Complaints in primary care
BMA advice for complaints in primary care
The NHS (General Medical Services Contracts) Regulations 2004 (Part 6) sets out requirements for a practice to have a complaints procedure, to ensure that the policy is accessible to patients and that patients are aware of it, as well as the patient’s right to assistance from independent advocacy services. It is a contractual obligation for practices to follow the complaints procedure and any failure to do so could be considered a breach. The Regulations state:
Who can make a complaint
The time scales for making a complaint
The need for a person to be appointed in the practice as responsible for the complaint procedure and complaint investigation
The need to record the complaint in writing
Acknowledge receipt of formal complaint within three working days
The record of the complaint should be kept separate from the patient’s medical records.
Every practice must appoint a 'responsible person' whose job is to ensure compliance with the current complaints regulations.
The responsible person must be a partner in the contract, but is permitted to delegate their practical responsibilities to a ‘complaints manager’.
CQC (Care Quality Commission) inspectors may ask the GP practice about how it shares the patterns and trends of complaints and request to see evidence of change to improve the service offered.
An annual report on complaints should be sent by the practice to NHS England and included in CQC inspection documents.
Who can make a complaint?
A complaint can be made by a patient, or anyone else who has been affected by the action, omission or decision of the practice that led to the complaint.
There is concern that in opening up the complaints system to individuals with indirect involvement there is potential for abuse of the system.
Practices should inform their LMC (local medical committee) if they encounter any apparent misuse of the complaints system.
In some cases a complaint may be made by a third party acting on behalf of someone else. For example, when:
the individual has died
the individual is a child
the individual is physically or mentally incapable of making a complaint
the individual asks a third party to make a complaint on their behalf.
Deadline to accept a complaint
A complaint must be made within 12 months of the date of the complaint event or within 12 months of the date that the matter came to the complainant's attention.
However, discretion can be used if the complainant is considered to have good reason for a delay.
What happens when a complaint is made to NHS England?
Complaints made to NHS England will be dealt with only through the complaints procedure if the complainant agrees to share the details of the complaint with the practice.
What is the role of NHS England complaint managers?
NHS England complaint managers can advise you on practice procedures as well as on dealing with individual complaints.
Importance of respecting a time-frame for responding to a complaint
Responding to a complaint in a timely, sympathetic and reflective manner often resolves the complaint and prevents escalation to the Ombudsman or a separate complaint to the GMC.
In England, there are no time limits set for responding to a complaint, but if a response is not provided within six months from the date of the complaint, the practice must write to the complainant to explain the delay.
In Wales, a full response should be sent to the complainant within 30 working days of receipt of the complaint. If this is not possible, the complainant should be informed of the reason for the delay and when they can expect a reply.
What happens when a complaint is made to the practice?
Oral complaint (aim for fast resolution)
A complaint that is made orally and that is dealt with to the complainant's satisfaction by the end of the next working day (<24hr) is not considered to be an official 'complaint' and the complaints procedure regulations need not be applied. Minor concerns can often be dealt with quickly and effectively by addressing the issue straight away, so it's important that practice staff know how to do this when appropriate.
Timeline of a formal complaint received directly to the GP practice (or via NHS England)
Acknowledge complaint by letter or telephone (keeping a record of the call) within three working days of its receipt, stating that the complaint will be investigated.
Complaints manager investigates the sequence of events. Complaints manager may be the practice manager or a senior GP.
Consider the need for a Significant Event meeting
Complaints manager writes practice response: explanation, apology, learning
The final response should include details of the patient's right to approach the Parliamentary and Health Service Ombudsman (PHSO).
The correspondence about the complaint is kept separate to the patient records.
A complaint resolution meeting is offered
The practice manager and the complaints manager (or a senior clinician) could meet with the complainant.
The involved doctor might attend too, depending on the complaint.
It is important to establish what outcome the complainant expects.
Complainant may be supported by Patient Advice and Liaison Service.
If still dissatisfied, complainant may contact Parliamentary and Health Service Ombudsman (PHSO).
What about an apology?
In law, an apology is not an admission of liability (established in the Compensation Act 2006).
It is appropriate to apologise when something has gone wrong.
If you are offering an apology it is absolutely right to say sorry for what was done in error, or not done.
Research shows that patients want:
Complaint is taken seriously
Staff to empathise with their situation
A fair process
All of their questions to be answered
An explanation and apology for any deficiencies identified
Support in coping with the consequences
To know their complaint made a difference
Resolution within a time period relevant to their case
Reassurance that the complaint will not compromise their ongoing care.
Parliamentary and Health Service Ombudsman (PHSO)
If the patient is dissatisfied with the final response from the GP practice they are entitled to escalate the complaint to the health service ombudsman.
The ombudsman is independent of the NHS and free to use.
What happens when the complaint involves a locum GP?
In order to account for complaints involving locum GPs, practices must seek an agreement from locums that they will participate in the complaints procedure if required to do so.
Practices should ensure that locums involved in the complaints process are given every opportunity to respond to complaints.
It is important that there is no discrepancy between the way the complaints process treats locums, salaried GPs or GP partners.