For a Practice Manager handling complaints can be a difficult challenge. No one likes to receive a complaint but complaints need to be dealt with professionally, promptly and properly. But as a Practice Manager you may not be in total control of the investigation!

• You may be faced with a difficult patient and find that the doctor concerned simply wants to fob off the complaint, streamline the response and then remove the patient and their family off the practice list.

• On the other hand you may have perpetual complainers who like Matilda who always told such terrible lies until the house burned down. But on this occasion the complaint has mileage.

• The complaint might be anonymous. Such complaints are normally treated with contempt and cannot be responded to but there may be something in there that requires attention.

• But then you might have a legitimate complaint with foundation that needs investigation and a proper response. So what do you do and how so you handle it.

Some things to remember:

Confidentiality

A complaint is confidential and should remain so. In the 70’s when I dealt with complaints at an FPC we eventually published a Press Release. Nowadays, a generalized report might be given to the PPG or NHS England once a year. But the air of publicity like comments on NHS Choices can leave a nasty taste in the mouth.

Consent

The person who complains must have the right to complain. The complainant of course might be the patient unless too young, too ill or too infirm. A patient with a mental incapacity might need someone else to make a complaint on their behalf. A patient who is deaf or blind may need help making a complaint. Anyone can make a complaint where a patient has died. It is clearly important to establish at the outset that a patient was registered at the time the events took place that are described in a complaint.

Appropriate Body

Having established the right to complaint, you may need to consider whether the complaint has been lodged correctly against the Practice and one or more of its members. The complaint may refer to Hospitals or to Community Nurses and staff not employed by the Practice. If the complaint is clearly not against the Practice it should be returned to the complainant along with the name and address of the person and organisation to whom the complainant should be directed. No comment should be made on the content of the complaint. If the complaint refers to the Practice and other health organisations and staff not employed by the Practice forward a copy to that ‘body’ and ask for a direct reply and inform the complainant that you have done so and that you will respond to the complaint about the Practice.

Bodies Responsible for Investigating Complaints

• Medical Practice
• Out of Hours Service Provider
• Community Nursing Service Provider
• NHS Hospital Trusts
• Private Provider
• NHS England
• Clinical Commissioning Group
• Public Health Provider
• A Pharmacy Provider

Patients have the right to direct their complaint to the body that commissions the service they are complaining about. This means that a complaint against a medical practice might land with NHS England instead of the practice.

Time Limits

Time limits are there for a purpose. Firstly the desire to make a complaint might not be immediately apparent certainly not until a sequence of events have occurred. Therefore it is reasonable to allow a period of 12 moths from the event that gave rise to the complaint. Added to that memory fades and it is unreasonable to expect a photographic of events that occurred in the distant past.

Record Keeping

Record keeping is a vital part of a complaints investigation. That is why it is so important to keep timely and adequate records. Practices should also keep home visit diaries and message books. These days emails relating to patients should also be kept.

Processing

Complaints should always be dealt with promptly. For a Practice Manager, the problem is bringing the task of responding to the top of the pile when there are so many other important and urgent tasks to deal with. A complaint should be acknowledged either the same day or the next working day. The process should be explained to the complainant – a leaflet would suffice. The response should state what date a response will be made by and if the Practice is unable to achieve that date a response date will be agreed with the complainant. A long delay in responding without a legitimate reason would be viewed with by disdain by the NHS Ombudsman.

Investigation

Depending on whom the complaint is made against a copy of the complaint should be given to those involved for their comments. The key is to keep control of the final response but this might not be possible. My experience over 20 years in the FPS service suggests that an informal approach to handling the complaint may pay off. This might involve a meeting with the complainant and a conversation which might explain the background to the service that was provided.  Under formal procedures it was my experience that complainants did not receive a full explanation of the events they complained about.  My recommendation is to take an informal approach to complaints at every opportunity.

Care use of Language

Not matter how a complaint is dealt with it is always important to commit to paper an explanation and if necessary an apology. However, this should not be done until all the evidence has been collected and if necessary professional advice has been taken. In my view the complainant should always be given the chance to make further comments and to ask questions. Great care should be taken not to make any comments particularly in acknowledging a complaint that might infer that an error has been made.

COMPLAINTS

C – Keep complaints confidential

O – Organize the investigation in a timely manner

M- Manage the complaint – don’t’ let it slip away from your control

P – Pass complaints on if not against practice

L – Listen carefully to complaint – it may have a point

I – Investigate carefully and thoroughly

N – Never underestimate the effect of a complaint on all parties

T- Tell patient of right of appeal

S – Say sorry responsibility has been accepted

Responses and Rights of Appeal

Formal responses should be carefully prepared. This might be a tricky one for the Practice Manager as the ‘doctor’ complained against might want to deal with it ‘personally’. What tends to be forgotten are the Rights of Appeal and these rights need to be clearly stated in the Response letter. The ultimate right of appeal is to the NHS Ombudsman. Failure to mention the right of appeal may be procedurally frowned upon. The complainant may benefit from getting it off their chest.

Robert Campbell worked as a Deputy Administrator in two Family Practitioner Committees and was Complaints Administrator at Birmingham FPC and as such has dealt with hundreds of complaints over the year at Service Committee and Tribunal levels as well as under the Informal Procedures.