Dealing with problems in professional practice

The RCGP estimates that GP practices each receive around four complaints per year about their services. You will encounter problems in professional practice, no matter how good a doctor you are, and it is important that you know how to respond to them professionally, and in accordance with the new NHS Complaints system coming into force in April 2009.

You may find it very stressful to receive a complaint, but there are so many possible reasons for a patient complaining that you should try not to let it upset you. Dealing with the complaint objectively, rather than emotionally, will also help to achieve a satisfactory outcome. Make sure that you understand and follow the practice’s complaints procedure, which should be covered during your induction.

There should be one person within the practice who administers the procedure for more serious complaints, but minor complaints should be resolved “on the spot” if possible. This might mean offering an immediate apology or explanation in response to a patient’s expression of dissatisfaction and trying to solve the problem with them. Taking an empathic rather than a defensive approach is very helpful here for defusing anger or annoyance. It is important to remember to log the complaint in the complaints register, even if it has been resolved.

More serious complaints should be referred to the designated complaints manager and:

• should normally be acknowledged within three days
• should be handled flexibly and responsively, in consultation with the complainant if possible
• investigated and resolved as speedily as possible, giving the complainant a full, clear explanation and, if mistakes have been made, an apology
• should feed into clinical governance and service improvements.

When a complaint that concerns you is being investigated, you will probably be asked to attend a fact-finding interview or to write a witness statement. If so, remember that the purpose is not to apportion blame, but to find out what happened and, if mistakes were made, to learn from them.

Stick to the facts and avoid offering opinion, speculation or defensive justifications.

NHS complaints

All complaints must have an organisational sign-off, where a sign-off letter is sent to the complainant, informing them that the practice is satisfied with the way it has been handled, and of the complainant’s right to seek an independent review.

If a patient is still dissatisfied after the local investigation, the complaint can be passed on to the Health Service Ombudsman. The Healthcare Commission will no longer handle patient complaints.

In Good Medical Practice, the GMC says patients “have a right to expect a prompt, open, constructive and honest response, including an explanation and, if appropriate, an apology”. Contrary to popular belief, an apology is not an admission of liability. You should be prepared to meet with the patient, or complainant, probably with the complaints manager. See it as an opportunity to listen to the patient, understand the reasons for the complaint and how the relationship can be taken forward and any similar problems avoided in the future.

Most complaints are an opportunity for learning – a Significant Event Audit is a good place to start. A separate file must be kept for complaints records; these should not be included in the patient’s medical records.

Practising empathy

A good general practitioner should practise with empathy. Put yourself in the complainant’s shoes, and tailor your responses to their needs. Understand the emotional impact that the events leading up to the complaint may have caused, and be aware that emotions may be highly charged. Keep calm, maintain good eye contact, and keep body language neutral during any subsequent complaint meetings. The tone of any responses should be conciliatory and empathic.

Claims

While complaints may occur immediately after an adverse incident, claims often take longer to arise. For this reason it is more likely that, if you are involved in a claim, it will be connected with an incident at a previous post in hospital practice. There are particular reasons to be cautious if this happens.

The first you may know about such a claim might be through contact from a solicitor, and it may not be obvious whether they are acting for the NHS Trust or the patient. It is important to establish this. They may well ask you a series of questions or invite you to make a statement. There are a few points to note:

• Get the facts – do not be tempted to rely on your memory. Ask to see the medical records, so that you can remind yourself what happened, and write any statement based on these. If you are not able to see them, contact MPS for advice.
• Stick to the facts – you may be invited to give an opinion on particular issues, but this is the role of an expert witness. Simply record your involvement in the case, don’t speculate about future management or what happened next.
• Contact MPS – if you feel vulnerable about your involvement, or would like help with writing a report or statement, contact us.