A patient has expressed their unhappiness with the service you are doing your best to provide and you need to deal with their complaint.
The start of this process never feel goods and your initial reaction will always be a sinking feeling. Yet effective complaints management can maximise your chances of giving the patient an appropriate, fair and meaningful response. In many cases, it will start a positive process of learning and improvement in the practice as well as preserving your relationship with the patient.
Complainants believe that the adverse experience they had could have been avoided. Sometimes this is indeed the case. Often, however, the care given to the patient was not negligent and mistakes were not made.
Whatever the situation, the patient needs a response and the first step to check your practice's complaints handling procedure and give the patient a copy of it. Then the practice should follow the procedure exactly.
|Practice complaints procedure|
The practice's procedure should have these elements:
Resolution at local level
Under the NHS Complaints Procedure, practices should initially try to resolve the problem locally and investigating what happened is the first step. The complaint may be resolved at practice level or the primary care organisation (PCO) may have to be involved, for example if the patient has bypassed the practice and gone directly to the PCO. In England, this may now mean that patients could go direct to NHS England with their complaint.
If the complainant is not the patient, it is important that the patient (if they have capacity to do so) has given their consent for person to bring the complaint on their behalf.
Once the practice has acknowledged the complaint in writing (enclosing its complaints leaflet and giving timescale details), the individual at the practice responsible for co-oordinating complaints – often the practice manager – should ask the clinician(s) and anyone else in the practice team involved in the incident to for a report of their version of what happened.
The complaints co-ordinator should then decide whether the practice needs further help, usually from the GPs' defence organisation, in formulating its response.
When responding, ask the patient if they wish to come to the surgery to discuss the complaint face to face with those involved and check whether having an independent facilitator to run the meeting would be helpful.
The co-ordinator needs to make sure in advance that all the individuals at the practice involved and their advisers agree that the proposed response is appropriate.
Referral to the ombudsman
Hopefully the problem will go no further but if the patient is dissatisfied with the NHS Complaints Procedure, they may take their complaint to the Parliamentary and Health Service Ombudsman if in England (or the equivalent body in Scotland, Wales and North Ireland).
The ombudsman service concerned will:
- Only investigate complaints that fall come under its legal powers and which have already been through local resolution.
- Advise the patient what will happen if it cannot proceed (for example, the case may be referred back for local resolution).
- Consider whether there is evidence of an administrative or service failure. If neither is present, it will not investigate.
- Investigate whether injustice or hardship has occurred as a result of the administrative or service failure.
- Consider whether an investigation will lead to a worthwhile outcome.
- Work with both parties to resolve the matter if it is clear that an injustice has not been put right.
Legal claims and professional misconduct
Patients who complain directly to the GMC will normally be referred back to the NHS Complaints Procedure if this has not already been worked through. If the complainant commences a legal claim, the NHS Complaints Procedure will cease. Some patients go through the NHS procedure and then pursue a legal claim.
Avoiding a formal complaint
Often, a GP will become aware during a consultation that there is a possibility of a complaint. This is a key point at which a formal complaint might be deflected by, for example, inviting the patient to come back for a longer appointment or arranging an appointment at outside normal surgery times.
Carefully managed, this will signal to the complainant that their dissatisfaction is acknowledged and being taken seriously. A full and timely explanation of what happened is usually what patients want.
Practices may be unaware that an apology is not necessarily an admission of liability. Expressing your sorrow or regret for an adverse outcome may be extremely effective in resolving a complaint. Your defence body can advise on how best to do this.
- Fiona Dalziel is a practice management consultant. www.dlpracticemanagement.co.uk