Earlier this year, NHS Digital reported that the number of complaints levelled at GP practices had ‘surged’. GPs and dentists received a total of 8,000 more written complaints in the 2016/17 year than in the previous year. This represented a 9.7% increase as the total reached 90,600, according to the figures. About half the complaints were upheld in full or part.
Those stats are hardly surprising given the fact services continue to be put under increasing pressure. And while the publication of the figures prompted calls from the usual suspects for increased funding, those requests once again went unnoticed and this week’s Budget did next to nothing to tackle the problems in primary care. That means practices need to learn how to deal with complaints – and one effective way to do that is actively invite feedback. Here’s why.
Listening culture: ask for feedback
The Parliamentary and Health Service Ombudsman – the organisation that makes final decisions on complaints that have not been resolved by the NHS in England – recently conducted a review into the quality of general practice complaint handling, to identify good practice and ways that the quality could be improved – and the leading principle is to invite and use feedback.
The Ombudsman explains that a service that is safe, responsive and well-led will treat feedback, concerns and complaints as an opportunity to improve. Often, opportunities are missed to respond to issues before they become complaints, as practices do not do enough to welcome feedback.
Care Quality Commission inspectors and local Healthwatch found that practices commonly didn’t have information clearly displayed in the waiting area or on their website about how to feedback or complain. Furthermore, evidence from Care Quality Commission inspections showed that not all staff in the practice knew how complaints policies, if they existed at all, should be implemented.
Showing how feedback, concerns and complaints have been used to improve services, gives people confidence that raising issues can make a difference. Research shows that only a quarter of individuals who experience a problem with their practice make a complaint and only four in ten believe complaining to their GP will make a difference. This highlights that unless practices invite feedback, they will miss opportunities to improve patient experience.
One practice – which was involved with the Ombudsman’s review – commented: “We have a culture where we escalate everything. We encourage verbal feedback and treat it like a written complaint…we’re a business, it’s just good customer service.”
For practices to be able to learn from feedback, concerns and complaints, they need to encourage feedback in all its forms and ensure people are told how to make a complaint as well as being signposted to sources of advice and support. The Parliamentary and Health Service Ombudsman research shows that GPs are the least likely NHS provider to offer advice or support to individuals making complaints when compared with dentists and hospital trusts.
Local Healthwatch have also highlighted inconsistencies in information about complaining across practices. It’s worth pointing out here that practices that don’t signpost to advocacy or provide basic information are falling short of their legal duties as set out in the NHS Complaint Regulations (2009).
Practical case studies
- Few complaints – requires improvement
During an inspection, the Care Quality Commission found that a practice with just two recorded complaints ‘requires improvement’. The practice received a rating of inadequate for ‘are practices responsive to people’s needs?’ – the main area where the quality of complaint handling is assessed. Inspectors found that:
- there was no information available to help patients understand how to make a complaint;
- some of the patients that the Care Quality Commission inspectors spoke to did not know how to complain and there was no defined system in place for handling complaints and concerns; and
- the practice did not have a complaints policy or procedure setting out what to do. The practice manager resolved complaints as they arose but there were no records of investigations and responses.
As a result, there was no evidence of any sharing of what the practice had learned from individual complaints or how it had used complaints to improve the quality of care.
- Being responsive – an outstanding practice
A practice that received 32 complaints in 12 months was rated ‘outstanding’ by the Care Quality Commission. The practice was particularly good at creating a culture where feedback, concerns and complaints were welcomed and encouraged. It achieved this in the following ways:
- Displaying a wide range of information to allow patients to access the complaints system including posters, leaflets, information on the practice’s website and information in the practice handbook.
- Encouraging and engaging patients in the delivery of the service, including through patient feedback.
- Creating a leaflet that detailed the complaints procedure and lists organisations that may be able to support individuals in making a complaint. The leaflet also contained a tear-off form for patients to complete if they wished to highlight any compliments, comments, concerns or complaints.
- Displaying ‘We’re listening’ posters in the waiting area to show that feedback had been received along with the action that had been taken to respond.
- Utilising the waiting area to encourage patients to feedback in person, via telephone or online.
The practice was able to show how it had responded to the 32 complaints in a thorough and timely manner, and demonstrated openness in responding to complaints. It learned from concerns and complaints and took action to improve the quality of care.
The practice had a Lessons Learned newsletter that identified what it had learned from complaints, which it shared with all staff. Staff told the Care Quality Commission inspectors that the circulation of the newsletter helped to ensure that they were all aware of lessons learned.
- Improving access to online complaints resources
In April 2014, Healthwatch Dorset produced it’s Something to Complain About? report, which undertook a review of GP complaints services across 101 local GP practices. Healthwatch Dorset found that there were a series of inconsistencies in the provision of complaints information on local practice websites, saying that ‘many practices failed to provide good quality, detailed and up-to-date information’ for anyone considering making a complaint.
Among its recommendations, Healthwatch Dorset called for all practices to regularly make sure that information is comprehensive, accurate and current. This information should be available on a single complaints page on a practice’s website.
A significant number of local practices responded positively to the report, with one member of staff calling the report ‘helpful and informative’. In a follow-up survey of local GP complaints services in March 2015, Healthwatch Dorset reported that 48 local practices had also updated their complaints information since the initial report was published. Many of those had updated the information on their websites, while half of the local practices without a website had since built one.
Do you encourage feedback in your practice? How do you ensure those comments are acted upon? Have you improved service delivery as a result? Please let us know by commenting below or head along to the Practice Index forum thread here.