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Learn and share lessons from complaints, say legal advisers

13 October 2008

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Patient complaints are significant events that need to be investigated and acted upon, and practices should have a system in place to ensure they do this, a leading medicolegal adviser has said.

The advice follows last week’s publication of the National Audit Office’s (NAO) report on complaints handling, highlighting a lack of learning from complaints.

Dr Michael Devlin, a medicolegal adviser from the Medical Defence Union (MDU), said: “In 2007, the MDU was asked to help with more than 3,300 patient complaints by our medical and dental members. Most were made as a consequence of a system failure such as the inadvertent filing of blood results that had not been acted upon.

“We entirely agree with the NAO’s recommendation, and usually advise our members, to use complaints as an opportunity to identify underlying system problems and seek to resolve them.

He added: “Patients and their representatives often say that their motivation in making a complaint is to find out what went wrong and they would like an apology. Equally important, they seek assurances that steps have been put in place to stop the same thing happening again.

“We recommend to all members that they log all significant events, including complaints, and have a system in place to ensure they are thoroughly investigated and that lessons are learnt and, if appropriate, systems or practice are altered accordingly. This will also include follow-up to ensure that any changes put in place have had the desired effect.

Dr Devlin also encouraged practices to cooperate with each other. “If practices are willing to share what they have learned with their colleagues in neighbouring practices, they may also be able to adapt their own procedures and to avoid similar problems arising themselves,” he said.

Dr Devlin said that the new NHS complaints procedure, planned for April 2009, would place greater emphasis on local resolution, and that those involved in responding to complaints will be expected to involve the complainant throughout the process, work within existing clinical governance procedures and demonstrate any improvements that have resulted.

Among the key points of the MDU’s advice are:

  • Where a complaint has been received this should be recorded in writing and acknowledged by the designated complaints manager within three working days in primary care. It can also be useful to offer the complainant a meeting to discuss the concerns raised. Such meetings can occasionally benefit from the presence of a conciliator.
  • One person should be given responsibility for clinical governance and initiating action following any adverse incident. Their duties could include checking adverse incident reports are complete, documenting the action to be taken and providing feedback to staff and implementing training where necessary.
  • Investigations should look beyond human error in order to identify and eliminate risks that could lead to a recurrence. For more serious incidents, you may decide to hold a meeting to discuss the issues in greater detail where all staff can contribute. Ensure a record is kept of the meeting and agree a date to follow up any action points.
  • Provide a full, detailed and positive response to a complainant within 10 working days of receipt in primary care. This should ideally include an account of what happened, an apology where appropriate and an explanation of any steps that have been put in place to prevent a repeat of the problem.
  • Report adverse incidents to the National Patient Safety Agency’s (NPSA) National Reporting and Learning System (NRLS), which aims to collate reports nationally and introduce guidance and preventative measures so that others can benefit.


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