Complaints – FAQs

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.

Read some frequently asked questions about the new regulations below.

1. How often should we review our complaints procedure?

We would suggest this is done annually. You will need to check that your procedures comply with the current regulations and the guidance and principles issued by the Department of Health (DH) and the Ombudsman.

You may find it helpful to liaise with other practices and your PCT over the final procedure as there is now a common process across health and social care. It is quite possible that your local health and social care economy is working towards a co-ordinated approach.

It is also suggested that you make sure ALL staff within the practice are aware of the process. Your PCT may be able to help with training. Don’t forget your complaints information leaflets also need to be kept up-to-date.

• Read the regulations
• Access the DH guidance
• View the PSHO principles.

2. Do we need to have a designated complaints manager?

Each practice needs to have a designated “responsible person” who should be a partner

Yes, but each practice also needs to have a designated “responsible person” who should be a partner. The responsible person will be responsible for ensuring compliance with the complaints regulations and making sure action is taken as a result of the complaint.

The responsible person and the complaints manager could be the same person. Check paragraph 4 of the regulations to make sure that you are compliant.

3. I’ve just received a complaint – what do I do?

You need to make early contact with the complainant. You are required to acknowledge the complaint within three working days and invite the complainant to discuss the way forward.

The sooner you engage with the complainant (subject to consent) the better. Waiting for a response to an invitation to discuss the complaint included in the acknowledgement letter can cause delay. The discussion does not have to be face to face – whatever is the most convenient for both parties.

To negotiate a plan, are you able to make contact with the complainant?

Note: You can start gathering together evidence whilst you are waiting for the complainant to make contact.

4. What should I include in an acknowledgement letter?

• An acknowledgement of receipt.
• An apology and recognition of distress, anxiety (condolences where appropriate).
• Enclose the agreed complaints plan if already discussed or a draft proposed plan with an invitation to discuss within a time-scale.
• Details of advocacy service, eg, ICAS.

5. We have received a complaint which is out of time; do we need to investigate it?

• A complaint should be lodged not later than 12 months after the date of the incident complained about, or the date on which the patient became aware that they had cause for complaint.
• However, although there is a time-scale for lodging a complaint, if there is good reason why the complaint could not be lodged within the time-scale and it is still possible to investigate the complaint effectively and fairly, then the time-scale should be waived.
• Ask the complainant for the reasons for the delay. You will then need to make a judgment as to whether or not the delay is justifiable.

6. We have received a complaint but feel we can easily resolve it

• Have you discussed the situation with the complainant?
• Are they willing for you to deal with the matter informally?
• Has this decision been an informed one?
• Have you provided them with the options available to them? For example, dealing with it informally with a verbal response or through the complaints procedure with a written response.
• Have you set a time-scale for feeding back to them?
• Are they clear that if you fail to resolve the matter informally they have the right to escalate the matter to a formal complaint?
• Have you made a record of this discussion?
• Although you may be dealing with a matter outside of the complaints regulations are there still lessons to be learned?

7. What should be included in the plan?

If the complaint has come via the PCT, have they already made any agreements with the complainant about how the complaint will be handled?

• Develop a template that covers all situations.
• If the complaint has come via the PCT, have they already made any agreements with the complainant about how the complaint will be handled?
• Consider including:
  • Complaint reference number
  • Complainant’s name and contact details
  • Complainant’s preferred means of contact (if it is email make it clear that this may not be a secure means of corresponding)
  • Patient’s name and details if different from complainant
  • Has consent been sought/obtained, if appropriate
  • Name of person who contacted the complainant
  • Date of contact
  • Summary of complaint with dates of incidents
  • List of issues to be investigated
  • Outcome the complainant is seeking
  • Agreed investigation plan (eg use of conciliator, internal investigation by …)
  • Consent to share information with those involved in the investigation
  • Agreed time-scale for a response
  • How the practice will provide the response
  • Details of source of advocacy suggested
  • Any further information that may be helpful (eg, language or disability issues).

8. What factors should I take into account when setting the time-scale?

• Do you have all the records to hand or do you need to recall these?
• Are you going to use someone from outside of the practice as part of the investigation (eg, a conciliator)?
• Is the investigation likely to include a meeting (how available are the parties)?
• Do you need to contact doctors who have left the practice?
• Also allow time to take advice from MPS. If the investigation is likely to take more than a few weeks, keep the complainant regularly updated at specified intervals and build this into your ‘Plan’.
• Sometimes you may find that what seemed to initially be a straightforward investigation can become more complex. There is no reason why you can’t go back to the complainant and renegotiate the time-scale as long as you can provide good reason for doing so.

9. The PCT wants to investigate our complaint – can they do this?

• The PCT does have the right to manage the investigation. Did they include you in the discussions around the management of the complaint?
• Ask the PCT why they are not allowing the practice to take full ownership of the complaint. Do you think the reasons are fair?
• Don’t forget the PCT will need to take into account the wishes of the complainant.

10. There has been a delay by the PCT in sending us a complaint.

Ask the PCT why there has been a delay. Was it an issue of consent to share the information? When you acknowledge the complaint you may wish to make reference to the fact that you have only just received the letter.

11. How do I decide how to investigate a complaint?

Use a risk assessment tool. The tool contained in the DH’s Listening, Responding, Improving A Guide to Better Customer Care pages 18-21 may be helpful.

The investigation should be proportionate to risk. For example, you are unlikely to consider involving an external investigator for a complaint about the practice’s appointment system. However also be aware of the complainant’s wishes.

12. The complainant wants someone from outside the practice to investigate the complaint.

• Would this be a proportionate and reasonable response to the level of seriousness of the complaint?
• Is the complainant happy for all relevant information to be shared outside of the practice?
• Is the complainant aware that they have the right to ask the PCT if they will manage the investigation?
• If an external investigation is felt to be appropriate, have you reached an agreement on who the external investigator will be?
• Are there any cost implications?
• Does that person have the necessary independence, skills and knowledge to undertake the investigation and are they indemnified?

13. Our PCT has told us that we have to pay for a conciliator – is this right?

PCTs no longer have any obligation to provide conciliation. However, is the PCT managing the investigation?

14. What should I include in a response letter?

Refer to the history you took; any examination and findings; treatment provided; advice given and any follow-up.

You should consider including the following elements in a response letter, but also be mindful of the plan you agreed with the complainant.

• An apology and some acknowledgement of distress (condolences where appropriate).
• A summary of the main issues they have raised in their letter (this will also help you focus your response).
• What action you have taken to investigate the complaint (eg, spoken to the staff concerned, reviewed records/policies).
• A clear explanation in response to each of the issues raised. If this relates to a consultation, refer to the history you took; any examination and findings; treatment provided; advice given and any follow-up.
• What action the practice is taking as a result of the complaint to reduce the risk of a similar occurrence.
• An invitation to meet or contact you again if they have any further questions.
• Details of their redress through the complaints procedure to the Ombudsman and their right to use the Independent Complaints Advocacy Service (ICAS).
• A reiteration of your apology for what occurred.

15. How long does a complainant have to approach the Ombudsman once local resolution is complete?

The complainant has 12 months from the point when they became aware that they had cause to raise a complaint. However, the Ombudsman will take into account the time taken at local resolution when deciding whether to exercise discretion to accept a case outside of the 12-month time limit.

It is suggested that in your final response you state the following:

16. I have been contacted by the Ombudsman to say the complainant wants them to look at the complaint. How long do they have to get back to me?

We understand that this can take up to 40 days.

17. I had a call from the Ombudsman’s office asking me to send them a copy of the complaint file. What should I do?

Firstly, for reasons of confidentiality, ask them to put it in writing or fax so you know they are who they say they are.

They will require the following documents:

• Copy of original complaint.
• Copy of your acknowledgement letter (offer to meet to agree plan/advocacy service).
• Copy of consent if relevant.
• Copy of complaint plan.
• Any intervening correspondence such as holding letter(s), with reasons for any delays.
• Copy of the investigations which might include: statements from staff/doctors, policies/procedures.
• Relevant extract of medical records.
• Final response including outcome, lessons learnt, action/changes to be made and details of PHSO.

Present your documentation in chronological order, most recent documents at the top.

18. We have received a complaint which also relates to the hospital and social care.

Ask to see the final co-ordinated response letter in draft to ensure that your comments are accurately reflected

Has the complaint also been sent to the other agencies? If not, you will need consent to share it.

Subject to agreement with the complainant, make contact with the complaints managers within the other agencies concerned. Decide who is going to take the lead on the complaint, be the main contact point with the complainant and co-ordinate the response.

When submitting your response to the co-ordinator of a multi-agency complaint, ask to see the final co-ordinated response letter in draft to ensure that your comments are accurately reflected.

More detailed guidance can be found in the DH’s Advice Sheet 2: Joint Working on Complaints – an Example Protocol.

19. Do we have to co-operate with other agencies in a multi-agency complaint or can we do our investigation separately?

There is a statutory duty to co-operate. The new process encourages a co-ordinated response. However:

• What are the views of the complainant?
• How interlinked are the issues?

20. How do we decide who should take the lead on a multi-agency complaint? We do not have the resources within the practice to do this.

• Resourcing and staff experience and expertise, are some of a number of deciding factors affecting who should take the lead.
• Against which agency is the most serious aspect of the complaint?
• Which agency has the major part of the complaint to investigate?
• Does the complainant have a preference?
• Have you considered approaching your PCT to see if they will co-ordinate on your behalf?

More detailed guidance can be found in the DH’s Advice Sheet 2: Joint Working on Complaints – an Example Protocol.

21. A complaint has come to us which actually relates to the hospital; can we pass it to the team?

• Have you got the complainant’s consent to forward the complaint elsewhere?
• If the complainant does not want you to share the letter, what are their reasons?
• Would they be happier for the PCT, as the service commissioner, to undertake the investigation?

22. If we get a complaint that indicates an intention to take legal action, what should we do?

The complaint can still be investigated under the complaints regulations, as legal action is no longer exempt from the regulations. However, seek advice promptly before making any contact with the patient, as there will need to be careful handling of the issues to prevent prejudicing any legal case.

23. A complainant has asked for compensation

The Ombudsman’s Principles for Remedy does include the possibility of financial remedy if the patient has suffered injustice and hardship as a result of maladministration or poor service. What the Ombudsman expects is for the patient, where possible, to be returned to the position they were in before poor service took place.

For further information, view the PHSO’s publication Principles for Remedy.

24. Will we be asked for the number of complaints we have handled at the end of the year?

Yes, you will need to provide an annual report to the PCT, including:

• The number of complaints received.
• The number upheld.
• The subject matter of the complaints.
• How many have been referred to the Ombudsman.
• Any issues of importance and/or action taken as a result.

However, it would be good practice, as a means of continuous improvement, to also log any compliments, comments and concerns as these, along with complaints, are valuable feedback from your patients.