and why she is so unhappy with the Trust’s actions.

The Practice SCA

31. 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 found no indications something has gone wrong here.

32. The Practice has explained to us and Ms L what happened. It has also provided emails supporting its account of events. It also told us about the relevant guidance in place at the time.

33. SCA guidance was in place throughout the entire series of events. It said, ‘it is important that the GP, or other primary care prescriber, is confident to prescribe the necessary medicines.’

34. It set out, ‘In proposing shared care agreements, a specialist should advise which medicines to prescribe, what monitoring will need to take place in primary care, how often medicines should be reviewed, and what actions should be taken in the event of difficulties.’

35. In May 2024 the local guidance came into place. It said if the Practice agreed to an SCA then the prescribing clinician retains responsibility for the medication. In this instance it would be a GP at the Practice. The guidance goes onto say a GP does not have to agree to an SCA if they do not feel confident managing the condition.

36. Ms L feels the Practice unfairly applied its policy to her son. She says it should have considered his SCA request on its own merits and not taken a ‘blanket approach’.

37. The private provider sent a letter to the Practice in September 2022. The letter said it would send over an SCA agreement shortly. However, the SCA never arrived.

38. In March 2023, Ms L attempted to order the medication from the surgery. However, because there was no SCA present at that time the Practice could not prescribe it. In response to Ms L’s actions the Practice attempted to contact the private provider, but the phone number provided was incorrect. Staff at the Practice then contacted Ms L who confirmed she would follow this up.

39. In April 2023 the private provider sent another letter, but again without the SCA attached. The Practice emailed it and requested the SCA but heard no response. Following a further medication request from Ms L in June 2023 it sent another email but did not receive a response.

40. The private provider sent the SCA in February 2024 but the Practice declined. It explained medication shortages that started in September 2023 meant GPs were not confident in managing the changes or doses.

41. Therefore, the Practice acted in line with relevant guidance when it asked the private provider to provide more information on the SCA. The private provider did not provide this information until February 2024. We cannot criticise the Practice for not agreeing to provide the medication Mr S was prescribed privately up to this point.

42. By the time the Practice had looked at the SCA it felt unable to prescribe the prescribe the necessary medicine safely. This was because they were not experts in deciding the type and dose of medication. This was relevant because of ongoing medication shortages that were relevant to Mr S’s care. We therefore consider the Practice acted in line with the national SCA guidance and local SCA guidance here.

43. We recognise Ms L feels let down by the Practice. We acknowledge the substantial amount she has paid for her son’s medication and the impact this has had on her and her family. We hope it is clear why we have not identified something went wrong.

CAMHS Referral

44. If we see an organisation has got things wrong then we consider what it has done to put things right. If we consider the organisation has resolved the impact we are unlikely to investigate further. Our Principles of Good Administration say organisations should provide effective services and deal with issues within reasonable timescales.

45. The Practice’s complaint response said it sincerely apologised for what happened. It explained an oversight meant staff did not send Mr S’s referral in 2022. This meant the referral was not processed as it should have been at the time.

46. At this stage it therefore appears the Practice did not act in line with our Principles and is therefore an indication of a failing.

47. Ms L says when CAMHS saw her son it immediately adjusted his ADHD medication. She says this adjustment meant he was able to manage his ADHD more effectively and concentrate better at school.

48. Ms L says as soon as she found out about the delay she approached a specialist consultant to speed the process up. She says this has caused her a lot of stress, and the cost of approaching the consultant was significant as a low-income family.

49. As an outcome to her complaint, Ms L says she would also like service improvements to stop the same problems happening again. She would also like a financial remedy to reimburse the money she has spent on medication from the private provider.

50. We have referred to our Principles of Remedy to considering whether the Practice has done enough to put things right. These say organisations should recognise what went wrong and understand the impact this had. They should also act to stop the same problem happening again.

51. In response to Ms L’s complaint the Practice apologised for the stress and frustration Ms L experienced throughout the process. It explained the mistake happened due to an individual oversight. To stop the same problem happening again, the Practice said it ‘reviewed and reinforced’ its internal processes.

52. In terms of the compensation Ms L wants, we consider this would not be an appropriate remedy to this particular part of her complaint. This is because the money she spent on medication was because there was no SCA in place at the time. As above, we consider there is no indication of failings regarding this issue so it would be inappropriate to recommend a remedy.

53. With this in mind, we consider the Practice has done enough in line with our Principles. As there is nothing left for us to achieve here we have decided not to investigate further.

54. We recognise the difficulties Mr S has experienced and how hard Ms L has worked to help him. We understand how time consuming this has been for her and the emotional impact it has had. We would like to thank them for bringing their complaint to us.

1. We have carefully considered Ms L’s complaint about Leicestershire Partnership NHS Trust (the Trust) and a GP Practice in the Leicester area (the Practice). We recognise the frustration these events have caused and understand why they mean so much to Ms L.

2. We consider the complaint about the Trust falls outside of our time limit and we have decided there is no good reason for us to put our time limit aside to consider it further.

3. We have also seen no indication anything went seriously wrong with one of the complaints about the Practice. Where something did go wrong the Practice has already done enough to put right the impact of these events.