For most doctors receiving your first complaint will come as a personal blow and can be extremely upsetting. Doctors tend to come into the profession with the aim of helping others, and the realisation that a patient feels the need to make a complaint can be distressing.
During the year to March 2016, there were 82,000 complaints made under the NHS complaints procedure about family health services. So there is every chance you will need to respond to a complaint at some point, even early on in your GP career. The good news is that most complaints can be resolved at an early stage by familiarising yourself with the procedure and getting advice.
There are regulations that dictate what constitutes a complaint, who can make a complaint and how you should respond. These vary depending on which particular UK jurisdiction you work in, within.
The regulations give clear time limits in which complaints need to be acknowledged, and in some locations, the time period in which you have to respond. For example, complaints should be acknowledged within three working days in England, Scotland and Northern Ireland and within two days in Wales. Additionally your practice with have its own local policy.
Writing a response to a complaint, can be difficult and time-consuming and this can be made all the more complex if there are multiple doctors, or care organisations involved. Patients can choose to make their complaint either directly to the practice or can submit the complaint via NHS England or the health board, and this may add an extra layer of scrutiny.
The complaints process is a two-stage process and it is good to know that a significant proportion of complaints are resolved locally at practice level without reaching the second stage of the process.
However, if a complainant remains dissatisfied after the local resolution phase they have the right to refer the matter on for further scrutiny by the Ombudsman. The Ombudsman can make a recommendation for a financial redress payment to be made to a complainant, if the complaint is upheld.
Additionally if a doctor is criticised by the Ombudsman this may require them to consider reporting the matter to the GMC.
While you may feel anxious about responding to your first complaint, by following these five steps, you can maximise your chances of resolving the patient’s concerns at an early stage:
1. Get advice from your medical defence organisation as soon as you can.
We can advise you on the process and how to ensure that you comply with the required time limits specified in the complaints handling regulations.
2. Draft your response to the complaint.
Include a full description of your involvement and your response to the specific concerns raised. We also recommend that you include details of your reflections on the case. Your medical defence organisation will be happy to guide you on the content and tone of your response.
Getting this response correct is important and it is the MDU’s experience that a thoughtful and reflective response, adopting an appropriate conciliatory tone can be instrumental in resolving the complaint at an early stage.
3. Identify any learning points.
The complaints regulations emphasise the importance of learning from any concerns raised, so it is important to discuss all complaints at a practice meeting to identify any possible learning points. This review should look at all aspects of the care provided to an individual, good and bad, and does not imply that there was any failure in care.
Identify learning points from clinical management and other aspects such as documentation or administrative support which can be used to improve future patient care. This meeting should be clearly documented within the complaints file and an action plan developed to respond to any identified problems.
4. Say sorry.
The GMC’s guidance in Good Medical Practice states you must be open and honest with patients if things have gone wrong. Additionally if any patients under your care have suffered harm or distress you should put matters right, where you can, offer an apology and explain fully and promptly what has happened and the likely outcome.
5. Discuss complaints at your annual review.
To comply with the GMC’s requirements on revalidation you will also need to discuss any complaints that you receive at your next annual appraisal or training review.
It can be helpful to have kept an anonymised record of the complaint, your response, any personal learning points that you have identified and what action you have taken in light of this. Additionally you should ask the practice, NHS England or the health board for a copy of the final response they will send to the patient for your records.
Keeping an anonymised record of this information in your folder can make preparing for the review less time consuming, and demonstrates that you have responded to any criticisms in a responsible way.
- Dr Lennard is medico-legal adviser at the MDU