Last reviewed 14 July 2021
Christine Grey explains the importance of practices dealing with complaints and the effects of the pandemic on processes.
During the Covid-19 pandemic, the responsibilities of GP practices receiving complaints did not change; as NHS England recently stressed, “recording, managing and resolving written complaints is an important part of modern service delivery and provides vital feedback for ongoing service improvement.” But investigations beyond local resolution were paused and are now suffering from backlogs of cases, and the collection of data on complaints against a GP practice for 2019 to 2020 was scrapped.
The pandemic has accelerated the necessity to streamline and simplify the system so, when data collection resumes on 9 August 2021, the process will look slightly different. Following the Paterson Inquiry Report, which identified the need for improvements in complaints handling across NHS and private healthcare, broader NHS complaint standards and guidance are on the horizon when public consultations resume.
Delays in complaints processing
Expectations of NHS providers in handling complaints are set out in The Local Authority Social Services and National Health Service Complaints (England) Regulations (2009), here, and the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 (Regulation 16), here.
There is much emphasis on the importance of dealing with complaints swiftly. Currently, a verbal complaint which is satisfactorily dealt with by the end of the next working day is not deemed to be an official “complaint” and, in this instance, the complaints procedure regulations do not apply.
However, any complaint that is made in writing to the practice should be dealt with by following its complaints procedure.
The 2009 Regulations state there should be two stages of dealing with complaints.
Local resolution by the provider or NHS England.
Parliamentary and Health Service Ombudsman (PHSO), here, if a complainant is dissatisfied after stage one.
Doctors and other staff being complained about can also take the case to the PHSO.
The PHSO paused work on NHS complaints from 26 March 2020, including accepting new complaints and progressing existing cases that involved using NHS resources at the time of the pandemic crisis. Days after this decision, NHS England announced that they would also pause investigation of new and existing complaints.
The PHSO which restarted its work on 1 July 2021, is currently getting through a backlog created by the pandemic, and is asking for people to not send a complaint to them if it is about:
delays with complaint responses
matters that are likely to resolve themselves within the next few weeks/months
delays in service delivery which are non-critical and are the result of an organisation coping with Covid-19.
To reduce delays, from 15 April 2021, the PHSO also made changes to the way it handles NHS complaints, which are listed in its Coronavirus Update, here.
NHS England has resumed its investigations but, as some of its offices are working remotely, asks those with existing complaint to use the email address or telephone number in their complaint acknowledgement letter, where possible.
Records and data collection changes
All complaints should be logged, whether they are received verbally or in writing, and it is very important to keep records of official complaints because Care Quality Commission (CQC) inspectors can ask a practice for a summary of complaints, how the practice shares patterns and trends in complaints, and may look at evidence of changes made to improve services.
The CQC said practices also need to make an annual report on complaints available to their commissioning body on request.
In addition, GPs must declare and reflect on any formal complaints about them at their appraisal for revalidation and should reflect on any complaints received outside of formal complaints procedures, as they may provide useful learning.
NHS Digital expects practices to complete a KO41b data return on complaints made against a GP practice, here. This collection monitors written complaints received by NHS primary care providers by service area and type and, as NHS England said, “provides vital feedback for ongoing service improvement”.
The data collection for 2019 to 2020 was scrapped after NHS leaders called for practices to be freed up to focus on their Covid-19 response. This information collection is being resumed on 9 August 2021 to capture data from 2020 to 2021, but with simplifications made in response to feedback via a GP bureaucracy review, and a consultation run by NHS Digital, to help reduce the administrative burden. This was considered considerable due to the “manual nature” of its collection and submission.
Changes to the collection and return process include an extension to the usual collection window from 6 to 12 weeks, and improvements on the portal to address previous technical issues and make the experience of uploading the return easier.
The results of the Consultation on Changes to the Data on Written Complaints in the NHS – Primary Care (GP and Dental) KO41b Collection and actions to be implemented were published on 17 June 2021, here.
Local resolution and practice responsibilities
Practices have a responsibility to have a complaints policy that tells patients how the complaints process works and how constructive feedback can be given. The Care Quality Commission (CQC) expects practices to publicise this well, which may include displaying information on the practice website, a leaflet and poster that is a simple version of the policy, and a full working policy for staff that reflects the Regulations and local organisation.
Each practice must have clear responsibility for complaints arrangements and appoint a complaints manager and a “responsible person”. More details about who the “responsible person” should be and how to respond to complaints are published on the British Medical Association (BMA) website section, Dealing with Complaints Made Against You as a GP Practice, here.
According to the British Medical Association (BMA), there is no requirement to send a complaint to NHS England. However, patients or a person acting on their behalf can complain to NHS England if they don’t want to complain to an NHS provider directly. They can complain to the provider or the commissioner of that service but not both; something that the CQC says is often misrepresented in local policy and practice information leaflets. It says the commissioner cannot investigate if the provider has already responded.
More advice from the CQC, including what inspectors look at when assessing GPs’ complaints management, is available here.
Future improvements and the Complaints Standard Framework
The House of Commons Select Committee on Public Administration and Constitutional Affairs (PACAC) invited the PHSO a few years ago to review front-line complaints systems. The resulting report suggested that some new legislative powers for the Ombuds were needed and long overdue. The Paterson Inquiry Report published on 4 February 2020, here, concurrently identified a need for improvement in complaints procedures across NHS and private healthcare.
PHSO research in Making Complaints Count, here, published a few months after that, together with feedback from an ISCAS focus group, highlighted three main areas for change.
Staff need a single vision for how they are expected to handle and resolve complaints.
They need consistent access to complaints handling training to support them in what should be recognised as a professional skill.
Public bodies should stop seeing complaints negatively.
The PHSO’s My Expectations report, here, also looked at what people expect to “see, feel and hear” when making a complaint, and there was a public consultation on implementing a Complaint Standards Framework that offers clear, consistent guidelines for the NHS.
The Framework will expand on the My Expectations report to include guidance on how organisations address issues including about what happens when people raise concerns without making a complaint and how to support staff who have been complained about.
Due to the pandemic, however, the PHSO said: “While the work to develop a Complaint Standards Framework continues, we have postponed temporarily the public consultation on the initiative.” The latest information on this is here.
Meanwhile, the PHSO’s new NHS Complaint Standards model procedure and guidance were published on 30 March 2021, are being tested in pilot sites this year and will be refined and introduced across the NHS in 2022. They have a focus on early resolution by “empowered and well-trained staff” and an emphasis on senior leaders reviewing what learning can be taken from complaints. More information is available here, together with the Report on Complaint Standards Consultation, here.
Croner, Complaints, here.
The General Medical Council’s (GMC’s), Good Medical Practice, here, describes how a “good” doctor should respond to a complaint.
PHSO, Making Complaints Count, here.
PHSO, Good Complaint Handling, here.
PHSO, CQC, NHS England and Healthwatch, How to Raise Concerns or Complaints About a GP Practice, here.
BMA, Dealing with Complaints Made Against You as a GP Practice, here.
BMA, Responding to Concerns: A Guide for Doctors Who Manage Staff, here.
NHS England guidance, How to Complain to the NHS, here, includes where patients can access support with their complaint.
NHS England Complaints Policy, here.
Medical Defence Union (MDU), How to Respond to a Complaint, here.
If a patient needs support putting a complaint together, they can contact their local advocacy provider, visit www.local.gov.uk. The local Healthwatch can give support and information. To find a local Healthwatch visit: www.healthwatch.co.uk.
PHSO telephone: 0345 015 4033 or visit www.ombudsman.org.uk for more information.