Complaints are common in medicine and it is highly likely that at some point in your career you will receive a complaint.  This document has been written to help you understand how complaints are handled and hopefully ease your progress through the process.  

Complaints are very distressing and will impact both your professional practice and personal health.  It is understandable to feel angry and upset after receiving a complaint.  However, it is important to remain calm and respectful so as not to further inflame the situation or hinder the complaints process.  There are always several routes of support including family, partners, and colleagues, and of course the LMC and your defence organisation.  

It is always advisable to discuss complaints against you or your practice of any nature with both the LMC and your defence union so that the correct action can be taken the first time.

Complaints are expected to be handled locally and may be received by a practice, the CCG, or the Area Team of NHS England.  If there has been some failure of local resolution or the final answer from the local resolution was not deemed satisfactory by the complainant because the appropriate processes were not followed, then the complainant has the right to forward the complaint to the Health Service Ombudsman for further investigation.

Complaints received at the practice level
It is at the discretion of the practice in close working with the complainant how this matter is dealt with locally.  It is advisable to have a robust complaints procedure in place to ensure that all matters a dealt with in a timely and professional manner.  Of note, it is a contractual obligation to comply with the complaints procedure set by a CCG or NHS England.

A practice must have a nominated person who is responsible for ensuring compliance with the complaints regulations.  This person must be a contract holder at the practice.  A practice is also expected to have a nominated person who is responsible for dealing with complaints.  These may be the same person or may delegate their responsibilities to others.

Oral complaints can be dealt with informally at the discretion between the practice and the complainant within 24 hours.  It is best to do this swiftly and informally to avoid escalation.

When a written complaint is received

1. there should be an acknowledgement by the practice to the complainant within 3 days of receipt of the complaint.  There is no need to address the complaint directly in the acknowledgment, but should merely inform the complainant that the matter will be investigated.  This can be done either by letter or telephone, but remember to record details of the encounter if this was done by phone.  It is preferable that this is done by letter.
2. The investigator should meet with the complainant to discuss the issues surrounding the complaint and to set a realistic plan of action for resolution.  However, prior experience shows that patients prefer not to meet but to have a discussion either over the telephone or by letter.
3. The agreed realistic action plan should then be carried out.

Formal complaints must be dealt with if the incident was within the last 12 months, or if the complainant only found out about the incident within the last 12 months.  After this period, the decision whether or not to investigate the complaint rests at the discretion of the practice.

Records of complaints must be kept separate from a patient’s notes and records of formal complaints resolved by the practice must be kept for 10 years.

Complaints received by a CCG or NHS England
There are several routes of disposal of the complaint when received by a CCG.

1. Hand back to primary care
If a complaint has been directed to a CCG, their complaints screening group will decide whether this should be handled directly by the practice or not.  If it is deemed that the complaint is suitable for resolution at the practice level, then it will be forwarded to the practice to deal with.

2. Pass to the Maintaining high professional standards group/committee (MHPS)
In reality, the screening group will already be working with the MHPS group to fact find and gather information to triage the complaint.  The involvement of the MHPS committee adds another layer of oversight to the process with the potential to formulate action plans based upon the decisions taken by all groups involved in fact-finding.

3. Immediate suspension.
In rare cases the Medical Director of NHS England may recommend immediate suspension of a practitioner should the severity of the case warrant this and it is impractical to convene a meeting of the MHPS committee as a matter of urgency. The matter will however be reported at the next MHPS committee.

It is at the stage of the screening process that most complaints are dealt with without most GP’s even being aware that there is a complaint against them.  However, should there be significant evidence that the standard of care offered was below the level that should be expected then a clinician may be contacted to provide further evidence toward the resolution of the incident.

If a written response to NHS England is requested

1. Acknowledge receipt of the letter from NHS England immediately, stating you will reply in due course.
2. Let your defence organisation and LMC know.  Feel free to discuss this with those close to you – you may need the support that they offer.  
3. If NHS England has requested the medical records from you, photocopy and send them immediately.  If you no longer hold the records, contact
Primary Care Support England
3 Caxton Road
4. Draft a letter of response and run it past your defence organisation before sending it.  Try to remain calm and reasoned in your response, only stating the concise facts and not conjecture or jargon.  Try to give your statement of the events in an objective chronological narrative giving as much detailed information as you think is important to resolve the complaint. This may also include some background information to set the scene.  It will be important to start collating the documented evidence that supports your version of the events.  Feel free to express regret at the distress that this may have caused for the patient and their family and pass on sympathy.
5. Forward this letter to the nominated NHS England representative as soon as is practically possible after it has been checked by your defence union.

Top Tips

a. Respect confidentiality at all times
b. Do not respond without expert advice first
c. Do not alter the patient’s notes after the event has occurred
d. Keep copies of all correspondence regarding the complaint
e. Do not remove a patient from your list because they have complained – this is not justifiable
f. All of the documentation regarding the complaint is available to all parties involved at any time.
g. It is your duty to comply and help with the investigation of any complaints against you.