This guidance covers the requirements of the NHS complaints system, including how to deal with complaints, and ensuring the system works for doctors as well as patients.
Northern Ireland, Scotland and Wales operate separate complaint procedures:
GP practices' responsibilities
- GPs must have a complaints procedure that tells patients how their views can be heard.
- It should include information on how the complaints process works, and how positive or constructive feedback can be given.
- CQC (Care Quality Commission) inspectors may ask the practice how it shares the patterns and trends of complaints, and to see evidence of change to improve services.
- Practices must appoint a complaints manager and a ‘responsible person’ who must be, in the case of a partnership, a partner.
- For a sole contractor, the responsible person must be that contractor, and for a company or other organisation, it should be a director. The same person can be appointed to both roles, and both can delegate practical responsibilities.
- Practices may share complaints managers if a full-time, one-practice role is not necessary.
Dealing with complaints
A complaint that is made orally and that is dealt with to the complainant’s satisfaction by the end of the next working day is not considered to be an official ‘complaint’, and the practice’s complaints procedure regulations need not apply. It’s therefore important to deal with complaints swiftly.
A complaint that is made in writing to the practice should be dealt with by following its complaints procedure.
Complaints must be made within 12 months of the event that is the subject of the complaint, or 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 the delay and if it is still possible to investigate the complaint fairly and effectively.
When a complaint is made directly to a practice, it is the practice’s responsibility to deal with it. At present there is no requirement for the complaint to be sent to NHS England, and no funding is provided for costs arising from the complaints process. It is a contractual obligation for practices to follow the process and a failure to do so could be considered a breach.
The formal complaints process
- An official complaint must be acknowledged by letter or phone (keeping a record of the call) within three working days of its receipt, stating that the complaint will be investigated.
- The acknowledgement doesn’t need to address the content of the complaint.
- A meeting should be arranged for the investigator to discuss the complaint with the complainant.
- It is important to quickly establish what outcome the complainant expects, and to tell them whether this is a realistic possibility.
- Establishing a good plan and direction for the investigation at an early stage is beneficial in the long run.
When a complaint is made to NHS England
When it receives a complaint about a practice, NHS England will seek permission from the complainant to share the details with the practice. If permission is not granted, the complainant will be informed that the matter cannot be taken further.
Department of Health guidance encourages NHS England to pass complaints to the practice to be dealt with, with the complainant’s permission. However, NHS England can take on the investigation itself, on behalf of the complainant. It is essential that NHS England takes a consistent approach to the complaints system.
There are currently no specifications for how NHS England should decide whether to investigate a complaint. LMCs should ask NHS England to openly set out its policy on how the decision is made.
The process should be open and transparent, with consistent and non-prejudicial criteria. Practices should contact their LMC if they feel they are treated unfairly or inappropriately, and LMCs should inform the BMA if they have concerns.
Support from NHS England complaint managers
NHS England complaint managers can advise on procedures and on dealing with individual complaints, if the problem persists or is particularly complex.
The complaints manager can give support to practice staff, including discussing whether the complaint is suitable for conciliation and arranging for a conciliator.
Who can complain
Complaints can be made by patients or by someone ‘who is affected, or likely to be affected, by the action, omission or decision of the responsible body which is the subject of the complaint’.NHS England complaints policy
This means potential complainants could be far beyond the practice list or patient representatives, and there is potential for abuse of the system.
While it is important that the complaints procedure doesn’t prejudice those with legitimate grievances, it should also protect GPs from the possibility of malicious accusations.
Practices should inform their LMC if they encounter any apparent misuse of the system.
Third-party complainants
Complaints may be made by a third party on behalf of someone else, such as 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.
When a complaint is made on behalf of a child or individual lacking mental capacity, the practice must be satisfied that:
- there are reasonable grounds for this method of representation
- the third party is genuinely acting in the best interests of the individual.
If the practice is not satisfied that this is the case, they must inform the representative in writing, stating the reasons for this decision.
Vexatious complaints
Vexatious (purely to cause annoyance to the practice) complaints that come directly to the practice can be rejected, with confirmation of the rejection and the reasons for it sent to the patient.
The practice should also inform its LMC if it feels the complaints system is abused. However, this does not diminish concerns about vexatious complaints that are made to NHS England.
Complaints about a locum GP
To account for complaints involving locum GPs, practices must seek an agreement from locums that they will participate in the complaints procedure if required. As complaints can be made to the practice up to a year after the event, complaints might arise after the locum GP has moved on.
Practices should ensure locums involved in the complaints process are given every opportunity to respond to complaints. There should be no difference in how the process treats locums, salaried GPs or GP partners.
This does not apply to out-of-hours organisations.
Disciplinary or legal repercussions
Complaints are separate from disciplinary procedures; a complaint does not necessarily mean disciplinary action will be pursued and there is nothing in the regulations that requires it.
However, it might run simultaneously with a disciplinary or legal procedure, where such procedures are not compromised by the complaints process or its outcome. Practices should seek advice from their legal and medical defence organisation advisers before proceeding.
LMCs should clarify with NHS England how they intend to ensure their handling of performance investigation and complaints procedures are appropriately separate, and should report concerns to the BMA.