The GP

Bernays and Whitehouse, Shirley Medical Centre, 8 Union Road, Shirley, Solihull, West Midlands, B90 3DT

Having attended this Practice as our family practitioners since being in the area—about 40 years for us—and knowing that they had had contact with my son since his birth, I was very disappointed at the reaction that I was suddenly a ‘third party’ and could have no input to my son’s medical needs.

This can be largely due to GPs’ misunderstanding of so-called confidentiality in adult health care. Against this must be the consideration that the GP (general practitioner) is rarely a specialist in anything and particularly not in the area of mental heath—and in hindsight this was obviously the case here.

Modern thinking (and actually written into recommended practice) is that the role of a Carer is paramount. Without the care and monitoring of a ‘third party’ (the Carer), mental illness sufferers are going to have a great struggle to keep well. Relevant information on a (would-be?) patient’s illness is always important and useful. All information needs to be taken into consideration by a multi-disciplinary team in the whole treatment of a patient who at some time may be beyond their own capacity, or capability to medicate themselves or control their actions. As parents and sole contacts (Carers by default) we felt shut out. The GP made it clear that cooperation was out of the question: hence nothing would be done to relay ongoing concerns about Nick.

I was in effect told later that there was nothing the GP would do unless a patient harmed themselves, or another person. Maybe this is why press headlines appear bold, and sickeningly often, in these cases where the policy has not worked, and another life has been lost.

Our GP was apparently not aware of the inclusive policy of involving and using Carers for good patient outcomes: something variously referred-to as the ‘triangle of care’ in the treatment of mental illness. Our mental health Trust was well aware of it, and was promoting it nationally at the time. Unfortunately their front-line workers were also ignorant of the policy and where it applied, even though some members had had ‘training’ in it efficacy.

Our GPs also turned out to be unaware of UK law in respect of Carer needs. It is a requirement that carer’s needs be assessed in their own right. This was unknown to me at the time but was never mentioned on several opportunities available to the GP. This might at least have made our status more obvious.

Even more disappointing was the Practice’s response to a repeated NHS complaint investigation request. This involved further bungling, now with a disturbing aspect which appeared to me to be deceit.

But the GP had had at least five opportunities to investigate harm done, and two of those were before my son died.

I wanted to know:

Why had the GP not made full use of approaches and use of information on my son’s deteriorating condition? The GP had in effect blocked access to secondary care by brushing off these approaches. The GP made it evident that they would not help, and that reflected on opportunities missed for monitoring. This was totally against NICE recommendations, and long-standing local procedures set up by the Trust initiated 5 years before.

Why did I have to bypass the GP (after 9 months of waiting) even to get a first ‘intervention’?   Explanation as above.

The GP is the ‘gatekeeper’ of access to health services but obviously this will not work where the doctor is unreceptive and the patient is ‘uncooperative’. Lack of capacity is seen in young and old patients, yet is somehow readily accepted that older patients can be ‘uncertain’, perhaps in dementia cases etc. In fact I have heard first hand that a carer only has to come along to assist a less-able older person, and the patient can be ignored in favour of the carer, as if the patient is not capable of speaking!

In our case, the GP having ‘created’ a difficulty in getting attention, it set the scene for mismanagement of all successive approaches.

Why had the GP antagonised the patient’s illness by inappropriate language and contacts, and broken trust by going against carer and patient wishes in apparent deceit of stated intentions? It was a bungled approach and we had been betrayed. My son was additionally suspicious, which led to a break in trust in us his parents, and resolutely refused to have further contact with any doctor. Trying to get help became harder. My son became more ill. Our GP was already acting against his interests.

Why did the GP apparently cover up facts about requests for attention? The GP knew full well that we had been asking for attention for over 5 years. They had been blocking services – and yet had stated we had not asked since the mismanaged approach about 9 months before my son’s death. But it was in the Practice’s records that I had actually made another futile attempt just a few months before Nick died.

After the event, why was the Practice unable to produce procedures or follow  the NHS Complaints Procedure (having neither policy or procedures) as required by their contract (with the PCT, at the time)? To-date the GPs have still not investigated the complaint: Death of Patient – a Serious Untoward Incident. Still waiting for that.

Why wasn’t an immediate SUI investigation triggered at the Practice, by the NHS Trust, when responding to my complaint which specifically requested -and agreed- that the Trust was to handle the entire complaint (as permitted and as under obligation, under NHS Complaints Procedures)? The truth perhaps is that the Practice had thought they had ‘got away with it’ when the Trust investigator had left the premises.

So after 5 years of difficulty with this Practice, ultimately to my son’s death, why did the GP consider that a half page of A4 – brief and not near full representation of the facts and failures – would suffice to get the Practice off the hook?

The entire episode was disgraceful, and at this moment the Ombudsman is dismissing facts of the case; and it has taken 8 years of my late, different, bereaved, life to get near any sense of resolution. I have been astounded that neither the PHSO or the GMC have shown interest in investigating malpractice, death, or deceit in investigation. The converse in fact: “Not their job”. Despite the fact that Services have had to admit they didn’t follow NHS procedures, the PHSO hangs on to their unreliable evidence in spite of revelations of actual experience.

Not surprising then that we seem to have a continuous stream of NHS abuse cases in the press. Professional bodies and the PHSO have been aware of the abuse but nobody wants to take responsibility to upset the status-quo of the NHS balancing act. Worse still, the PHSO and hence NHS could have learnt how to help kids who are still taking their own lives for the same reasons: LACK OF SUPPORT – almost of epidemic occurrence.

After the Practice failed to set up an investigation through a third party (another GP who was already appraised of the complaint) as required and recommended by the definitive NHS complaints procedure, we left this ‘rogue’ maladministered GP Practice – minus our son.

Addendum: It was through hearsay only that I discovered over 8 years after care problems, the GP involved was no wiser as to the value and scope of mental health interventions. The GP had apparently not taken advantage of mental health training offered by BSMHFT since complaints had highlighted the necessity.