The vast majority of the enquiries we receive at the Medical Defense Society relate to NHS complaints – and this is a key area in which GPs need support.
While all GPs aim for the very highest standards of care it’s a fact of life that not everyone will always be wholly satisfied with their care. Whether fair or not, complaints can occur and you need to know how to appropriately react to them.
While we would always recommend that our members come to us for full support after a complaint, we’re also keen to ensure you have handy information at your fingertips too. With that in mind, here’s a handy refresher to get you up to speed.
GPs and the NHS complaints procedure: What you need to know
The NHS complaints procedure has two basic tiers – one that is more informal entitled ‘feedback’ and the other billed a complaint.
Depending on the severity of the issue at hand, encouraging and engaging with feedback at an early stage can prevent an unnecessary progression to the ‘complaint’ phase.
It makes sense to provide clear opportunities to offer feedback in order to deal early with dissatisfaction and allow action to ensure similar problems can be avoided. Obviously it is in the best interest of both patients and GPs for complaints to be dealt with expeditiously.
The Health Select Committee has stated: “In moving to a culture which welcomes complaints as a way of improving NHS services, the number of complaints about a provider, rather than being an indicator of failure, may highlight a service which has developed a positive culture of complaints handling and it will be important for system and professional regulators alike to be able to identify the difference.”
Complaints can be made directly to the provider or to the commissioning body.
Meeting standards in responding to a complaint
Unsurprisingly, GPs often have concerns around responding to a complaint in terms of accepting or implying liability. However it is important not to delay or avoid acknowledging and dealing with issues as this can inflame matters. A simple and sincere apology can, when appropriate, prevent a complaint escalating.
A thematic review of general practice complaint handling across England said: “GPs can fear liability, litigation and a damaged reputation, which can act as a disincentive to being open and honest, despite a duty to do the right thing.”
Saying sorry need not be an admission of liability and doctors have responsibilities to be open and honest under the duty of candour.
Staff within your practice must be well trained and briefed on how to deal with feedback and complaints and a sensible procedure put in place.
Appropriate advice should be taken in terms of training, procedure development and, where necessary, at the point of a complaint being received.
Requirements must be met in relation to acknowledgement of a complaint, proper investigation, feedback and resolution. In addition, patients must not be treated differently despite their complaint. Your procedure should ensure this point is demonstrable.
A complainant is also entitled to expect appropriate action to be taken in response to the issue they raise.
When and how can a complaint be made
An NHS complaint can be made long after the incident or issue in question as, while there is a time limit, it is broad.
The rules state a complaint should be made: “Within 12 months of the incident, or within 12 months of the matter coming to your attention.”
Even that time limit can be extended.
It is admissible for the complaint to be made by any person appointed by the patient, providing they have their permission that could be a family member, carer, friend or even a local MP. Confidentiality rules still apply.
Advice and liaison services can assist in ensuring complaints are brought in a timely way and may support resolution. Displaying details of local Healthwatch and similar services allows patients to access good quality advice on raising their compliant and providing the necessary information for you to deal with it well.
Escalation of a complaint
If a complaint is not dealt with to the satisfaction of the person who raised it, it may be escalated to the Parliamentary and Health Service Ombudsman.
The ombudsman can make a variety of recommendations but does not have the power to impose those.
It can ask for:
- Action to be taken to put things right
- A decision to be reconsidered if it is lear mistakes were made, the matter was not dealt with fairly or procedure was not followed
- The improvement of services to avoid the same things happening again
The Parliamentary and Health Service Ombudsman should not usually look at a complaint where there is or has been the option for resolution via a legal mode, such as court or tribunal. Discretion can be shown.
How well do GPs do when it comes to handling complaints?
The ‘thematic review of general practice complaint handling across England’ found that whilst 55% of general practices did a good job of complaint handling, 45% were falling short.
The review said: “Most people have far more contact with their GP practice than with any other NHS service, and they are often an individual’s link in to other NHS services. That’s why getting complaint handling right in general practice is so important – it has the potential to make a difference to everybody who uses the NHS.”
The review stated that in 2014-15, the Parliamentary and Health Service Ombudsman completed received 5,086 complaint enquiries about general practice. Of those 696 (14%) were investigated and 32% upheld. This was at the lower end of the uphold rate, with 44% of cases about acute trusts and 33% of mental health, social care and learning disability trusts upheld.
It said GP practices tend to receive 8.5 complaints annually. GPs face the additional challenges of not usually having a specialist team to deal with complaints and the likelihood of a close relationship between the person being complained about and the internal investigator.
Top tips for GP complaint handling
A joint publication from the Care Quality Commission, NHS England, Healthwatch and the Parliamentary and Health Service Ombudsman offers 10 tips to help GPs improve complaint handling in their practices.
It says: “Complaints and concerns are a valuable source of feedback that can help your practice improve its service. Handling them well not only shows patients that you are listening and that their concerns matter, but it can also help to improve your reputation.”
The ten pointers on complaint handling best practice are:
- Show how you have responded to complaints and feedback with a ‘you said, we did’ resource such as a noticeboard
- Invest in training to share experiences of complaint handling and resolution
- Work with the Patient Participation Group, for example to:
- Ensure your complaints policy is clear, easy to understand and fit for purpose
- Actively collect feedback from patients
- Help review comments and feedback
- Be open and responsive
- Clearly explain decisions about care and treatment, following NICE guidelines.
- A genuine apology may prevent an issue developing into a formal complaint
- Acknowledge the value of advocacy services and Healthwatch groups and signpost to them
- Use NHS England’s Assurance of Good Complaint Handling for Primary Care Toolkit
- Ensure a joint approach where the complaint is about another provider too
- Only remove a patient from your list due to and at the time of an incident, not as a result of a complaint