What complaint?

Locums often feel excluded from the complaints process. Sarah Whitehouse and Sara Williams explore whether the new NHS complaints system will encourage practices to better involve locums

When it comes to responding to complaints, one of the biggest hurdles for locums to clear is actually being told about them, as one locum recently pointed out: “Practices simply don’t tell us that we’ve had a complaint”. This can lead to a situation that leaves not only locums, but patients in the dark.

A new system

The Department of Health (DH) has reformed the NHS and social care complaints system so that it is more open and accountable, fair and proportionate and above all patient-focused. A two-tier system was introduced in April 2009, with the Parliamentary and Health service Ombudsman (PHSO) holding responsibility for handling second-stage complaints. If a patient cannot resolve their complaint locally, they can take it forward to the PHSO.

But will this new system encourage practices to involve locums in handling complaints more frequently? The answer to this question is yes; complaints against locums should be investigated by the practice and, if they have left the practice, they should be contacted if possible for their comments.

Handling complaints

There is likely to be a new system in place following the government’s changes, so when you start working at a practice you should familiarise yourself with their complaints procedure during your induction. There should now 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.

The complaints manager

The complaints manager’s role is to ascertain the facts relating to a complaint, assess the evidence and report the findings. Complaints should:

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

The complaints manager will prepare a report on the findings. In the document Listening, responding, improving: a guide to better customer care, the DH states that the manager should have an open dialogue with both parties so that their final report does not surprise anyone involved.

According to the DH: “Before the report is finalised everyone involved should be given the chance to give their views on what has been said.”

So if a complaint concerning your practice is being investigated, the complaints manager should seek your views, if possible, whether you are a locum or a partner. This will probably involve being asked to attend a fact-finding interview or writing a witness statement. If you find yourself in this situation stick to the facts and avoid offering opinion, speculation or defensive justifications.

You may wish to see a copy of the reply the practice intends to send to check it for factual accuracy. Complainants now have 12 months from the occurrence giving rise to the complaint or from the time that they become aware of the matter, to make a complaint.

The complaints manager will retain 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.

The locum’s role

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”. Remember, an apology is not an admission of liability so be prepared to meet with the patient, or complainant, and liaise 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, so good practices will hold a significant event audit (SEA). If you are involved in the complaint, suggest being involved in any subsequent SEA meetings. This will offer a chance to liaise with the practice team and learn from the complaint.

Record keeping

You should always keep good medical records and this is particularly important if a complaint is made as this will help you remember what happened and assist you in providing a clear explanation if asked for your comments. In Good Medical Practice, the GMC says, "Keep clear, accurate and legible records, reporting the relevant clinical findings, the decisions made, the information given to patients and any drugs prescribed or other investigations or treatment." In addition it is helpful to document any follow-up advice.

Practising empathy

A good locum will 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 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 practice that you worked at. 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: 

• Establish 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 independent medical expert. 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, do not hesitate to contact us.

Future complaints

Only time will tell whether locums feel more involved in complaints handling, but the new system is tighter and less bureaucratic, and the additional guidance implies that complaints against locums cannot be handled effectively without gathering their input, where possible. One thing that is clear is that where a locum is involved in a complaint in an environment where regulators are pressing hard for increased communication, transparency and more accountability, the locum’s viewpoint becomes indispensable.

Further reading

It is important that you are familiar with the new complaints procedure; MPS has produced a number of resources, eg, booklets, factsheets, web links, to help you understand the new regulations.