Even if you consider a complaint unjustified or just plain trivial, you need to take it seriously and respond appropriately. A dismissive or unprofessional response could result in a failure to resolve the complaint as well as negative publicity for your practice and it may invite criticism from the ombudsman.
According to the Medical Defence Union (MDU), over 90% of GP complaints are resolved locally, but the Health Service Ombudsman for England still received 2,951 complaints about GPs during 2011-12, an 18% rise on the previous year.1 Most were advised that they first needed to complain to their practice but of the 65 cases the Ombudsman investigated, 80% were upheld. This prompted a call for:
Your complaints procedure
Your ability to manage complaints effectively depends largely on your practice’s complaints procedure. If you have not reviewed this for some time, it is a good idea to see how it measures up.
Consider the last few complaints your practice received – did following the procedure make you feel comfortable and in control, or at the mercy of events? Did anything happen that wasn’t covered in the procedure? Did staff understand the procedure and how it applied to them? And most importantly, did it help you to resolve the problem to the patient’s satisfaction? If the answer to any of these questions is no, it may be time for a reappraisal.
Your complaints procedures should follow the Local Authority Social Services and National Health Service Complaints (England) Regulations 2009 (or the equivalent regulations in Wales, Scotland and Northern Ireland). Based on the most common queries from MDU GP practice members, we suggest it includes the following points:
Complaints manager and responsible person
Identify the practice complaints manager and the responsible person (usually a senior partner). The latter must ensure the practice complies with the complaints procedure and signs off complaint responses. This can be the same person as the complaints manager, but we suggest that the roles are kept separate if possible.
If someone other than the patient - such as a family member - makes a complaint, the procedure should explain how to check they have the authority to do so. If the patient lacks capacity to consent, their representative must be able to demonstrate sufficient interest in the patient’s welfare and be an appropriate person to act on their behalf.
The procedure should emphasise the need for flexibility. For example, although complaints should usually be made within 12 months, you should consider complaints outside this time limit if possible, or talk to the complainant about what steps you can reasonably take to address their concerns.
Investigation and response
If the matter cannot be dealt with there and then, the complaints procedure should stipulate the need for a clear investigation plan for each complaint. This will normally set out:
The complaints manager must acknowledge the complaint within three working days, explaining how it will be investigated and where the complainant might seek independent advice, such as through the Independent Complaints Advocacy Service (ICAS). The complainant should receive a prompt and complete response, and you are expected to provide reasons if there is a delay of more than six months.
Written responses must be signed off by the practice’s responsible person, or another senior member of the practice not involved in the substance of the complaint, who can provide an independent perspective. The response letter must be open and honest. You should acknowledge mistakes, apologise where appropriate and inform the complainant of any action taken. You should also inform the complainant of their right to request a review by the ombudsman if they remain dissatisfied.
Your complaints procedure should stress the need to keep careful records of all complaints, including the name of the complainant, the subject matter, the date on which it was made and all correspondence, as well as any action taken. These will help you manage the complaint and provide evidence of effective complaints handling. You are advised to keep complaints records separate from patients’ clinical records.
The complaints procedure should not end when you have responded to the complainant as practices also need to demonstrate they have learned lessons and, if appropriate, adopted changes aimed at improving patient care and safety.
Under the regulations, you need to produce an annual complaints report, which should be available on request and sent to your commissioning body. It should give details of the complaints received, those that you decided were well-founded, any lessons learnt (particularly if there are any patterns of complaints in the reporting period), and details of complaints referred to the ombudsman.
As the following fictional case shows, a practice complaints procedure which prompts sensitive and careful complaints handling maximises your chances of resolving problems quickly.
An elderly patient with chronic obstructive pulmonary disease (COPD) contacted his GP practice to request a home visit as he had experienced a particularly bad night. Unfortunately the new receptionist who answered the call was still unfamiliar with the telephone system and cut him off. When he called back she told him that he was too late to request a routine home visit and she would need to arrange a call back from the emergency GP. By the time a GP visited the patient later that day, he felt better but he complained about the receptionist’s attitude and failure to apologise.
In her role as complaints manager, the practice manager followed the practice’s established complaints procedure. She acknowledged the complaint straight away and told the patient when he could expect a response. She then listened to a recording of the call, obtained statements from the patient, both receptionists and the GP before reviewing the practice’s telephone and home visit protocols and staff training records.
The incident was discussed at a practice significant event meeting. The receptionist complained that she felt unable to cope with the volume of calls at busy times and the telephone system was not very user-friendly. The practice manager agreed to look into the feasibility of a new telephone system but it was also agreed that all reception staff should receive telephone skills training. In addition, in consultation with the GP partners, she updated the practice’s home visit protocol so that reception staff had more guidance on how to triage calls.
With the agreement of a senior partner, who was the practice’s responsible person, the practice manager wrote to the patient, summarising her investigation into the complaint and the action the practice had taken. She also told him how sorry she was for the distress caused. The patient later called her to say he was grateful for the professional way the practice had responded to his concerns.
Ten top tips for responding to complaints
1. Publish information for patients about the complaints procedure. Explain to patients who wish to complain how they can do so and where they can find help.
2. Talk to complainants about the outcome they expect and agree how long you will take to investigate and respond.
3. Offer to meet complainants, and consider whether a conciliator may help. In some cases, it may be appropriate to consider seeking an independent clinical opinion, if the complainant agrees.
4. Try to remain objective. If possible, someone who is not the subject of the complaint should review complaint responses.
5. Involve your medical defence organisation early. The MDU will guide members through the complaints procedures to help prevent the complaint escalating and can review your written response.
6. Take account of the seriousness of the concerns and
the lessons learned and ensure that the response is balanced and appropriate. Use clear everyday language in your written response and try to resolve any misunderstandings the patient may have.
7. Be open and honest, acknowledging mistakes and the distress caused by them, and where appropriate, offer a clear and unambiguous apology. Avoid false apologies: for example ‘I’m sorry you feel the care wasn’t good enough’.
8. Have a system in place for reviewing and learning from complaints and inform the complainant of any action taken.
9. Monitor complaints and produce annual reports on them, recording the lessons learnt.
10. Removing a patient from the list is an action of absolute last resort. In most cases, the patient should have received a warning before removal, and this is a contractual requirement for most GPs. l
1. Listening and Learning: The Ombudsman’s review of complaint handling by the NHS in England 2011-12, Parliamentary and Health Service Ombudsman, 8 November 2012.
Dr Wendy Pugh is a medico-legal adviser at the Medical Defence Union.