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GP mythbuster 103: Complaints management
How should providers respond to complaints?
The General Medical Council (GMC) ethical guidance states a ‘good’ doctor will:
- make the patients your first concern
- take prompt action if you think the patient is being compromised
- establish and maintain good relationships with patients
- be honest and open and act with integrity.
- listen to, and respond to, patients concerns and preferences.
Practices must follow:
- The Local Authority Social Services and National Health Service Complaints (England) Regulations (2009). This sets out expectations for NHS providers in how to manage complaints.
- Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 (Regulation 16).
The British Medical Association (BMA) has produced guidance on dealing with complaints made against a GP practice. They have also produced specific guidance for GPs who manage staff. This helps managers of other healthcare professionals better manage concerns raised to them.
Patients or a person acting on their behalf can complain to NHS England. This is if they don’t want to complain to an NHS provider directly. They can complain to the provider or the commissioner of that service but not both. This is often misrepresented in local policy and practice information leaflets. The commissioner cannot investigate if provider has already responded. NHS England has published guidance on how to complain to the NHS, including where patients can access support with their complaint.
The Local Authority Social Services and National Health Service Complaints (England) Regulations (2009) state there should be two stages of dealing with complaints:
- Stage one: local resolution by the provider or NHS England. Most complaints resolve quickly and efficiently this way, or
- Stage two: Parliamentary and Health Service Ombudsman (PHSO). If a complainant is dissatisfied after stage one, they can complain to the Ombudsman.
Doctors and other staff who are being complained about can also take the case to the Ombudsman. For example, if they are not satisfied with a response given on their behalf by a commissioning body.
Independent doctors are unable to use the PHSO. They have no legal requirement to have an appeals mechanism. It is good practice to provide independent adjudication on complaints. For example, using a service such as Independent Sector Complaints Adjudication Service (ISCAS).
Timescales and initial response to complaints
The Medical Defence Union (MDU) have produced guidance on how to respond to a complaint. It states that:
- The tone of a response needs to be professional, measured and sympathetic.
- Patient confidentiality should be considered, and timescales agreed.
- Verbal complaints (not resolved in 24 hours) should be written up by the provider. They should share this with the complainant to agree content.
- Practices cannot insist complainants ‘put their complaints in writing’.
The Local Authority Social Services and NHS Complaints (England) Regulations 2009 state that complaints can be verbal or in writing.
When practices doubt if information received is a complaint or a concern/feedback, they should ask the patient/enquirer.
Practices must make sure complainants receive a timely and appropriate response. This is usually three working days to acknowledge receipt of the complaint.
There are time limits for making a complaint. Complaints must be made within 12 months after:
- the date of the matter that is the subject of the complaint occurred; or
- if later, the date of the complainant knowing they had cause to complain.
The timescale can be extended in certain circumstances.
The complaint regulations do not state a timescale to respond. The timescale is agreed with the complainant during the acknowledgement process. If complainants get no response within six months of their complaint being received, they can go straight to the PHSO.
The Local Authority Social Services and NHS Complaints (England) Regulations (2009) state:
- Practices have a duty to co-operate in multi-agency complaints. If a complaint is about more than one health or social care organisation, there should be a single co-ordinated response. The practice should discuss and agree timescales with the complainant. They should agree which agency will lead.
- If a complaint becomes multi-agency, the practice should seek the complainant’s consent to ask for a joint response. The final response should include this.
A complaint can be made to provider/commissioner but not both. This is often misrepresented in local policy and practice information leaflets.
Complaint management at a practice
Practices must have a well-publicised complaints process. It should set out arrangements for the handling and consideration of complaints. This may include:
- information on the practice website
- a leaflet and poster which is the simple version of the policy
- a full working policy for practice staff reflecting the Regulations and local organisation.
Each practice must have a clear responsibility for complaints arrangements. This is to avoid delays in complaint management. For example:
The responsible body must send the complainant a written response, signed by the responsible person. Regulation 4 of The Local Authority Social Services and NHS Complaints (England) Regulations (2009) requires responsible bodies to designate a person to ensure compliance with the arrangements. It also requires a complaints manager to be responsible for managing the complaints procedure.
Acknowledging and acting on complaints
It is important for providers to acknowledge complaints. They may thank the complainant for raising their concerns.
Manage any immediate issues appropriately and promptly to ensure the safety of the person. Providers should give assurance that the care and treatment for the person(s) being complained about will be treated with respect and courtesy. They will not be compromised because of the complaint.
- clearly identify every issue which needs a comment/response
- make sure the complaint is properly investigated
- identify who will answer each issue raised.
Providers may consider if an independent investigator may be more effective. Anyone making a complaint about the NHS is entitled to support by an NHS Complaints Advocate. Local HealthWatch organisations can tell a practice who their local provider is. When investigating, providers can ask the complainant for more information if necessary.
Complaints files/investigations are not routinely stored as part of clinical records. This is to avoid future prejudice. It may also be necessary as part of clinician confidentiality.
Practices should make an annual report on complaints available to their commissioning body on request. They must provide the CQC, with a summary of complaints when requested.
NHS Digital expect practices to complete a KO41b data return on complaints. NHS Digital publish this annually. This expectation is suspended because of the COVID-19 pandemic.
The Royal College of General Practitioners (RCGP) has produced guidance for revalidation. GPs must declare and reflect on any formal complaints about them at their appraisal for revalidation. GPs should reflect upon any complaints received outside of formal complaints procedures. They may provide useful learning.
Nurses can use information about complaints as part of their NMC revalidation. This feedback can contribute towards submissions about practice related feedback. It can also be part of a written reflective account.
When we inspect
We use Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 (Regulation 16). This is when we review if the practice is safe, effective, responsive, caring and well-led. When assessing complaints management, we look at:
And key line of enquiry (KLOE) R4 Concerns and Complaints
Inspection teams will seek assurance that:
- People who use the service know how to make a complaint or raise concerns.
- People feel comfortable, confident and are encouraged to make a complaint and speak up.
- The complaints process is easy to use. People are given help and support where necessary.
- The complaints process involves all parties named or involved in the complaint. They have an opportunity to be involved in the response.
- The provider uses accessible information or support if they need to raise concerns
- The complaints are handled effectively, including:
- ensuring openness and transparency
- regular updates for the complainant
- a timely response and explanation of the outcome
- a formal record.
- Systems and processes protect people from discrimination, harassment or disadvantage.
- Complaints are logged and monitored to assess trends and shared with the wider team. They are used to learn and drive continuous improvement. Trends are used to highlight where changes or improvements may be needed.
- Last updated:
- 10 May 2021