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Decision Report 201806950

  • Case ref:
  • Date:
    May 2019
  • Body:
    A Medical Practice in the Tayside NHS Board area
  • Sector:
  • Outcome:
    Upheld, recommendations
  • Subject:
    policy / administration


Mr C complained about the information which a GP entered on a form for Employment Support Allowance (ESA). The GP had included historical information in Mr C's medical records, which Mr C felt was not relevant.

We took independent medical advice from a GP. We found that although the information was contained in Mr C's medical records, it was not relevant to the reasons why Mr C was unable to work at that time. The form does not ask for a summary of a patient's past medical history but rather about the patient's current medical conditions which may be a barrier to them being fit for employment. We upheld the complaint.


What we asked the organisation to do in this case:

  • Apologise to Mr C for including information which was not relevant to his current medical condition. The apology should meet the standards set out in the SPSO guidelines on apology available at

What we said should change to put things right in future:

  • The GP concerned should ensure that in future only relevant information regarding the patient's current medical condition is entered in the ESA form.

Updated: May 22, 2019