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How does the CQC expect practices to handle complaints?

With patient complaints on the rise, solicitor Gemma Nicholas from Ridouts explains what the CQC looks for in relation to complaints handling during its inspections.

Gemma Nicholas, Solicitor, Ridouts
Gemma Nicholas, Solicitor, Ridouts

Over the last two years, many have predicted that there would be an upsurge in GP complaints, owing to the changes in working practices to cope with COVID-19. This article explores what primary medical service providers can do to strengthen their complaints processes with the aim of avoiding falling foul of Regulations 16 and 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 (“the Regulations”).

What are patients complaining about?

The CQC has revealed that it received 8,267 negative comments from the general public between January to November 2021 on its ‘Give Feedback on Care’ portal, compared with a total of 3,001 for the same period the year before.

The vast majority related to those who were unable to book an appointment, and of particular concern among patients was the inability to access doctors face to face.

While the figures showed an increase in negative comments, they also revealed an increase in positive comments from 804 in January to November in 2021 to 1,462 for the same period in 2022. But it was the rise in negative comments that gained all the headlines.

Innovation and the use of new technologies skyrocketed at the start of the pandemic as practices were instructed to move to a total triage model by NHS England. GPs embraced telehealth technologies including remote patient triage and video consultations.

But times have changed, and with the removal of COVID-19 restrictions, patients may be expecting things to go back to pre-pandemic days. However, this has simply not been possible for many practices given the focus on the vaccination campaign in recent months, the huge rise in demand and the workforce shortage.

Strengthening your complaints handling processes

While the CQC’s feedback portal is not the same as formal complaints received by practices, these too have risen during the pandemic.

Practices need to ensure that their complaints processes follow The Local Authority Social Services and National Health Service Complaints (England) Regulations (2009) and Regulation 16 of the Regulations. 

A two-stage complaints process is required with stage one being local resolution by the practice or NHS England and stage two signposting complainants to the Parliamentary and Heath Service Ombudsman if they are dissatisfied after stage one. According to Regulation 16 the practice’s complaints process must effectively identify, receive, record, handle and respond to complaints.

Timescales for dealing with complaints are not statutory, but practices must ensure that ‘complaints are dealt with efficiently’ and ‘complainants receive a timely and appropriate response’.

What does the CQC expect?

The CQC suggests that communication acknowledging receipt of the complaint should be sent within three working days.

The main concern of the CQC at inspections appears to be practices not having in place a clear complaints policy setting out the appropriate stages and practices not following the timescales within their own policy. Ridouts has also experienced the CQC take issue with practices limiting the channels via which patients can complain, such as not accepting verbal complaints.

Once the complaint has been dealt with, that is not the end of the matter as far as the CQC is concerned. The regulator expects to see that complaints are logged and monitored to assess trends and shared with the wider team.

According to the CQC’s website, complaints must be ‘used to learn and drive continuous improvement’ and trends must be ‘used to highlight where changes or improvements may be needed’.

Inspection outcomes

Complaints is an area that regularly features in GP inspection reports and the only way to challenge CQC comments about this through the factual accuracy process is with clear evidence of the steps followed by the practice to deal with the complaint as well as records to show lessons learned.

Regulation 17 of the Regulations deals with good governance and is an overarching regulation requiring practices to have quality assurance and audit systems to ensure compliance with all of the other regulations.

Compliance with Regulation 17 is reflected in the ‘well-led’ section of inspection reports. Due to the overarching nature of Regulation 17, any regulatory breach or CQC concern is often repeated in the well-led section of the inspection report, the implication being that the practice’s quality assurance systems failed to identify the individual breach/issue.

So in order to avoid a breach of Regulation 17 and maintain a good well-led rating, a robust complaints management system is key. Ridouts can support you through tricky patient complaints as well as to challenge CQC inspection reports through the factual accuracy process. 

  • Gemma Nicholas is a solicitor at Ridouts
  • Ridouts specialist health and social care lawyers can assist GP practices facing enforcement from the CQC, or threats of it, and can advise on regulatory matters and engagement more broadly. For more information, please contact them on 0207 317 0340 or request a call back via their website.

Ridouts Professional Services Ltd

Ridouts is a law firm that only acts for care providers. We provide legal, operational and strategic advice when providers are faced with matters that could negatively impact their businesses, such as poor CQC inspections and enforcement action. www.ridout-law.com

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