How To Handle A Complaint In The Uk

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1 MEDICAL PROTECTION SOCIETY PROFESSIONAL SUPPORT AND EXPERT ADVICE MPS COMPLAINTS SERIES BOOK 5 NHS complaints procedure An overview

2 Contents Regulations and principles page 3 Putting the regulations and principles into practice page 3 Who can complain? page 5 Possible claims for compensation page 5 Confidentiality issues page 5 Time limits for making a complaint page 6 Deputising and out-of-hours services page 6 Locums and doctors in training page 6 Keeping records page 6 NHS England Involvement page 7 The Parliamentary and Health Service Ombudsman (PHSO) page 7 Important please note Due to the dynamic nature of medical law we suggest that you access our website at for the most up-to-date information. October Medical Protection Society 2009, reprinted 2011, 2012 Reviewed October Review date: October This booklet is published as a resource for MPS members in the UK. It is intended as general guidance only. MPS members are always welcome to telephone our medicolegal advice line for more specific practical advice and support with medicolegal issues that may arise. The Medical Protection Society is the leading provider of comprehensive professional indemnity and expert advice to doctors, dentists and health professionals around the world. We are a mutual, not-for-profit organisation offering more than 280,000 members help with legal and ethical problems that arise from their professional practice. This includes clinical negligence claims, complaints, medical council inquiries, legal and ethical dilemmas, disciplinary procedures, inquests and fatal accident inquiries. Fairness is at the heart of how we conduct our business. We actively protect and promote the interests of members and the wider profession. Equally, we believe that patients who have suffered harm from negligent treatment should receive fair compensation. We promote safer practice by running risk management and education programmes to reduce avoidable harm. MPS is not an insurance company. The benefits of membership are discretionary this allows us the flexibility to provide help and support even in unusual circumstances. Cover image: istockphoto/abel Mitja Varela

3 NHS COMPLAINTS PROCEDURE AN OVERVIEW 3 New regulations governing NHS complaints in England came into force on 1 April The regulations, along with guidance, are designed to make complaints handling open and accountable, fair and proportionate, and patient-focused with a view to seeking continuous improvement. NHS England was formed in April 2013 and replaces the decommissioned Primary Care Trusts and Strategic Health Authorities. Complainants can choose to raise their complaint with NHS England and have it investigated by one of their Local Area Teams. In addition, the Care Quality Commission (CQC), formed in 2009 to regulate and inspect health and social care services in England, and with whom GP practices were required to register in April 2013, has a set of essential standards that it uses to measure compliance with the regulations of the Health and Social Care Act One standard relates to complaints, stipulating that patients must have their complaints listened to and acted on properly. Regulations and principles The procedures are not prescriptive, but the regulations provide a legal framework within which the principles of good complaints handling should be applied. This framework provides: A common process across health and adult social care A two-tier process of local resolution with redress to the Parliamentary and Health Service Ombudsman (PHSO). Patients and their carers will be encouraged to voice their compliments, concerns and comments as they arise, directly with the healthcare worker concerned. The NHS Constitution makes clear what people should expect when they complain. It is important that you are familiar with your organisation s complaints procedure, and have the skills to communicate effectively in what can be emotionally fraught circumstances. Putting the regulations and principles into practice Infrastructure The practice should: Appoint a practice partner to act as a responsible person to ensure compliance with procedures and that action is taken as a result of the complaint Appoint a complaints manager to manage the handling of complaints. The responsible person and complaints manager can be the same person

4 4 COMPLAINTS Have in place a complaints procedure which meets the requirements of the regulations and is underpinned by the principles Co-operate with any multi-agency complaints Publicise its procedures Prepare an annual report which includes: The number of complaints received and whether these were upheld How many of these complaints were referred to the PHSO The subject matter of the complaints Action taken as a result of the complaints. The Procedure The PHSO promotes doing it once and doing it well. The way a response is written, or the way a meeting is conducted, can often be the deciding factor as to whether or not a complaint proceeds further. Sometimes, acknowledging that the person s feelings of frustration or anger at what happened are real and understandable, regardless of whether the complaint is justified or not, is enough to defuse the situation. Practices might find the following guidance for an effective practice complaints procedure helpful: Try to resolve concerns informally, outside of the regulations, with the agreement of the patient Have a process for handling and co-operating in multi-agency complaints Work closely with NHS England on individual complaints Make provision for an oral complaint to be committed to writing Acknowledge complaints within three working days Use a risk assessment tool to determine the seriousness of the complaint, and investigatory tools, eg, conciliation, internal or external investigation Discuss with the complainant how the complaint will be handled and within what timescale

5 NHS COMPLAINTS PROCEDURE AN OVERVIEW 5 Make provision for a written plan, where possible agreed with the complainant, which includes: Details of all parties and how they can be contacted The issues that require addressing The complainant s expected outcomes How the matter will be investigated (proportionate to risk) The timescale for the investigation and any interim progress reports to be provided to the complainant How the response will be provided What support has been suggested for the complainant How the practice will provide follow-up on any action taken as a result of the complaint as a means of continuous improvement. Who can complain? A complaint can be made by a patient or person affected, or likely to be affected, by the action or decision of an NHS organisation or primary care practitioner. A complaint can also be made by someone acting on behalf of the patient or person with their written consent. Possible claims for compensation If you are aware through a complaint that a patient intends to pursue a claim for compensation, please contact MPS as soon as possible. A claim no longer excludes investigation of a complaint under the NHS complaints procedure and therefore particularly careful handling of the complaint is required in order not to prejudice any legal action. Confidentiality issues You must ensure that the patient has given their written consent before you can disclose clinical information to a third party. Consent can be a complex matter, particularly if the patient has died, was a child or an adult without capacity: in which case we advise you to contact MPS for further advice.

6 6 COMPLAINTS Time limits for making a complaint Complainants now have 12 months from the occurrence giving rise to the complaint or from the time that they become aware of the matter. The complaints manager retains the discretion to investigate complaints brought later than this if there are good reasons for the delay and it is still possible to carry out the investigation. Deputising and out-of-hours services Where there is a complaint against a deputising doctor, it can be made directly by the complainant to the deputising service, or the practice may make the complaint on behalf of the complainant. The patient s registered GP will not necessarily be involved in the investigation at all, although he/she should be told of the complaint out of courtesy. If the practice had opted out of providing out-of-hours services, the organisation responsible for providing the out-of-hours service should ensure that the complaint is investigated. Locums and doctors in training Complaints against locums and doctors in training should be investigated by the practice and, if they have left the practice, the doctors concerned contacted if possible for their comments. Keeping records A separate file must be kept for complaints records; these should not be included in the patient s medical records. Clear and accurate documentation is essential for good complaints handling. All complaints should be logged and the log reviewed regularly to identify themes and trends indicating areas for service improvements. Actions taken to improve services as a result of a complaint must be reported to the complainant. Once a complaint has been resolved, the practice should keep records for ten years. Records should include copies of all correspondence between the complainant and the practice (including correspondence with NHS England or Ombudsman if they have been involved). Draft documentation should be destroyed once finalised. Any correspondence between MPS and the practice should not generally be included when releasing the file as it could be considered as privileged.

7 NHS COMPLAINTS PROCEDURE AN OVERVIEW 7 NHS England involvement If a complaint is lodged with NHS England, it has the option to investigate the complaint if this is felt to be appropriate or, with the patient s consent, to ask the practice to investigate. NHS England can be part of local resolution but should not be used as a second stage. If the complainant remains unsatisfied they can approach the PHSO. The Parliamentary and Health Service Ombudsman (PHSO) Although most complaints will be resolved locally, the procedures state that you must let the complainant know of their right to ask the PHSO to review their complaint if they remain unhappy once local resolution is completed. In the case of complaints which cover both health and social care issues, the PHSO will work closely with the Local Government Ombudsman. Unhappiness about the outcome of the complaints process is not sufficient cause for the PHSO to investigate; complainants will need to provide reasons why they are still dissatisfied and consider whether or not they have suffered hardship or injustice.

8 8 MEDICAL PROTECTION SOCIETY NHS COMPLAINTS IN ENGLAND PROFESSIONAL SUPPORT AND EXPERT ADVICE General enquiries T F E Medicolegal enquiries T F E Membership enquiries T F E Please direct all comments, questions or suggestions about MPS service, policy and operations to: Chief Executive Medical Protection Society 33 Cavendish Square, London W1G 0PS, United Kingdom In the interests of confidentiality please do not include information in any that would allow a patient to be identified. The Medical Protection Society A company limited by guarantee. Registered in England no at 33 Cavendish Square, London W1G 0PS MPS is not an insurance company. All the benefits of membership of MPS are discretionary as set out in the Memorandum and Articles of Association. MPS0827 5: 12/13

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