NHS Complaints Procedure in England
Correct as of June 2011
New regulations governing NHS complaints in England came into force on 1 April 2009. The regulations, along with guidance, are designed to make complaints handling open and accountable, fair and proportionate, and patient-focused – with a view to seeking continuous improvement.
Regulations and principles
Patients and their carers will be encouraged to voice their compliments, concerns and comments as they arise
The procedures are not prescriptive, but the regulations provide a legal framework within which the principles of good complaints handling should be applied. This framework provides:
- A common process across health and adult social care
- A two-tier process of local resolution with redress to the Parliamentary and Health Service Ombudsman (PHSO).
Patients and their carers will be encouraged to voice their compliments, concerns and comments as they arise, directly with the healthcare worker concerned. The NHS Constitution makes clear what people should expect when they complain. It is important that you are familiar with your organisation’s complaints procedure, and have the skills to communicate effectively in what can be emotionally fraught circumstances.
Putting the regulations and principles into practice
Try to resolve concerns informally, outside of the regulations, with the agreement of the patient
Infrastructure
The practice should:
- Appoint a practice partner to act as a responsible person to ensure compliance with procedures and that action is taken as a result of the complaint
- Appoint a complaints manager to manage the handling of complaints. The responsible person and complaints manager can be the same person
- Have in place a complaints procedure which meets the requirements of the regulations and is underpinned by the principles
- Co-operate with any multi-agency complaints
- Publicise its procedures
- Prepare an annual report which includes:
- The number of complaints received and whether these were upheld
- How many of these complaints were referred to the PHSO
- The subject matter of the complaints
- Action taken as a result of the complaints.
The procedure
The PHSO promotes “doing it once and doing it well”.
The way a response is written, or the way a meeting is conducted, can often be the deciding factor as to whether or not a complaint proceeds further. Sometimes, acknowledging that the person’s feelings of frustration or anger at what happened are real and understandable, regardless of whether the complaint is justified or not, is enough to defuse the situation.
Practices might find the following guidance for an effective practice complaints procedure helpful:
- Try to resolve concerns informally, outside of the regulations, with the agreement of the patient
- Have a process for handling and co-operating in multiagency complaints
- Work closely with the PCT on individual complaints
- Make provision for an oral complaint to be committed to writing
- Acknowledge complaints within three working days
- Use a risk assessment tool to determine the seriousness of the complaint, and investigatory tools, eg, conciliation, internal or external investigation
- Discuss with the complainant how the complaint will be handled and within what timescale
- Make provision for a written plan, where possible agreed with the complainant, which includes:
- Details of all parties and how they can be contacted
- The issues that require addressing
- The planned outcomes
- How the matter will be investigated (proportionate to risk)
- The timescale for the investigation and any interim progress reports to be provided to the complainant
- How the response will be provided
- What support has been suggested for the complainant
- How the practice will provide follow-up on any action taken as a result of the complaint as a means of continuous improvement.
Who can complain?
A complaint can be made by a patient or person affected, or likely to be affected, by the action or decision of an NHS organisation or primary care practitioner. A complaint can also be made by someone acting on behalf of the patient or person with their written consent.
Possible claims for compensation
If you are aware through a complaint that a patient intends to pursue a claim for compensation, please contact MPS as soon as possible. This is NO LONGER excluded from the NHS complaints procedure and therefore particularly careful handling of the complaint is required in order not to prejudice any legal action.
Confidentiality issues
You must ensure that the patient has given their written consent before you can disclose clinical information to a third party. Consent can be a complex matter, particularly if the patient has died, was a child or an adult without capacity: in which case we advise you to contact MPS for further advice.
Time limits for making a complaint
Complainants now have 12 months from the occurrence giving rise to the complaint or from the time that they become aware of the matter. The complaints manager retains the discretion to investigate complaints brought later than this if there are good reasons for the delay and it is still possible to carry out the investigation.
Deputising and out-of-hours services
Where there is a complaint against a deputising doctor, it can be made directly by the patient to the deputising service, or the practice may make the complaint on behalf of the complainant. The patient’s registered GP will not necessarily be involved in the investigation at all, although he/she should be told of the complaint out of courtesy.
If the practice had opted out of providing out-of-hours services, the trust is responsible for ensuring that the complaint is investigated.
Locums and doctors in training
Complaints against locums and doctors in training should be investigated by the practice and, if they have left the practice, the doctors concerned contacted if possible for their comments.
Keeping records
A separate file must be kept for complaints records; these should not be included in the patient’s medical records. Clear and accurate documentation is essential for good complaints handling.
All complaints should be logged and the log reviewed regularly to identify themes and trends indicating areas for service improvements. Actions taken to improve services as a result of a complaint must be reported to the complainant.
Once a complaint has been resolved, the practice should keep records for ten years. Records should include copies of all correspondence between the complainant and the practice (including correspondence with the PCT or Ombudsman if they have been involved). Draft documentation should be destroyed once finalised. Any correspondence between MPS and the practice should not generally be included when releasing the file as it could be considered as privileged.
PCT involvement
If a complaint is lodged with the PCT, it has the option to investigate the complaint if this is felt to be appropriate or, with the patient’s consent, to ask the practice to investigate. The PCT can be part of local resolution but should not be used as a second stage. If the complainant remains unsatisfied they can approach the PHSO.
The Parliamentary and Health Service Ombudsman (PHSO)
Although most complaints will be resolved locally, the procedures state that you must let the complainant know of their right to ask the PHSO to review their complaint if they remain unhappy once local resolution is completed.
In the case of complaints which cover both health and social care issues, the PHSO will work closely with the Local Government Ombudsman.
Unhappiness about the outcome of the complaints process is not sufficient cause for the PHSO to investigate; complainants will need to provide reasons why they are still dissatisfied and consider whether or not they have suffered hardship or injustice.