When patients complain about the service they have received, defusing the situation tactfully and without reacting emotionally increases the likelihood that the problem will go no further than the practice.
More than 90 per cent of complaints in general practice are resolved at local level, so it appears that GPs and practice staff are rather good at sorting out patients' perceived grievances. Taking the following simple steps will help.
Appoint a complaints manager
Practices should appoint a dedicated complaints manager. This task normally falls to the practice manager, who has a senior role in the practice and is less likely to be directly involved in the incident that has resulted in the complaint.
The complaints manager can investigate complaints and keep a comprehensive log of how each complaint is handled. Bear in mind that practices have to inform their primary care organisation of the number of complaints received.
Ask for a written account
Patients often complain verbally. If they are concerned about a minor matter, such as waiting a long time to see their GP, the complaint can be dealt with immediately by apologising and explaining when they are likely to be seen.
If the complaint concerns a more serious matter, such as alleged misdiagnosis, it is important to maintain clarity by having a written account of it.
Patients are not obliged to complain in writing, although many will. If the patient does not put the complaint in writing, the complaints manager should draw up a summary of the patient's concerns and check the patient is happy with what has been written.
Investigate the complaint
The complaints manager should acknowledge that a complaint has been received, then conduct a thorough investigation. This will involve interviewing and obtaining statements from relevant members of staff, including the GP or practice nurse concerned. Reception staff might also need to provide statements about the incident if, for example, telephone conversations to book an appointment or obtain test results are relevant to the complaint.
Write a response
When you have the information, the complaints manager should draft a conciliatory response to the patient. It might be worth involving your medical defence body at this stage, because it can advise you about these letters. 'It is to be hoped that, with a skilfully drafted letter and assuming the complainant is happy with the response, that will be that,' says MDU medico-legal adviser Dr Michael Devlin.
Apologise if appropriate
Often patients who complain simply want an apology or an expression of regret for what has happened. The MDU advises that it is appropriate to apologise when a complaint is made, because you will be saying sorry that the patient feels this way, not admitting you caused the distress. 'We feel it emphasises the conciliatory nature of dealing with responses,' says Dr Devlin. 'This is not meant to be an adversarial process, it is meant to be there solely to resolve a concern.'
Respect patient confidentiality
Issues of confidentiality can arise when someone makes a complaint on behalf of a patient. Regardless of how distressing the complaint might be, confidentiality must be respected. In these situations, the practice complaints manager should send a consent form to the patient, which should be signed and sent back to the practice, authorising the complainant to act on behalf of the patient in the matter.
If local complaints resolution fails
Complainants who are dissatisfied with the outcome of local complaints resolution can request an independent review by the Healthcare Commission or refer the complaint to the Health Service Ombudsman. In a situation like this:
- Contact your medical defence organisation at the earliest possible stage. It will be able to advise you on the issues likely to be raised and help you to draft a suitable response.
- Keep a record of the entire process. A well-organised complaints file demonstrating a clear sequence and a logical way of dealing with the matter will help to persuade the Healthcare Commission or the ombudsman that everything reasonable has been done to resolve the complaint.
- Make sure that you know why the complaint has not been resolved. The Healthcare Commission might be unclear about why the patient is unhappy and could ask you why you think the matter has not been resolved. Dr Devlin says that the practice's response to these questions is 'a very important one to get right because it can give a steer to the Healthcare Commission'.
- Be aware that a case referred to the Health Service Ombudsman can end up before a parliamentary select committee if it is a matter of public interest. Reports of all cases referred to the ombudsman can be found at www.ombudsman.org.uk.
- For more details of the NHS complaints procedure, see www.dh.gov.uk and www.healthcarecommission.org.uk.