Guidance on the requirements of the NHS complaints system, including advice on how to deal with complaints. It also includes advice on ensuring that the system works for doctors as well as patients.
Who is this guidance for?
This guidance applies to GP practices in England. It offers advice to LMCs (local medical committees), practices and GPs on how to deal with complaints received within GP practices.
Northern Ireland, Scotland and Wales operate separate complaint procedures:
What can GP practices do?
GPs must have in place a complaints procedure that informs patients of ways in which their views can be heard. This should include information on how the complaints procedure works and also how patients can give positive or constructive feedback. 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.
Every practice must appoint a 'responsible person' whose job is to ensure compliance with the current complaints regulations. This person must be a partner in the contract, but is permitted to delegate their practical responsibilities. It is also essential to appoint a complaints manager, responsible for handling and considering any complaints. This role may be carried out by the ‘responsible person’, by another employee or by an individual who is not a practice employee.
Practices are also permitted to share complaints managers if a full-time, one-practice role is not considered necessary. Complaints managers can also delegate their practical responsibilities.
What happens when a complaint is made to the practice?
When a complaint is made directly to a practice it is the responsibility of the practice to deal with it. There is at present no requirement for the complaint to be sent to NHS England and no funding will be provided for any costs arising from the complaints process. It is a contractual obligation for practices to follow the complaints procedure and any failure to do so could be considered a breach.
The importance of dealing with a complaint swiftly and effectively is clear. If an oral complaint is dealt with to the complainant's satisfaction within 24 hours then it will not be necessary to embark upon the formal complaints process. Swift resolutions are therefore good for the image of the practice and for avoiding bureaucratic burdens.
In the formal process, practices must send some form of acknowledgement to a complainant within three days of the complaint being received. This acknowledgement need not address any of the issues relating to the detail of the complaint itself, but should inform the complainant that the matter will be investigated. This acknowledgement can be made in written form or by telephone. If made by telephone, a record should be kept.
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 let them know whether this is a realistic possibility. Establishing a good plan and direction for the investigation at an early stage will be beneficial in the long run.
What happens when a complaint is made to NHS England?
When a complaint is made to NHS England about a practice, they will seek permission from the complainant to share the details of the complaint with the practice. If permission is not granted, the complainant will be informed that the matter cannot be taken further.
The DH guidance encourages NHS England to pass complaints to the practice to be dealt with. This can be done with the permission of the complainant and at this point the complaint would be considered to have been made to the practice itself. However, NHS England is permitted to 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 make the decision on whether or not to investigate a complaint themselves. LMCs should ask NHS England to openly set out their policy on how this decision will be made. This process should be open and transparent with the criteria used being consistent and non-prejudicial. Practices should be advised to contact their LMC if they feel they are being treated unfairly or inappropriately and LMCs should inform the BMA if they have concerns that this matter is being addressed inadequately or inappropriately.
Who might be a complainant?
Complaints can be made either 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'. This means that potential complainants stretch way beyond the confines of the practice list or patient representatives and there is potential for abuse of this system.
Vexatious complaints that come directly to the practice can be rejected, with confirmation of the rejection and the reasons for the rejection to be sent to the patient. The practice should also inform their LMC if they feel that the complaints system is being abused. However, this does not diminish concerns about vexatious complaints that are made to NHS England. Once again, if the practice feel they are being unfairly treated by NHS England, they should make their concerns known to their LMC.
When a complaint is made on behalf of a child, the practice must be satisfied that there are reasonable grounds for the complaint being made by this individual rather than the child. The practice must also be satisfied that the complaint is being made in the best interests of the child. If the practice is not satisfied that this is the case, written notification of this decision must be sent to the representative.
What happens when a complaints is about more than one service?
There is a single complaints procedure for all health and social care services. Usually, the organisation with the largest part in the complaint would be considered the lead agency and would be responsible for co-ordinating the investigation.
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, if the problem persists or is particularly complex. The complaints manager can discuss the options with you, including whether the complaint is suitable for conciliation.
Complaints managers may provide support to practice staff, such as:
- Advice and help to staff on handling difficult situations
- Help with wording letters and patient information
- Obtaining feedback from patients on particular practice issues
- Patient focus or customer care training
- Arranging for a conciliator
- Acting as an 'honest broker'
What is the definition of a complaint?
A complaint that is made in writing to the practice should be dealt with by following the current complaints procedure regulations.
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 complaints procedure regulations need not be applied.
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.
A complaint must be made within 12 months of the date 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 a delay in complaining and if it is still possible to investigate the complaint fairly and effectively.
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. While it is important that the complaints procedure does not prejudice those with legitimate grievances, it should also protect GPs from the possibility of malicious accusations. 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.
When a complaint is made by a third party 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.
What do we have to do immediately?
An official complaint must be acknowledged by letter or telephone (keeping a record of the call) within three working days of its receipt, stating that the complaint will be investigated.
Practices must also appoint, or reappoint, a complaints manager. In addition, they must appoint 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 of the organisation. This is a minor change from the previous system where the equivalent position could be held by a manager in the practice. It is acceptable to appoint the same person to both roles.
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.
As complaints can be made to the practice up to a year after the reason for the complaint, it is possible that complaints will arise after the locum GP has moved on. Practices should ensure that locums involved in the complaints process are given every opportunity to respond to complaints and it is important that there is no discrepancy between the way the process treats locums, salaried GPs or GP partners.
This does not apply to out-of-hours organisations.
Does the complaints procedure have disciplinary or legal repercussions?
The complaints process is entirely separate from disciplinary procedures. A complaint does not necessarily mean that disciplinary action will be pursued and there is nothing in the regulations that states a requirement to do so. However, it is possible for the complaints procedure to run simultaneously with a disciplinary or legal procedure where such procedures will not be compromised by the complaints process.
The current complaints procedure asserts that, where possible, a response should be issued; however, the disciplinary or legal case must not be jeopardised by the response. In such cases, practices will wish to seek advice from their legal and medical defence organisation advisers before proceeding. Practices should be prepared for the possibility of facing disciplinary, complaints and legal proceedings concurrently.
LMCs should clarify with NHS England how they intend to ensure that their handling of performance investigation and complaints procedures are separated appropriately and should report concerns to the BMA GPC; similarly, practices should contact their LMC for advice if they feel the actions of NHS England are unfair or inappropriate.