A practice in the Kirklees area

6. Mr F complains about his treatment by the Practice in July 2024 when a verbal altercation with a member of Practice staff which led to a PATCHS communication (Practice communication system) being sent from Mr F to the Practice.

7. Mr F complains following a verbal altercation with a member of staff on reception prior to his appointment on 2 (Practice states) or 10 (Mr L states) July 2024, the Practice removed him from its register of patients.

8. He states the Practice failed to safeguard him, despite diagnosed physical, neurological, and mental health conditions listed on his medical record, prior to and during a medical incident (11 July 2024) following his deregistration.

9. Following the events on 2/10 July, Mr F says he experienced a medical incident due to psychological distress and aggravated health conditions while walking home.

10. He states he did not have access to GP care during this incident and there was ‘no safeguarding response’ and his disabled mother avoidably had to seek medical assistance for him during the incident.

11. We appreciate how this complaint has impacted Mr F and we will explain our decision in more detail below. We hope our explanation provides him with reassurance we have carefully considered his complaint before reaching our decision.

12. Mr F is a 40-year-old male with epilepsy (a chronic brain disorder characterised by recurrent unprovoked seizures). He is a carer for his mother. He is awaiting formal assessment for autism spectrum disorder (ASD – a neurodevelopmental condition affecting social communication, behaviour and interests) and attention deficit hyperactivity disorder (ADHD – a neurodevelopmental condition characterised by patterns of inattention, hyperactivity and impulsivity which can affect daily functioning).

13. The Practice Manager wrote to Mr F on 5 July 2024 advising he was to be removed from the Practice list and saying his behaviour was unacceptable. The letter references the interaction with a member of staff on 2 July 2024 and the PATCHS practice note from Mr F dated 4 July 2024 as the reason for his removal from the patient’s list, citing the zero-tolerance policy due to his ‘unacceptable use of language’.

14. Mr F experienced a medical event on 11 July 2024. He tells us this was due to the impact of the Practice letter advising of his removal from the patient register, received on 5 July 2024. Following this, he states he suffered a collapse while walking home and suffered severe difficulty breathing, impaired vision, neurological episodes, including seizures, fainting, and blackouts, serious loss of coordination, leaving him barely able to walk. He says his mother, who is disabled was ‘actively attempting’ to get him care.

15. Mr F says the Practice failed to ensure he had access to primary care and failed to safeguard him on deregistration, as a vulnerable patient.

Issue 1 - Removal from the Patient List

18. 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 something has gone wrong.

19. Mr F has told us on 2 July he had an interaction with a member of staff at the Practice who refused to identify herself, referred to him as ‘obese’, discussed elements of his medical history in front of other staff. He says due to this he withdrew his consent for this member of staff to access his records. He said he had felt unwell at the time and the member of staff had not acknowledged this.

20. It is worth noting Mr F disagrees with the date the interaction took place, although evidence suggests it did take place on 2 July 2024. He does not dispute the interaction took place.

21. The Practice Manager wrote to Mr F on 5 July 2024 advising him he was to be removed from the Practice list and saying his behaviour was unacceptable. The letter references the interaction with a member of staff on 2 July 2024 and the PATCHS practice note from Mr F dated 4 July 2024 as the reason for his removal from the patient’s list citing the zero-tolerance policy due to his ‘unacceptable use of language’.

22. The letter states there has been a breakdown in the patient/GP relationship and the Practice would write to Patient Services explaining the reasoning for Mr F’s removal from the Patient’s list. The letter states Mr F has 28 days until he will be removed and provides contact details for Patient Services for him to seek support in finding a new GP Practice.

23. The PATCHS record from Mr F date stamped at 1:10pm on 4 July 2024, shows he referred to a ‘clinically obese staff member from the office’.

24. In the Practice’s complaint response dated 8 January 2025, it included a statement from the member of staff, which said she had an uncomfortable interaction with Mr F at the reception desk where he had been rude and objected to her accessing his records.

25. The Practice explained in its response it had removed Mr F from its patient list in line with its Zero Tolerance Policy. The policy lists ‘verbal abuse towards the staff in any form including verbally insulting the staff’ as behaviour it finds inappropriate. The policy says, ‘When trust has irretrievably broken down, it is in the patient’s interest, just as much as that of the practice, that they should find a new practice.’

26. The NHS England, violence prevention and reduction standard (version 1), January 2021 empowers local NHS services to compile a zero-tolerance policy to protect and safeguard NHS staff and patients.

27. The Practice’s VAP Policy defines violence and aggression towards a person as, "a physical contact with another person which may or may not result in pain or injury. The contact is uninvited and is an attempt to cause harm, injury or to intimidate. Non-physical aggression includes the use of language which causes offence or threatens the safety of a member of staff". It notes there are posters stating the Practice’s policy are posted around the waiting room for reference.

28. Section 13.10.1 of the Practice’s GMS contract says where a Practice has reasonable grounds for wishing a patient to be removed from its list of patients it should give notice in writing to the person of its specific reasons for requesting the removal of the individual, when it wrote to him giving 28 days’ notice of his removal.

29. Having considered what happened and the policies which set out what should have happened, we consider the Practice acted in line with those policies when it decided to remove Mr F from its patient list. It explained how his behaviour met its definition of unacceptable behaviour and explained it considered his written communication was offensive and insulting and its staff member had been upset.

30. The Practice gave Mr F 28 days warning of the removal and provided information for how he could register with an alternative GP. The removal letter explained the Practice considered the relationship between Mr F and the Practice had broken down and in line with the Practice’s GMS Contract, we consider this is reasonable grounds to remove a patient.

31. We have seen indications the Practice’s decision was in line with its NHS Contract and the policies set out above. We have seen no indication of failings for this issue and will not be taking any further action on this part of the complaint.

Issue 2 – Failure to provide care during medical incident on 11 July

32. Mr F says he experienced a medical event on 11 July 2024 due to the impact of the Practice letter advising him of his removal, received on 5 July 2024. He said following this he suffered a collapse while walking home and suffered: • severe difficulty breathing • impaired vision • neurological episodes, including seizures, fainting, and blackouts • serious loss of coordination, leaving him barely able to walk

33. He says his mother, who is disabled, was ‘actively attempting’ to get him care. He says the Practice failed to ensure he had access to primary care and failed to safeguard him, as a vulnerable patient.

34. There is no medical record or documentation of the medical incident having occurred following the receipt of the removal from the patient list letter.

35. Mr F stated on 19 February 2025 the incident had occurred while walking home from the surgery on 11 July 2024. He experienced ‘neurological deteriorations, collapse-type symptoms and severe psychological distress’.

36. He confirmed he did not attend Accident & Emergency (A&E), and his disabled mother sought medical assistance for him as he ‘had no GP access and there was no safeguarding response.’ He also did not contact 111 or 999 or attend an urgent care centre.

37. Mr F was deregistered from the Practice on 8 August 2024 and so had access to his Practice at the time of the medical incident. If he had attended the Practice on 11 July 2024, he would have been advised to attend A&E. The Practice also provided Patient Support details for onward support to Mr F and provided 28-days’ notice before deregistering.

38. As Mr F did not attend the GP surgery, A&E or an urgent care centre there is no clinical documentation to confirm what occurred during the medical event and what support he required. There is also no call handler or paramedic account or report to refer to.

39. Mr F had a telephone appointment with the Practice to discuss his wellbeing and mental health on 17 July 2024 where his risk was assessed. A meeting with Mr F was held on 7 August 2024 when Mr F attended the Practice with the Practice Manager and a medical secretary, to discuss the deregistration letter sent to Mr F on 7 August 2024.

40. The incident on 2 July 2024 was discussed and the PATCHS communication was provided to Mr F. There was no constructive resolution to the discussion due to reported ‘loud and intimidating behaviour’ from Mr F and the meeting ended.

41. In conclusion, we have not seen evidence Mr F had no access to primary care during the medical incident on 11 July. We have seen no evidence to say he contacted the Practice to ask for its help and was refused, on this date.

42. The Practice provided medical support on 17 July 2024 when he attended the Practice and discussed his notice of deregistration from the patient register and the extended timeline over the 28-day period following the zero-tolerance letter being sent.

43. We are sorry to hear of Mr F’s medical incident. As we have identified no indications of maladministration or service failure in the investigation of this complaint, we will not be taking any further action on this part of the complaint.

1. We have carefully considered Mr F’s complaint about care, treatment and communication as a patient at the Practice. We understand the complaint relates to a decision to remove him from the patients register following a verbal altercation with a Practice member of staff in July 2024, and a medical incident on 11 July 2024 having received his deregistration letter.

2. Having carefully reviewed Mr F’s case, we have decided not to consider it further. We have looked closely at the Practices’ policies for safeguarding, zero-tolerance, and violence and aggressive patients, alongside communication between Mr F and the Practice, and what the Practice did and should have done based on guidance. We have seen no indication the Practice did anything went seriously wrong.

3. We acknowledge the impact Mr F has told us about and we recognise the medical incident would have been distressing to experience. We hope the change in Practice helps to improve Mr F’s health and wellbeing.

4. As we have identified no indications of maladministration or service failure in the investigation of this complaint, there will be no detailed investigation into this complaint and it will be closed at primary investigation.

5. Complaints give us valuable insight into the organisations we investigate, so we would like to thank Mr F for sharing his experience with us. We recognise this is not an easy step to take.  It is important to acknowledge that where we have not identified any indications something went wrong in relation to care, treatment and communication with Mr F’s previous Practice, it does not detract from his experience, nor the impact this had on him.