A new white paper from Management in Practice and Pulse looks into how complaints and regulatory systems could be reformed, as practice managers struggle with rising complaint volumes and the growing workload associated with handling them. In the first part of the serialisation of this report, Jaimie Kaffash examines why complaints are increasing.
There has been an increase in complaints in general practice. NHS England figures show a 71% rise in complaints from 2020/21 to 2024/25. This wasn’t a consequence of a dip during Covid – the number of complaints were relatively flat from 2016 to 2021 (see Chart 1).
Some of this increase is due to genuine patient grievances as a result of the pressures facing practices. It could be access problems, which are getting worse (even if the blame should be on the continued underfunding of general practice). However, these pressures also mean that what may have been minor issues are not being addressed in time within the practice, and are subsequently becoming official complaints and perhaps even being escalated to local commissioners, the CQC or – for GPs – even the GMC.
Such complaints are, sadly, a symptom of a broken system. And, while practice managers would be justified in arguing that these are systemic issues that practices only have limited ability to address, it is of little surprise that patients are more likely to raise them.
Chart 1: Total written complaints about GPs
But there are also an increasing number of complaints that are not related to worsening standards of care in their practice. Some complaints are due to practices being the ‘lightning rod’ of the NHS’s problems, facing the brunt of patients’ frustrations with secondary care, for example. Others are due to wider societal issues that are lowering the threshold around what patients will complain about.
Amazon Prime expectations
For the report, we surveyed both practice managers (a total of 284 respondents) and GPs (a total of 836 respondents). The results were revealing. Practice managers and GPs said they believed there has been a lowering in the thresholds of what constitutes complaints.
One of the main observations is that there is a growing societal blame culture, and people are becoming accustomed to next-day, ‘Amazon Prime’-type services.
One practice manager says: ‘There has been a noticeable increase in complaints over recent years. In my experience, many complaints now come from patients aged between their 20s and 40s, or from relatives advocating on behalf of older family members. Expectations around access and response times have increased significantly, and complaints are often regarding relatively minor issues. In some cases, elderly patients themselves appear uncomfortable with the complaints being raised on their behalf.’
Another says: ‘There’s been a definite increase in complaints post Covid. There are noticeable increases following negative media or when the Government unhelpfully announces things to the press and that is the first we have heard of it.’
Others have raised the issue of politicians perpetuating a blame culture, raising patients’ expectations with false promises and giving them a licence to criticise the health service with their own damning remarks. One respondent cites Prime Minister Keir Starmer’s September 2024 speech that the NHS must ‘reform or die’ as such an example.
Another practice manager said they had seen a spike in complaints in the last eight months, adding: ‘Patients’ expectations of what services we provide have gone up, to the point we’re getting more bits of feedback and complaints. Internally when we talk about it, we do link it to [former health secretary] Wes Streeting making the comment that you should be able to contact a GP in the same way that you order a pizza.’
AI letters creating more work
Another new trend identified by practice managers and GPs is the use of AI in composing complaints letters. There are, of course, benefits for this in giving patients who may not have been able to provide feedback before the opportunity to do so. But it has also had the effect of lowering the threshold for what patients will complain about.
If you were to type in ‘complain about a GP being dismissive’ in ChatGPT – one of the most popular AI tools – it will generate a full page complaint letter in less than 10 seconds. Respondents told us that AI is both increasing the volume of complaints and making individual complaints letters longer, more complicated and even more time-consuming to respond to.
One practice manager says a typical three-quarter page letter would be stretched to seven pages if generated by AI. Unsurprisingly, respondents also told us that the details in these letters were often inaccurate. Some also contain legal threats that mean practice staff have to spend much more time responding to them and running it past their medical defence organisations. One respondent says a GP partner had recently spent three days reviewing and responding to an AI-generated complaint. Another respondent says AI is the ‘biggest threat’ to their ability to handle complaints due to the increasingly workload.
Lee Bennett, strategic complaints lead at NHS England, who trains practices on the complaints processes, says his team are doing work on AI: ‘Some patients are using it to write their letters and respond to the letters that they get from practices. This is proving quite a challenge across the NHS and other Government bodies. It’s making some of the complaint letters overly complicated, confusing and in some cases inaccurate.’
As a response to this trend, the Ombudsman has put a statement on its website that suggests useful prompts as a way of preventing complex letters.
Professor Victoria Tzortziou Brown, president of the RCGP, says: ‘Technology, including AI, may make it easier for patients to raise concerns and improve accessibility for some people, but there is also a risk that it could increase the number of complaints made in the heat of the moment or without full context. Complaints processes still require careful human judgement, and it’s important that concerns are considered fairly, proportionately and on an individual basis.’
Technology has also allowed an increase in unofficial complaints through social media, with Google reviews being a particular issue for practices.
One practice manager says: ‘We find Google reviews to be quite unhelpful at times. They turn into an anonymous forum for complaining, often with comments that are unreasonable but don’t violate Google’s terms and conditions. They also tend to mean that the patient or patient’s representative aren’t actually following the practice’s complaints procedure, which doesn’t help anyone.’
They are ‘more hurtful’ than official complaints, says one GP: ‘I see Google reviews as negative because if a doctor is named on a public platform or social media, it is professional defamation as anyone can read those. I think they feel a lot worse and are more hurtful than a regular complaint made directly to the practice, simply because it’s on the internet (a public platform) for all to see. I feel that practices should not allow Google reviews – like schools do in the UK.’
A&G and secondary care pressures
Pulse’s survey also reveals that practices are increasingly dealing with complaints that are about hospitals or other parts of the NHS – complaints that might meet normal thresholds, but are not relevant. Of the 822 GPs who responded, 80% agreed (42% strongly agreeing) with the statement that ‘the number of complaints made against GPs that are really about secondary care or community care issues is increasing’.
CHART 2: ‘The number of complaints made against GPs that are really about secondary care or community care issues is increasing’
As one GP put it: ‘What I certainly have noticed increasingly are complaints or criticism of hospital services – especially long waiting times but also poor communication regarding appointments and, sadly, the perceived attitude of some of the medical staff. This can result in me having to contact secretaries or medical staff and also spending time explaining hospital letters.’ Another had a similar sentiment: ‘Often complaints are brought against practices due to poor performance of other areas of the NHS, mostly secondary care, but also the ambulance service and out of hours care.’
Rebecca Curtayne, external affairs manager at Healthwatch, which describes itself as a health and social care champion, and author of its report on complaints, says that this is in part due to a lack of information: ‘A lot of those complaints should be going up to the up to ICBs. Patients don’t get it that they can complain to the GP or the ICB. They don’t always have to go to the practice if they don’t want to.’
Trusts also have their own patient and advice liaison service (PALS) – although GPs told us that they are hearing more reports from patients about a lack of response from these organisations. One GP said: ‘The reason we get a lot of complaints is that GPs are seen as part of the same system. We’re seen as someone they can access. Some of our local hospitals, you can’t find the contact number, PALS services are now overwhelmed. If they do have a complaint and they want to take it to secondary care, they give up.’
There is a lack of support from local commissioners, too. As on practice manager put it: ‘I had a recent example where the patient wrote in desperation to the ICB to help her but they passed it back to the surgery. The patient isn’t frustrated with us but wanted the ICB to find out what the hospital has done with her referral.’
In England, the expansion of advice and guidance is set to exacerbate these problems. With general practice set to retain responsibility for services they would not have done in the past. More than 80% of GPs agreed that this is likely to lead to more complaints – with 51% strongly agreeing (see Chart 3).
Chart 3: ‘The increase in the use of advice and guidance/rationing of referrals is likely to lead to more complaints against GPs’
As one GP put it: ‘In the current climate this is increasingly problematic with both referrals and radiology requests being screened by secondary care and many are refused. This ends up taking even more time explaining to a demanding and unhappy patient why we can’t do as we have been asked.’
Workload implications
This is having an effect on practice workload. Our survey of practice managers and GP partners reveals that practices were spending an average of 3.4 hours a week dealing with complaints. But nearly one in five says complaints were taking up more than five hours a week of practice time (see Chart 4).
Chart 4: How much time does your practice spend on dealing with patient complaints per week?
One practice manager commented: ‘Complaints can be quite demoralising for staff who are already experiencing low morale working in general practice. Complaints are also at times very time consuming and can lead to other work having to be bumped off the agenda. There is also quite a bit of anxiety about complaints escalation – if a patient is unhappy with the response to a complaint, they can choose to take their complaint to NHS England or even the parliamentary ombudsman. This can be very stressful for individuals named in a complaint.’
However, there is another way of looking at this, says Lee Bennett of NHS England: ‘I encourage practices to say thank you to a complainant when acknowledging their complaint. Practices might not feel grateful for a new complaint but when I remind them that a patient could opt to go to the GMC under fitness to practise rather than through the local complaints process, use social media (which is very difficult to respond to publicly) or raise a concern with the CQC.
‘Surely it’s better for practices to have a chance to repair a relationship locally through the complaints process and many practices understand this when we talk it through at the training?’
How the complaints and escalation process works across the UK
Patients are encouraged to complain about their GP practice if they experienced poor care or delays, they believe their concerns were dismissed or they were spoken to unprofessionally.
They are urged to complain directly to the practice involved in the first instance. The process is broadly similar across England, Scotland, Wales and Northern Ireland and patients must submit their complaint within 12 months of the event. Patients have the right to complain in person or over-the-phone as well as in writing.
In England, all health organisations are urged by NHS England to acknowledge complaints within three working days of receiving them. If they are verbal complaints and can be resolved by the next working day, they don’t need to be taken any further. Otherwise, organisations should aim to resolve reasonably quick complaints within ten working days. Complaints that need an investigation should receive a response within 40 working days or, if they are more complex, within six months.
In Scotland, Wales and Northern Ireland, GPs – as with all public bodies – are encouraged to resolve complaints within five working days and then patients should be given a final decision on the response within 20 working days.
Patients who don’t want to complain directly to the practice can also go to their local Integrated Care Board (ICB) in England, the local health boards in Scotland and Wales and the health and social care trusts in Northern Ireland. They can also contact NHS England in England or the Strategic Planning and Performance Group in Northern Ireland, a division of its Department of Health. (NHS Inform in Scotland and Public Health Wales encourage patients to complain directly to practices.)
Patients who aren’t happy with how their complaint has been handled by the GP practice (or local health board or trust) can escalate it to the ombudsman for England, Northern Ireland, Scotland and Wales respectively. But the ombudsman will only consider complaints if patients have tried complaining and resolving the issue with the practice first, and they’ve reached the end of the road. The ombudsman only investigates a small number of the most serious cases they receive and the threshold is high.
If patients believe their GP has shown misconduct, poor performance, physical or mental ill-health that impacts their ability to practise they can complain to the General Medical Council (GMC), which regulates all UK doctors. Again, the bar is high and 80% of cases are closed by the GMC at the initial triage stage. If the GMC does go ahead with an investigation they will look for further evidence from medical records, witness statements and expert reports.
The GMC’s senior decision makers will then decide whether to close the case or agree undertakings or, in serious cases, refer it to the Medical Practitioners Tribunal Service (MPTS). The MPTS is a public hearing and if they find a doctor’s fitness to practice is impaired they could be given set ‘conditions’ or ‘undertakings’ on which to practise – such as only working while supervised. Doctors may also be suspended or, in the worst cases, struck off.
Alongside this, there is the legal route for patients, who can employ solicitors to purse GPs in the courts.
In the next part of this series, we will look at how some practice managers are improving their processes, despite a lack of funding.
Read our white paper on complaints in general practice in full – download your free copy today
The white paper is supported by Medical Protection
