A practice in the Brent area

6. Mr A complains about the care and treatment provided to his late father, Mr T, between. Specifically, he complains the Practice:

• incorrectly diagnosed Mr T with Alzheimer’s disease in January 2025 • failed to complete the necessary paperwork following Mr T’s death in April 2025 in a timely manner and • responded to his complaint using hostile language and refused to meet with him and his family.

7. Mr A says his father’s incorrect Alzheimer’s diagnosis affected the care provided by the care home and caused distress to the family. He also says the Practice’s actions delayed his father’s funeral, causing further distress and practical difficulties, and led to Mr T’s body being embalmed, contrary to the family’s Hindu beliefs.

8. Mr A says the Practice’s poor communication while his father was a patient was frustrating, as repeated requests to meet the GP went unanswered.

9. As an outcome to his complaint, Mr A is seeking an apology and service improvements.

10. Mr T, moved into a care home in May 2023 and subsequently became a patient of the Practice supporting the care home in December 2023.

Diagnosis

14. 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.

15. Mr A complains the Practice incorrectly diagnosed Mr T, with Alzheimer’s disease in January 2025.

16. Alzheimer's disease is the most common cause of dementia in the UK. Dementia is the name for a group of symptoms associated with an ongoing decline of brain functioning. It can affect memory, thinking skills and other mental abilities.

17. In its response of 14 July 2025, the Practice explained the diagnosis of Alzheimer’s was made on 31 January 2025, based on Mr T’s clinical history, cognitive assessment, and supporting investigations. It explained Mr T’s records indication rapid deterioration in memory over a period of nine months. The scans showed nothing acute but progressive small changes.

18. It goes on to explain GPs with suitable experience can diagnose dementia, including Alzheimer’s, especially when memory clinics are not feasible due to patient condition or NHS backlog. The diagnosis was made following local and national guidelines, with all appropriate investigations completed to exclude other causes. The Practice asserts the diagnosis was communicated to nursing staff. It explains Mr A and his family members had opportunities to discuss the diagnosis during ward rounds or via the NHS App.

19. We refer to NICE Guideline NG97 which sets out how initial assessments should be conducted in a non-specialist setting. It sets out the following:

‘At the initial assessment take a history:

• from the person with suspected dementia and • if possible, from someone who knows the person well (such as a family member).

If dementia is still suspected after initial assessment:

• conduct a physical examination and • undertake appropriate blood and urine tests to exclude reversible causes of cognitive decline and • use cognitive testing.

• When using cognitive testing, use a validated brief structured cognitive instrument’

20. We can see a cognitive assessment of Mr T was conducted by the GP and account of his history was also considered in line with guidelines. An Mini-Mental State Examination (MMSE) test was also performed for diagnosis. A Mini-Mental State Examination (MMSE) is a set of 11 questions. It's used by doctors and other health professionals to check for cognitive impairment.

21. The records show on 7 January 2025 an MMSE was completed and scored. On 29 January 2025, the records show a discussion between clinicians around Mr T having dementia, during which it was considered he would not benefit from a referral to the memory clinic because he was receiving end-of-life care. We can also see Mr T was suspected of having dementia as documented in his medical records as early as April 2023. The Practice also conducted an initial assessment on 7 January 2025 of Mr T where his history was taken and reviewed.

22. We do not consider there are indications of service failure in relation to this aspect of Mr A’s complaint. The evidence shows the Practice carried out an initial assessment, including taking a history, conducting an examination, and using cognitive testing, in line with the NICE guideline referred to above. Our clinical adviser has reviewed the concerns raised and confirms this view.

23. For the reasons outlined above, we will not be taking any further action on this aspect of Mr A’s complaint.

Death Certificate Delay

24. Mr A says the Practice did not complete the necessary paperwork after his father’s death in April 2025 in a timely manner, which led to the cremation being delayed by seven days.

25. In its response of 14 July 2025, the Practice said it completed the death certificate on 28 April 2025 and sent it to the Brent Medical Examiner’s Office shortly after Mr T’s death on 22 April 2025. The certificate was then issued to the Brent registrar on 29 April 2025.

26. The Practice explained, under the Medical Examiner system, all deaths must be reviewed by the Medical Examiner or Coroner before a death certificate can be issued. It said this process can take several days and that the availability of funeral or cremation slots may also contribute to delays.

27. The Practice explained the paperwork was completed in line with national guidance and within the expected timeframe. It said the period from Mr T’s death to the issue of the certificate was seven days, or five working days, which it considered standard.

28. The Practice further explained that the Brent Medical Examiner’s Office would have contacted the family to discuss the circumstances and cause of death. It said that, if concerns had been raised at that stage, the process might have been expedited within 24 to 48 hours. The Practice said it did not receive any such communication from the family during this period.

29. We refer to the following guidance: The National Medical Examiner’s guidance for England and Wales (Published 30 July 2024). This states;

30. ‘The medical examiner office sends the completed Attending Practitioners’ Medical Certificates of Cause of Death to the registrar, and the death must then be registered within 5 days’

31. We can see the Practice completed Mr T’s death certificate within 24 hours of receiving it from the Medical Examiner’s Office, and Mr T’s death was registered the following day. We therefore consider the Practice acted in line with the relevant guidance and completed the documentation within an appropriate timeframe.

32. For reasons set out above, we do not consider there are any indications of a service failure in relation to this aspect of Mr A’s complaint. The evidence shows the Practice completed the relevant documentation within an appropriate timeframe and in line with the relevant guidance.

Complaint Response

33. Mr A says the language used in the Practice’s complaint response was hostile, which caused further upset and distress to Mr T’s family.

34. The NHS complaints policy outlines what should be included in a final written response. It states:

‘ The response will include, as appropriate:

• a reminder of the issues investigated and the outcome sought • an explanation of how we investigated the complaint • the relevant evidence we considered • what the outcome is • an explanation of whether or not something went wrong that sets out what happened compared to what should have happened, with reference to relevant legislation, standards, policies, procedures and guidance • if something did go wrong, an explanation of the impact this had • an explanation of how that impact will be remedied for the individual • a meaningful apology for any failings • an explanation of any wider learning we have acted on or will act on to improve our service for other users • an explanation of how we will keep the person who raised the complaint involved until all action has been completed • confirmation that we have reached the end of our complaint procedure • details of how to contact the Parliamentary and Health Service Ombudsman if the individual is not satisfied with our final response • a reminder of where to obtain independent advice or advocacy.’

35. Having considered the Practice’s complaint response against the NHS complaint standards, we consider it fell below the expected standard. The final written response appeared argumentative, including questions directed back to Mr A, which is not what we would expect in a final response.

36. The complaint standards make clear that responses should be written with the reader in mind and that the tone should be appropriately adapted. We do not consider that happened here. We therefore raised our concerns with the Practice about its handling of the complaint.

37. We raised our concerns with the Practice, and it apologised for the language used in its response to Mr A. It explained it would make service improvements moving forward. We consider there are indications that the Practice has acted in line with the NHS complaint standards by providing an apology, and promoting a learning culture by using the complaint as an opportunity to develop and improve its services and people. We consider this is a proportionate remedy, based on the circumstances of the case, and for this reason, we will not be taking any further action on this part of the complaint.

38. We recognise this does not change the experience Mr T and his family had, but we hope it is reassuring for the family that these circumstances have been reflected upon and positive changes made for future patients in similar positions.

1. We have carefully considered Mr A’s complaint about the Practice. We were sorry to learn how Mr A, and his late father, Mr T, were affected by the concerns he has raised. It is evident this was a difficult time for the family, and this has continued to trouble Mr A due to his concerns about the care his late father received.

2. We have considered the information provided by Mr A and the Practice. After doing so, we did not identify any service failure in relation to the Alzheimer’s diagnosis made by the Practice or the time taken for the Practice to complete the death certificate documentation.

3. We have identified indications of service failure in relation to the way the Practice handled Mr A’s complaint. We have looked at the actions taken by the Practice in response to Mr A’s complaint and consider there are indications that both organisations have acted in line with the NHS complaint standards by giving a fair and accountable response, providing an apology, and promoting a learning culture by using the complaint as an opportunity to develop and improve its people and the service it provides.

4. We will explain the reasons for our decision in this statement.

5. Complaints give us valuable insight into the organisations we investigate, so we would like to thank Mr A for sharing his experiences with us. It is important to acknowledge that where we have not identified any indications something went wrong in relation to the concerns Mr A raised, it does not detract from Mr T’s experience, nor the impact it had on him and his family.