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JimLawyer
JimLawyer, Solicitor
Category: Law
Satisfied Customers: 13947
Experience:  Senior Associate Solicitor
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I am getting treated differently at a GP practice, East of

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I am getting treated differently at a GP practice
JA: Where are you? It matters because laws vary by location.
Customer: East of England, Cambridgeshire
JA: What steps have you taken so far?
Customer: Complained to manager then complained to NHS and MP. Manager lying and has stopped me getting appointments
JA: Is there anything else the Lawyer should know before I connect you? Rest assured that they'll be able to help you.
Customer: No
Customer: replied 12 days ago.
File attached (TLL467S)

Hello, this is Jim and welcome to JustAnswer. I will be the lawyer working with you today.
Sorry to hear of the issue. I will set out my written answer shortly.

The National Institute for Health and Clinical Excellence (“NICE”) is an advisory body established by the Health & Social Care Act 2012. It's role is to provide guidance & support to providers & commissioners of healthcare to help them improve outcomes for people who use the health & social care system, by defining quality in the NHS. It produces robust evidence - based guidance & advice for health practitioners.

The Secretary of State is accountable to Parliament for the healthcare system including NICE. But NICE recommendations are only guidance. They influence local decisions about which services to provide for patients but their recommendations are not a legal right & the NHS is not required to adhere to them (aside from a legal requirement to fund the relatively small set of treatments covered by NICE’s technology appraisals). Local commissioners make choices about which treatments are available on the NHS. These choices can vary from area to area. However, patients also have rights, enshrined in the NHS Constitution & it is important to know them.

As per the report you attached, the NHS Constitution says "you have the right to receive care & treatment that is appropriate to you, meets your needs & reflects your preferences",

and importantly:
"you have the right to drugs & treatments that have been recommended by NICE for use in the NHS, if your doctor says they are clinically appropriate for you".

Patients have options if denied treatments or medicines.

You should ask your UK treating doctor to contact your clinical commissioning group (CCG) and request treatment from them. It helps to know the policy of your local CCG. Most clinical commissioning groups publish lists on their websites of the treatments they do not routinely fund. Some agree joint policies with neighbours. These broadly fall into 2 categories

  1. Treatments not funded because they have low clinical value

  2. Treatments only funded for certain individuals e.g. patients selected for treatment based on factors that may affect the success of their treatment if e.g. overweight or smokers. Decisions to deny treatment can therefore represent the best outcome for patients if the risks associated with the procedure, outweighs the benefits. Patients can still access these treatments not routinely funded in some circumstances. Clinicians can submit individual requests to their CCG (or NHS England / NHS Improvement, for services within their commissioning remit) on behalf of the patient.

(Individuals with cancer may have additional options. They can apply to the Cancer Drugs Fund set up by government in 2011 to provide access to drugs not routinely provided by the NHS)

If dissatisfied, patients can complain to the NHS - their GP or provider Trust. If dissatisfied with the outcome of the NHS complaint, they can then appeal to the Parliamentary Health & Social Care Ombudsman here: https://www.ombudsman.org.uk/making-complaint

Patients also have the right to compensation where they have been harmed by negligent treatment.

Patients can also exert pressure by referring the matter to their local Healthwatch - who are patient’s consumer champions - yours can be found here: https://www.healthwatch.co.uk ) / to the local press / to your local MP (which you say you have already done).

If the doctor refuses to approach the CCG, there could be another General Medical Council / regulatory issue.

The General Medical Council (GMC) requires doctors to provide effective treatments for patients based on the best available evidence. NICE says while health professionals are encouraged to follow their recommendations , they are not intended to replace clinical judgement. Doctors can make justifiable decisions to depart from NICE guidance in the patients best interests after discussion with the patient.
It is important therefore for doctors to explain why they believe it is in the patients best interests to depart from NICE guidance together with alternative courses of action & possible outcomes. The GMC says that persistent failure to follow NICE guidance could put the doctor’s registration at risk. You would also be within your rights to report the doctor to the GMC as a result: 0161(###) ###-####or by emailing *****@******.***

I hope this helps and answers the question - my goal is to ensure you are happy with the answer and have the information you need. If you have any follow up questions then please let me know. I will reply as soon as I can to help with any further queries.

Many thanks,
Jim

Please let me know if the answer helped or if you need me to cover anything else?. I am happy to clarify the answer or if you have any follow up questions. If so, I’d be grateful if you would let me know. I am free most days, including weekends, so feel free to ask me anything you are unsure of.

Best wishes,

Jim

Customer: replied 12 days ago.
If the ombudsman say they cant deal with my complaint, what would be my options after that?
Can i report the manager to the GMC?
to the GMC, but I’m sure the Ombudsman will help. As a last report court action could be pursued (judicial review) though a no win no fee law firm will be required for that
JimLawyer and other Law Specialists are ready to help you

last *resort*, sorry for the typo