Responding to complaints in England

A complaint is any expression of dissatisfaction. These can be made verbally or in writing. They can be directed either to the organisation involved, such as a GP practice/hospital, or to a commissioning body, which would be termed a local level complaint.

NHS Complaints procedure and timescales

All complaints should be made within 12 months of an incident or the complainant becoming aware of a concern. The time limit can be extended if good reasons are provided for the complaint not being made sooner. It is, therefore, recommended that complaints outside of this timeframe are still investigated, unless it is no longer possible to do so.

Acknowledgement of a complaint should be sent within three working days. This should include an offer to discuss how the complaint will be handled. There is no defined time limit for the full response. The complainant should be advised of the likely timescale at the outset and of any delays if these occur. Many organisations have their own timeframes, which should be set out in their complaints policy.

Under the NHS Complaints Regulations, responding to a complaint is an organisational responsibility. The healthcare provider should appoint a complaint manager (often the practice manager in primary care) and a responsible person (RP) (often a senior partner or partner with responsibility for complaints in primary care, or the Chief Executive in secondary care) although both roles can be performed by the same person. The RP is responsible for signing off the response and ensuring that any learning identified from the events of a complaint is actioned by the healthcare organisation. The organisation that receives the complaint should investigate it locally first and liaise with any other organisations which may be involved to provide a single response.

The subject of the complaint should not usually respond directly to the complainant. The involvement of the RP allows for a greater degree of impartiality in the letter of response.

If local resolution is not achieved, complainants have the right to seek an independent review by the Parliamentary and Health Services Ombudsman (PHSO) and this information must be included in a complaint response together with their contact details.

Good medical practice and complaints

All doctors have professional obligations in relation to responding to complaints. The GMC’s Good medical practice states: “You must respond promptly, fully and honestly to complaints. You must not allow a patient’s complaint to adversely affect the care or treatment you provide or arrange”.

Patient confidentiality

Where someone other than the patient has complained on their behalf, consent to respond must be provided by the patient. Where a patient lacks capacity to consent or is deceased, you need to ensure you can justify disclosure of information to the complainant in line with the GMC’s guidance on Confidentiality.

Decisions regarding disclosure of information can sometimes be complex and we recommend seeking advice from MDDUS if you are unsure.

The complaint response

A well written complaint response, demonstrating reflection and learning, can be instrumental in preventing a concern from escalating. Most complainants are looking for:

• a thorough investigation of their concerns
• a clear explanation of what happened
• assurance that steps have been taken to learn from events
• a genuine and meaningful apology.

Your professional duty of candour requires you to be open and honest and apologise when something has gone wrong with a patient’s care or has the potential to cause harm or distress.

The healthcare organisation must consider its statutory duty of candour as part of the investigation of the complaint.

Apologising when things go wrong is an essential part of practice and can assist in maintaining good patient relationships. A sincere apology can often lead to earlier resolution of complaints. Apologies can demonstrate insight and professionalism and do not of themselves amount to admissions of liability. MDDUS provides more detailed advice on good apologies.

• Investigating the complaint

  All complaints should be thoroughly investigated, ideally by someone not directly involved in the concerns. A holding response letter should include a summary of the complaint so that it is clear what will be investigated and provide a likely timeframe for a response.

  When investigating a complaint, the investigator should:

  • review the patient’s records (in cases of clinical concerns), recorded telephone calls or video consultations and any relevant policies or guidance.
  • give all individuals involved the chance to comment, either verbally or as a written statement. In doing so they should have access to the complaint and relevant clinical notes or recordings. Anyone providing a statement should include an account of their involvement and an answer to any specific questions from the complaint.
  • explore learning points and consider how they will be actioned.
  • undertake and document a more formal review, such as a Significant Event Analysis (SEA), where the concerns raised are significant, for example where the patient may have come to harm. This should be shared with the complainant, if requested.

• General principles

One response.  It is advisable that the complaints lead or RP provides a detailed letter of response incorporating the comments of all those involved, rather than individuals providing separate responses.

The right tone. Try to keep your response professional, empathetic and objective. You should refrain from emotive or defensive language. Make sure it acknowledges and addresses all the concerns raised in the complaint. To set a conciliatory tone, it is helpful to start with an apology for the patient’s concerns and reassurance that you have taken the complaint seriously.

Simple language. The response should be written in language the patient will understand. You should explain any medical terms and avoid abbreviations. Where included, you should set out whether observations and/or investigations were normal or abnormal.

Be specific. You should then answer any specific questions that the complainant has raised. You should however avoid speculation. It is okay to say you do not have an answer or will try to find out.

Learning points. The response should include evidence of reflection, and details of any specific learning points, together with how these will be addressed. This demonstrates the organisation has taken the complaint seriously and is willing to act on learning points identified to improve patient care.

Offer to meet. The letter should end with an offer to meet to discuss the response and must include details of the complainant’s right to seek an independent review of their complaint by the PHSO. The PHSO provides an example of wording to include in your response. Please see our advice on "meeting with a complainant"

MDDUS review. It can be beneficial to have your response reviewed by MDDUS before you submit it. All patient identifiable details should be removed from the correspondence before it is sent to MDDUS, however please leave in clinicians’ names as well as the name of the signatory to the letter.

If you are asked to provide a statement

If you are asked to provide a statement as part of a complaint investigation, please see our medical advisory guide on writing a statement.

Appraisal discussion

You should discuss any complaint you have been involved in at your appraisal. This should focus on the learning identified and any planned actions arising from your reflections. Reflective notes do not need to capture full factual details of an experience and should be appropriately anonymised. They should focus on the learning or actions taken from a case or situation.

Complaint documentation

All correspondence relating to a complaint should be held securely in a complaint file, separate from the patient’s records and should be kept in line with the NHS retention schedule. You should keep only the final version of any letter/s of response or witness statement/s and not draft versions.