NHS patients have 12 months from the date of an incident, or the date they first became aware of a problem, to make a complaint. When responding, practices do not have the same luxury of time, so it is important to be aware of the limits set out by the NHS complaints procedure for acknowledging, investigating and responding to complaints.
However, these time limits may occasionally be difficult to achieve, perhaps because a member of staff goes on leave just as the complaint is received or has already left the practice. In these circumstances, it is important that the quality of the response does not suffer, as in the example below, which is based on cases from the MDU's files:
Case study: failure to diagnose chest infection
A male patient in his 40s complained that one of the GPs had failed to diagnose a chest infection which was eventually picked up when he visited A&E. The practice acknowledged the complaint within three days, but there was a delay of several weeks in responding because the GP in question was on leave and then off sick.
When he returned to work, the practice investigated the complaint and drafted a response explaining the GP's management of the patient and apologising for any distress caused by the delay. The practice manager would normally check the final response before sending it to the patient, ensuring times and dates were correct; however, because the response had been held up and needed to be sent out immediately, this didn't happen.
Unfortunately, some of the dates in the response were incorrect. The patient pointed this out and accused the practice of a cover-up. The practice apologised profusely for the error but the patient remained dissatisfied and complained to the Health Ombudsman.
Time limits in the four UK countries
The time limits for acknowledging and responding to complaints vary within the four countries of the UK. In England, Scotland and Northern Ireland, practices have three working days to acknowledge a complaint, whereas in Wales it is two working days.
In England, there are no time limits set for responding to a complaint, but if a response is not provided within six months from the date of the complaint, the practice must write to the complainant to explain the delay.
In Wales, a full response should be sent to the complainant within 30 working days of receipt of the complaint. If this is not possible, the complainant should be informed of the reason for the delay and when they can expect a reply.
In Scotland, complaints are divided into two broad categories. Simple complaints which can be resolved without the need for investigation, should be addressed within five working days, although this period can be extended to 10 working days if necessary. Most clinical complaints are however more likely to fall into the category which require investigation when you are obliged to confirm that the complaint will be investigated within 20 working days or explain why you won't be able to do so. If there is a delay, you should tell the complainant when they may expect a response.
In Northern Ireland, the investigation should normally be completed within 10 working days but, again, if this is not possible, you will need to explain why to the complainant and tell them when they will receive a response.
Many organisations, such as local NHS England Teams, NHS trusts and out-of-hours organisations, have their own internal policies and deadlines. These deadlines do not always correlate with those set by the complaints regulations.
It is advisable to co-operate with these if possible, but, should you find yourself facing unworkable deadlines, you may need more time to respond. In such a case you might wish to approach the organisation, explain the difficulty you face and request an extension to the deadline. It is important not to let these deadlines affect the quality and accuracy of your response to the patient.
Responses outside time limits
The outcome in the case above illustrates how rushing your response can cause problems. Usually, the complainant is anxious to receive a prompt response and practices are anxious to resolve complaints at the earliest opportunity. However, your ability to resolve a complaint successfully will be helped by a thorough investigation and detailed response and sometimes this takes more time than expected. When a delay occurs, it is important that you inform the complainant of the reasons for the delay and when you expect to get in touch with them.
When a patient complains after 12 months
Sometimes, a patient will complain about an incident that happened, or which they became aware of, more than 12 months before the date of their complaint. The complaints regulations state that you should consider a complaint made outside the time limit if the complainant has good reason for complaining and if, despite the delay, it is still possible to investigate the complaint fairly and effectively.
It is also worth bearing in mind that, in responding to a complaint, even outside the 12 month time limit, you may avoid the patient pursuing other avenues for raising a problem, such as the GMC or a civil claim.
The difficulties faced by out-of-time complaints is that it will probably be difficult to recall the events being complained about, or the staff involved may have left the practice. In this scenario, you are expected to make reasonable attempts to contact ex-staff members. If you are unable to do so, you can only respond on the basis of the entries in the medical records and your standard practice at the time.
Your medical defence organisation is a good source of further information and advice on responding to complaints.
- Dr Peter Connell is a medico-legal adviser at the MDU