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Locum GPs and the complaints process

Locums often feel excluded from the complaints process, write Sarah Whitehouse and Sara Williams.

When meeting complainants, keep calm and keep body language neutral – emotions can be highly charged (Photograph: SPL)
When meeting complainants, keep calm and keep body language neutral – emotions can be highly charged (Photograph: SPL)

When it comes to complaints, locums - and their patients - may be left in the dark. As one locum recently pointed out: 'Practices simply don't tell us that we've had a complaint.'

However, the DoH has reformed the NHS and social care complaints system so it is more open and accountable, fair and proportionate and patient-focused.

A two-tier system was introduced in April 2009, with the Parliamentary and Health Service Ombudsman holding responsibility for handling second-stage complaints. If a patient cannot resolve their complaint locally, they can take it forward to the ombudsman.

This should encourage practices to involve locums in handling complaints: complaints against locums should be investigated by the practice and, if they have left the practice, they should be contacted if possible for their comments.

The complaints manager
When you start working at a practice, familiarise yourself with its complaints procedure during your induction.

There should now be one person within the practice who administers the procedure for more serious complaints, but minor complaints should be resolved 'on the spot' if possible.

This might mean offering an immediate apology or explanation in response to a patient's expression of dissatisfaction and trying to solve the problem with them.

The complaints manager's role is to ascertain the facts relating to a complaint, assess the evidence and report findings. Complaints should normally be acknowledged within three working days; handled flexibly and responsively, in consultation with the complainant if possible; investigated and resolved as speedily as possible, giving the complainant a full, clear explanation and, if mistakes have been made, an apology. They should feed into clinical governance and service improvements.

The complaints manager will prepare a report on the findings. In Listening, Responding, Improving: A Guide to Better Customer Care, the DoH states that the manager should have an open dialogue with both parties so that their final report does not surprise anyone involved.

So if a complaint concerning your practice is being investigated, the complaints manager should seek your views, if possible, whether you are a locum or a partner. This will probably involve being asked to attend a fact-finding interview or writing a witness statement. If you find yourself in this situation stick to the facts, avoid offering opinion, speculation or defensive justifications, and refer to your medical records.

These should be 'clear, accurate and legible', 'reporting the relevant clinical findings, the decisions made, the information given to patients and any drugs prescribed or other investigations or treatment' as stipulated in the GMC's Good Medical Practice. In addition, document any follow-up advice.

Request to see a copy of the reply the practice intends to send to check it for factual accuracy. Complainants now have 12 months from the occurrence giving rise to the complaint or from the time that they become aware of the matter, to make a complaint.

The complaints manager will retain the discretion to investigate complaints brought later than this if there are good reasons for the delay and it is still possible to carry out the investigation.

Learning opportunity
In Good Medical Practice, the GMC says patients 'have a right to expect a prompt, open, constructive and honest response, including an explanation and, if appropriate, an apology'. An apology is not an admission of liability so be prepared to meet with the patient, or complainant, and liaise with the complaints manager.

Complaints are an opportunity for learning, so good practices will hold a significant event audit (SEA). If you are involved in the complaint, suggest being involved in any subsequent SEA meetings.

Put yourself in the complainant's shoes, and tailor your responses. Understand the emotional impact that the events leading up to the complaint may have caused, and be aware that emotions may be highly charged. Keep calm and keep body language neutral during any subsequent complaint meetings. The tone of any responses should be conciliatory and empathic.

Dealing with claims
While complaints may occur immediately after an adverse incident, claims often take longer to arise. For locums involved in a claim, it is likely it will be connected with an incident at a previous practice. There are reasons to be cautious if this happens.

The first you know about such a claim might be through contact from a solicitor, and it may not be obvious whether they are acting for the NHS trust or the patient. It is important to establish this. They may well ask you a series of questions or invite you to make a statement (see box). Contact your defence body if you need help putting this together.

Only time will tell whether locums feel more involved in complaints handling, but the new system is tighter and less bureaucratic, and the additional guidance implies that complaints against locums cannot be handled effectively without gathering their input, where possible.

  • Sarah Whitehouse is a staff writer at the Medical Protection Society; Sara Williams is a writer and editor
  • This is an edited version of an article first published by the MPS in Sessional GP, its annual magazine for locum GPs (www.medicalprotection.org.uk)
Claims - Making a statement to a solicitor
  • Establish the facts Do not rely on your memory. Ask to see the medical records, so that you can remind yourself what happened, and write any statement based on these.
  • Stick to the facts You may be invited to give an opinion on particular issues, but this is the role of an independent medical expert. Simply record your involvement in the case, don't speculate about future management or what happened next.
  • Contact your defence body If you feel vulnerable about your involvement, or would like help with writing a report or statement.

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