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Medico-Legal - Complaints system one year on

Some practices have yet to adopt the new process, say Terri Bonnici, Sue Taylor and Sara Williams.

Responding to a complaint promptly, followed by effective discussions, can lead to an early resolution (Photograph: Gary Roebuck/ALAMY)
Responding to a complaint promptly, followed by effective discussions, can lead to an early resolution (Photograph: Gary Roebuck/ALAMY)

April 2009 saw the introduction of a reformed NHS complaints system in England but, nearly 14 months later, there are still practices that have not met their obligations under the new rules.

The revised system seeks local resolution through more patient-centred processes, and has a strong focus on outcomes. Practices should have implemented and followed these new processes from the outset, so how well have they coped?

From the Medical Protection Society's (MPS) experience, some have coped well and others not so well, or not at all.

Some practices have embraced the new procedures and are developing good protocols, but there are others that have not.

A challenging system
How to deal with a patient complaint is one of the main reasons why GPs contact the MPS. In 2009/10, the MPS responded to more than 2,000 enquiries about complaints in the UK. Since the introduction of the new system, the complexity of enquiries in England has increased.

The MPS has identified some common problems among the reasons given by practices about why they found the new complaints system challenging. These range from a lack of information or being excluded from the process due to limited time and resources. But by taking an organised approach to the hurdles, practices can overcome them.

Plan of action
We discovered that some practices were unaware that they needed to draw up a plan of action if they receive a complaint from a patient. They were still working under the old procedure: acknowledging the complaint within three days and stating they are going to investigate and will respond shortly.

The new process requires practices to contact the patient within three days of receiving the complaint and offer them the opportunity to discuss and agree a plan of action detailing how the complaint will be taken forward.

This should include discussing what the patient's expectations are and what outcome they would like to achieve, and negotiating a timescale within which they will get a response to their complaint.

Evidence of improvement
Many practices do recognise that something has gone wrong when they respond, but they do not go the extra mile to demonstrate what they have learnt from the complaint.

The Parliamentary and Health Service Ombudsman (PHSO) can call on practices for evidence about how they have learnt from a complaint.

Practices can get on top of showing lessons learnt from complaints by sending staff on training courses, organising meetings to discuss procedures, revising protocols and so forth.

They should record the details of what they have done and put together written guidance for the practice team.

Involving the PCT
Many practices are unaware of the greater role that PCTs now play. Before April 2009, PCTs were simply the gateway for complaints; now they have to take on the responsibility for them. Patients can complain directly to the PCT and it can decide to co-ordinate the response or even fully investigate the complaint. If the complainant remains unhappy they can then go to the PHSO.

Where a complaint involves different agencies and social care organisations, practices have a duty to co-operate with a view to providing a co-ordinated response.

By not doing so, practices could be criticised for not complying with multi-agency working.

Up-to-date information
All practices should have updated their complaints policies and their patient information to reflect the new regulations. However, MPS is still seeing examples of practice information and procedures providing inaccurate information.

It is vital that practices learn to handle patient complaints effectively and in line with the new system. Mishandling a complaint could result in the PHSO criticising the practice or recommending that the complainant gets financial compensation.

A poorly handled complaint is more likely to become protracted and can escalate to the GMC or become the subject of a compensation claim.

Learning tool
Complaints should be embraced as part of general practice, not as a thorn in its side. Complaints are an effective way to identify problems and drive up standards of care, which will benefit both staff and patients.

Practices that have invested time in complaints from the outset by obtaining mutual understanding with the patient of the issues, finding out what the complainant wanted to achieve and negotiating achievable outcomes, have seen benefits for both parties.

It is clear that the new system is working for some practices, but not others. For the latter there is still work to do.

  • Terri Bonnici and Sue Taylor are GP complaints advisers and Sara Williams is a writer and editor at the Medical Protection Society
  • Download the MPS booklets on complaints at www.medicalprotection.org/uk/booklets
  • MPS GP complaints advisers run training sessions on the complaints system for practices of more than 15 people: contact sandra.scott@mps.org.uk
Tips on handling complaints

Tips based on feedback and good practice shared by practices across England:

  • Early contact with the patient followed by effective initial discussion can lead to early resolution.
  • If the complaint is serious, ask the patient if they prefer the complaint to be investigated by a doctor not involved in the care provided.
  • PCTs can give independent help by providing a conciliator or a clinical adviser to help deal with complaints.
  • Offer to follow-up every practice response by telephone within 10 days, to see if anything further can be done.
  • Feedback on improved services as a result of complaints to all patients, for example on practice noticeboards.
  • Share feedback and good practice at local LMC meetings or at local practice manager network meetings.
  • Check that you have done all that is required by using the Ombudsman's Self Assessment Tool. You need to register at www.ombudsman.org.uk to access it.

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