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14 March 2019
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Medical Defence Union (MDU) medico-legal adviser Dr Kathryn Leask on how practices can effectively address complaints at an early stage
Dealing with a practice complaint can be time consuming and, depending on the context, distressing.
However, in the Medical Defence Union’s (MDU) experience, the time taken to provide a response will be well spent if the complainant’s concerns can be addressed at the first opportunity.
A thorough complaints investigation and thoughtful response can also help to avoid an investigation by the Parliamentary and Health Service Ombudsman, while maintaining the practice’s professional reputation.
Complaints can focus both on clinical care the patient received and administrative issues within the practice.
Concerns may already have been identified by the practice before a complaint is received and action might already have been taken to address this. In other cases, the complaint could be unexpected and you may feel it is unjustified or unfair.
Regardless of the nature of the complaint, it is important to ensure that you follow your complaints process and that the concerns fully addressed, as this may reduce the likelihood of the complainant taking their concerns further.
The MDU recommends practices to consider the following steps when responding to a complaint:
All written complaints and any verbal complaint that cannot be resolved within 24 hours need an appropriate written response. A dismissive or unprofessional response is often the reason a complaint cannot be resolved and is referred on to the ombudsman.
It’s worth noting that the number of complaints being referred to the ombudsman, once attempts at local resolution have failed, is increasing with 1,591 complaints being referred for more in depth consideration in the first quarter of 2018.
While there are no time limits within which you must respond to a complaint, your response should be timely.
If there are any delays, for example because you need to gather comments from a number of colleagues, or other organisations, the complainant should be kept updated and advised on when they are likely to receive a response.
Where a complaint has been made via NHS England, its complaints department is likely to apply a deadline for you to respond.
It is important to get advice early from your medical defence organisation to ensure the complaints process is being followed and all of the complainant’s concerns are being fully addressed. This includes explanations for what has happened and where appropriate, an apology.
When investigating a complaint it is important to obtain comments from all relevant staff members, such as GPs, nurses or reception staff.
The statements could be seen by the complainant or the ombudsman so it’s important to ensure that they are written in a professional way, providing a factual account of events.
These comments should be used to prepare a single response to the patient. It is important to identify the best person to write the response: if clinical concerns have been raised a senior doctor may be best placed to respond, rather than the practice manager.
As well as responding to the concerns raised the practice is expected to hold a complaints or significant event meeting where the incident can be discussed and any learning points identified.
These may relate to practice protocols, procedures or clinical care. Where lessons have been identified it is important that these are addressed as soon as possible.
Even if nothing could have been done differently, a complaint provides a good opportunity to review training needs and professional development.
The complainant should be informed of the outcome of the meeting and what action will be taken as a result of their complaint.
Minutes of the meeting should be taken and these should be written in such a way that they can be disclosed to the complainant, or the ombudsman, should they request them
It can be helpful to offer the complainant a meeting to discuss their concerns. This can take place before or after a written response is provided, depending on the complainant’s preference.
Consider going through the clinical records during the meeting, if appropriate; explaining any medical terms or investigations to the complainant.
This can often resolve the concerns at an early stage and address any misunderstandings. As well as offering a meeting, the complainant should be advised of their right to take their complaint to the ombudsman if they are not satisfied with the practice response.
While receiving a complaint can give you that sinking feeling, you can maximise your chances of resolving matters at an early stage by following these five steps.
The good news is that, in the MDU’s experience, most complaints can be resolved by the practice so it is worth familiarising yourself with the procedure and getting advice.