The current Regulations governing NHS complaints are not prescriptive in the sense that they impose rigid timescales to meet or stipulate how you should investigate a complaint, but they do provide a legal framework within which you must apply certain principles (see Appendix 2 for a visual representation of the system).
The practice has a duty to give complainants the support that they need to follow the complaints procedure
The framework sets out the following fundamental requirements:
1. The practice must have arrangements in place to handle complaints efficiently, investigating them properly and delivering a timely and appropriate response. It must make information about these arrangements available to the public.
2. The practice has a duty to give complainants the support that they need to follow the complaints procedure or to inform them of advice available (such as PALS or ICAS).
3. Complainants must be treated with respect and courtesy and must be told the outcome of the investigation.
4. The complaints-handling arrangements must include procedures for ensuring that necessary actions are taken in light of the outcome of a complaint.
5. One of the practice’s partners must be designated the “Responsible Person” who ensures that complaints are handled in compliance with the Regulations and that lessons learned from complaints are implemented.
6. The practice must also have a designated “complaints manager” to manage the complaints procedures. This person must be readily identifiable to service users, but does not necessarily have to be one of the practice team. It can be someone employed to carry out the role across a number of health and social care organisations if you decide to set up a joint complaints function.
7. The “Responsible Person” and the “complaints manager” can be the same person.
8. Complaints can be made by patients or anyone affected by the actions, omissions or decisions of the practice, either on their own behalf or by a representative. In the case of a representative, the practice must be satisfied that he/she is acting in the best interests of the person on whose behalf he/she is complaining. If it decides that this is not the case, it must notify the complainant in writing, giving reasons for its decision.
9. Complainants can direct their complaints to the PCT rather than the practice and the PCT may undertake the complaint handling itself or, if it deems it appropriate and has the complainant’s consent, refer the complaint to the practice concerned. The PCT is obliged to notify the practice of the details of a complaint, provided it has the complainant’s consent to do so.
A letter should be sent to the complainant setting out how the complaint will be investigated and the expected timescales
10. Oral complaints that are satisfactorily resolved no later than the next working day are not subject to the Regulations. (This does not prevent the practice from dealing informally with concerns raised by patients.)
11. All other complaints – whether made orally, in writing or electronically – must be acknowledged, either orally or in writing, within three working days of receipt. If the complaint is made orally, it must be recorded in writing and a copy given to the complainant.
12. The acknowledgement must include the offer of a discussion (which might be by telephone or a meeting) to agree a plan of how the complaint will be handled and agree reasonable timescales for investigating and concluding the complaint.
13. If the complainant declines the offer to discuss the issue, the practice should decide how the complaint will be handled, based on the available information. A letter should be sent to the complainant setting out how the complaint will be investigated and the expected timescales.
14. The complaint must be investigated appropriately and speedily and the complainant should be kept informed of progress.
15. The handling of cross-boundary complaints must be co-ordinated between the organisations involved and the complainant should be given a coordinated response. The responsible bodies concerned have a duty to cooperate with each other.
16. Once the investigation has been concluded, a letter (or, with the complainant’s consent, an email) must be sent to the complainant, setting out how the complaint has been investigated, the evidence considered and the conclusion reached. This letter should also include details of actions the practice has and will be taking as a result of its findings. Explanations of clinical matters should be written in accessible language.
17. The letter should be signed by the “Responsible Person” (or someone delegated by the practice to carry out this function on his/her behalf). It should confirm that the practice is satisfied with the way it has dealt with the complaint, making it clear that nothing more can be done at local level and that the complainant can take the complaint to the Ombudsman if he/she wishes.
Oral complaints that are satisfactorily resolved no later than the next working day are not subject to the Regulations
18. The practice’s complaints handling arrangements must be monitored to ensure that they are working effectively and that no discrimination against complainants has ensued.
19. A record must be kept of each complaint received, detailing the subject and outcome of the complaint and whether it was resolved within the agreed timescale.
20. The practice must supply the PCT with an annual report containing the following information:
- The number of complaints received
- The number of complaints that were upheld
- The number of complaints that are known to have been referred to the Health Service Ombudsman
- A summary of the reasons for the complaints
- A narrative about significant issues relating to the practice’s experience of complaints during the year, including lessons learned and actions taken.
The report must also be made available to any person on request.
Within this framework, each organisation is free to develop its own procedures to suit the local situation and to apply them flexibly to accommodate the circumstances pertaining to individual complaints.
Because this is a fairly loose framework, it is important to understand the principles that should apply in order to ensure that you are complying with both the spirit and letter of the Regulations.
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