We have updated this guidance to reflect:
- the introduction of integrated care boards (ICBs)
- complaints standards introduced by the Parliamentary and Health Service Ombudsman (PHSO).
The General Medical Council’s Good medical practice, states that a ‘good’ doctor will:
be honest and open and act with integrity
listen and respond to patients’ concerns and preferences.
All providers must handle complaints efficiently and investigate them properly. This involves:
- treating complainants with respect and courtesy
- providing appropriate assistance or information to understand the complaints procedure
- responding promptly, fully and honestly
- apologising when appropriate.
They must not allow a patient’s complaint to adversely affect the care or treatment provided or arranged.
The Local Authority Social Services and National Health Service Complaints (England) Regulations (2009). This sets out expectations for NHS providers when managing complaints.
Regulation 16: Receiving and acting on complaints Health and Social Care Act 2008 (Regulated Activities) Regulations 2014
Medical Defence Union (MDU) guidance How to respond to a complaint.
It is important that your practice acknowledges complaints no later than the third working day after receiving them. You must offer the complainant the chance to discuss how the practice will handle the complaint.
The Local Authority Social Services and NHS Complaints (England) Regulations 2009 state that complaints can be either verbal or in writing. However, providers cannot insist complainants ‘put their complaints in writing’.
If you are not sure whether the information received is a complaint, a concern, or simply feedback, you should ask the patient or enquirer.
Your response to the complainant should be professional, measured and sympathetic in tone. It should consider patient confidentiality.
Acting on complaints
- manage any immediate issues appropriately and promptly to ensure the person’s safety
- clearly identify every issue that needs a comment or response
- investigate the complaint properly
- identify who will answer each issue raised.
When investigating, you can ask the complainant for more information if necessary.
You may also consider whether an independent investigator may be more effective. Anyone making a complaint about an NHS service is entitled to support from an NHS Complaints Advocate.
Complaints and investigations are not routinely stored as part of clinical records. This is to avoid future prejudice and may also be necessary as part of clinician confidentiality.
Complaint records should be retained for 10 years.
If you receive a verbal complaint (that is not resolved in 24 hours) you need to make a written record of it. You need to share this with the complainant so they can agree the content.
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 commissioner (NHS England until 1 July 2023 then this becomes delegated to ICBs). 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.
There are time limits for making a complaint. Complaints must be made:
- within 12 months after the date when the matter happened that is the subject of the complaint
- the date when complainant knew they had cause to complain, if more than 12 months later.
The timescale can be extended in certain circumstances.
The complaint regulations do not state a timescale in which to respond. You should agree this with the complainant during the acknowledgement process. If complainants get no response within 6 months of their complaint being received, they can go straight to the PHSO.
Complainants must receive a timely and appropriate final response to their complaint. This should include the outcome and any action taken as a result of the investigation of their complaint.
Who people can complain to
If a patient or a person acting on their behalf does not want to complain to an NHS provider directly, they can complain to the commissioner of that service. (Commissioners are NHS England until 1 July 2023 and then ICBs after this date).
The Department of Health and Social Care guidance on how to complain to the NHS includes information to help patients find support with their complaint. NHS England have also produced guidance on giving feedback or making a complaint about your health care
They can complain to either the GP 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 a complaint if the provider has already responded.
The regional complaints function will be transferred to integrated care boards.
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.
People can make a complaint to either a provider or a commissioner, but not both.
Managing complaints in a GP practice
Your practice must have a well-publicised complaints process. It should set out arrangements for handling and considering complaints. This may include:
- information about the policy on the practice website
- a leaflet and poster showing a simple version of the policy
- a full working policy for practice staff that reflects the regulations and local organisation.
Each practice must have clear responsibilities and arrangements for managing complaints. This is to avoid delays in responding.
The Local Authority Complaints Regulations require each practice to designate a responsible person to:
- manage the complaint
- ensure compliance with the arrangements, including sign off of the complaint.
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, use a service such as Independent Sector Complaints Adjudication Service (ISCAS).
Practices should produce an annual report on complaints, which they must provide to their commissioning body on request. They must also provide a summary of complaints to our local teams if we ask.
NHS England expects practices to complete a KO41b data return on complaints. NHS Digital publishes this annually.
The Royal College of General Practitioners(RCGP) has produced guidance for revalidation. This suggests feedback from patients can be used at their appraisal. 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 may not look at every regulation in the Health and Social Care Act during every assessment. But where we identify concerns about managing complaints, we will use:
We will look for assurance that:
- people feel comfortable and confident, and are encouraged to make a complaint and speak up
- the process is easy to use so people understand how to make a complaint or raise concerns
- the practice offers help and support where necessary, using accessible information
- the process involves all parties named or involved in the complaint and they have an opportunity to be involved in the response
- complaints are handled effectively, including:
- ensuring openness and transparency
- regular updates for the complainant
- a timely response and explanation of the outcome
- keeping a formal record.
- systems and processes protect people from discrimination, harassment or disadvantage
- complaints are monitored to assess trends that are used for learning, and shared with the wider team or externally as appropriate to make changes and drive continuous improvement.