ࡱ> KMJy 4bjbjEE .>'',8WWWWWkkk8 k"$$$$$$$="HWHWW]...WW"."..:,P@k s0 "d""W .HH." : LMC Recommendations on Complaints Handling in General Practice Introduction Complaints about general practitioner services arise remarkably infrequently. However, because of the nature of the job and the emotional commitment that clinicians make to their patients the first reaction on receiving a complaint is often one of shock and sometimes anger. The first question may be 'why are they blaming me?' However, patients generally only raise complaints either because they genuinely feel there is a problem with the service or because they to are emotionally involved and both of these are understandable reasons for raising a concern. Helping practices deal with complaints remains a significant part of the work of the LMC office and although the number is small each can be very time consuming. In 2002 Somerset Community Health Council produced a report on 'continuous improvement program for patient care in GP practices' which identified wide differences in the responsiveness of practice systems to patient complaints. They recommended that best practice could be more widely disseminated to the advantage of both practices and complainants. In response to this the LMC convened a working group to review the complaint process and suggest some areas in which it could be improved. Membership of the Group- Kate Atkins(Practice Manager, Somerset Coast), Jo Bell (ICAS pilot lead for CHC), Cilla Grain (Conciliator), Philipa Hawkes (Taunton Deane PCT non executive and Complaints Convenor), Jane Hole (PALS lead for Somerset), Richard Hughes (GP, Mendip), Carol Lomas (Chief Officer CHC), Izzy Tucker (Clinical Governance Manager, South Somerset) and Harry Yoxall (LMC Medical Secretary) 1 How Should Practices Encourage/Receive Information from Patients It was agreed that many patients have concerns that they would not wish to raise as formal complaints. We recognise three ways in which patients may wish to raise issues with practices. 1.1 Suggestions - These fall into the 'wouldn't it be a good idea if' and 'have you thought of' category. Practices that encourage suggestions say that they can be very helpful. We recommend that practices consider having a poster inviting suggestions with a pad of suggestion slips and a suggestions box in the waiting area. 1.2 Concerns - These can be characterised as 'I'm not very happy that' or 'I don't want to complain but' type remarks. Sometimes these are best dealt with through a formal complaints procedure but patients often wish to raise things they are uneasy about without going down a formal process. We recommend that Practices should always have someone available with whom a patient can discuss a concern at the time. This person should make a written note of the concern and the practice should ensure that the patient is contacted by telephone or writing within an agreed time frame. Complaints - Patients need to know how they can make a complaint. A complaints procedure for the practice should be mentioned in the practice leaflet and also advertised in the waiting area. Patients wishing to complain should be encouraged to do so in writing but if they choose not to do so the details of the complaint should be written down and a copy of that note be given back to the patient so that he or she can be confident that the right issue is being addressed. Prompt and courteous attention to complaints often leads to early resolution. Complainants expect their complaint to be taken seriously, the matter to be handled promptly courteously, and appropriate change to be introduced if necessary. Few have a wish to pursue matters all the way to a formal IRP. 2 How Should Practices Respond to Complaints Generally there should be a named individual responsible for dealing with complaints, usually the practice manager. An initial acknowledgement of a complaint should be sent as soon as possible and ideally this should give a time scale for dealing with the issues raised. If answers can not be given during the given timescale then a further holding letter should be sent explaining that the matter is still under investigation and giving the revised timescale. The initial response to a clinical complaint should say that it will be addressed by the Senior Partner, the Clinical Governance Lead or in large practices the Clinical Governance Group but wherever possible the same time constraints should apply. There maybe value in approaching a clinician from outside the practice to look at events at an early stage particularly if this person has some standing and is not connected with the practice directly. 'Very few complainants wish to change practices. Many raising legitimate complaints find it quite hard to do so. A prompt sympathetic and honest response will often repair damaged relationships so that they are stronger than before and patients who've had a complaint properly dealt with are often extremely loyal.' 3 Procedure for Next Steps Depending on the complainant's response to the practice's reply there are a number of possible alternatives. If the complainant does not wish to take further action then it is sensible to write them a note of thanks for raising the matter and to notify them of the action the practice is going to take as a consequence. If the complainant remains dissatisfied then it maybe wise to involve another agency. If the remaining matters are not really a complaint but more of a dissatisfaction with the configuration of NHS services or access to care then suggesting the PALS service maybe helpful. If a formal complaint is being pursued against the practice or another NHS organisation then we strongly recommend that the patient be put in touch with the pilot ICAS (presently run by the CHC but ultimately to become the responsibility of CHIPPI). The pilot service is derived from the CHC complaints team who have very considerable experience in helping complainants. They will ensure that the complainant understands the process, is directing their attention to the correct organisation, and does not pursue an NHS complaint where this is the wrong course of action. Where an NHS complaint involves more than one NHS provider it maybe helpful to involve the PCT complaints team. We felt that the PCT complaints team could have a important roll in co-ordinating complaints responses. At present each individual NHS body replies to complaints so that where an episode of care has covered a number of different organisations then each will respond separately. If the PCT team where to accept responsibility for collating all these and ensuring that there are no gaps in the narrative then in our view complainants would be better served and its more likely that any service failings would be addressed and acted upon. 4 Practice Formal Procedures By the time a complaint has reached the need for a formal meeting its easy for attitudes to have polarised. Its good practice to ensure that any meeting is in a reasonably comfortable and fairly neutral location (not, for example, the GPs consulting room), that tea or coffee is offered, and that the complainant is encouraged to bring a friend with them. Ideally this is somebody from ICAS. Its also vital that there is a note taker who sends notes in draft to all the parties concerned allowing them an adequate time to respond. The complainant should be encouraged to write down their questions before the meeting and there needs to be somebody to take the Chair. Sometimes this could be the senior partner or a doctor not involved with the complaint, sometimes it might be the ICAS representative or sometimes it might be sensible to involve a neutral third party. It should never be assumed that it is too early to ask for help from a conciliator. Even before a formal meeting a conciliator may help the complainant and the practice resolve the issue and he or she will often be able to make sure that the complainant has identified the specific matters they wish to raise so that any formal meeting is more likely to be fruitful. 5 Progressing Complaints After any formal meeting and once the notes have been agreed the practice should write to the complainant itemising any action to be taken and the timescale. If it is felt that there is no point in any further meeting then the complainant should be advised about how they can request an independent review. He or she needs to understand that there is a time limit to their making such a request. Its also important that complainants understand when the practice decides that there is no further progress that can be made internally. If not already involved its worth referring the complainant to ICAS at this stage. 6 Inappropriate Complaints Rarely complaints arise out of services provided by practices that are not part of their NHS contract patients need to understand that the formal NHS procedures would not apply in these circumstances. Apparently vexatious complaints can sometimes be avoided if practices are responsive to the concerns raised by patients with mental health problems and personality disorders. Sometimes it maybe appropriate to recognise these disabilities by treating such individuals as a special case when it comes to accessing services. Its important to recognise that patients who become verbally aggressive or sometimes even violent maybe expressing themselves in the only way they know how. Often there is a genuine complaint that triggers this reaction. Where a complaint is truly vexatious then it is appropriate that the PCT be informed. If after the complaint has been heard the practice feels that the doctor patient relationship has irretrievably broken down and the patient is to be asked to leave the list - note that raising a complaint is of itself not a reason for removing a patient - then the practice should speak to Patient and Practitioner Services so that the receiving practice when the patient is reallocated is aware that there have been difficulties in the past. Note that if legal action is intrain then the NHS complaints procedure terminates forthwith but that a request to medical records from a solicitor does not of itself constitute a legal process. 7 Complaints Reporting to PCTs Some problems have arisen in Somerset over different approaches to complaints reporting by practices. The LMC view is that it would be better if complaints were reported with more detail rather than simply breaking down complaints by the area of concern. Its particularly important to distinguish between complaints raised that related directly to practice services and those that relate to other NHS care, and we would also suggest that complaints should be allocated significance on a scale of say 1 to10. Although this is entirely subjective and may not reflect the patients individual concern it does allow practices and PCTs to get some feeling for the balance between complaint volume and complaint significance. We recommend that complaints reaching a high significance score should automatically be reported to the PCT as significant events. Finally, recognising that complaints are infrequent we would encourage practices to share the positive letters and comments received from patients to more truly reflect the public's view of the excellent service that general practice provides for the population of Somerset. Dr Harry Yoxall Medical Secretary March 2003     D R A F T D R A F T D R A F T  PAGE 6 @MW]>k:;=Y] v"x""%p'r'')* ,,2.5.//2J34444444444444444Ⱦh#0JmHnHu hp50Jjhp50JUhp5jhp5U hp5>*CJ hp56CJhp556CJ hp5CJ hp55CJ hp55CJ1?@M  2=$ & F hdh^`a$$ hdh^a$$ h"dh^`"a$$ hhdh^ha$ $ hdha$ $dha$$a$=>k3<=Yw"x""&q'r''))**////K3 $ hdha$$ hhdh^ha$$ hhdh^ha$$ hdha$K3^4_4o4444444444444444444$a$$ hhdh^ha$$ hhdh^ha$,&P . A!"#n$S% ^ 666666666vvvvvvvvv666666>6666666666666666666666666666666666666666666666666hH6666666666666666666666666666666666666666666666666666666666666666662 0@P`p2( 0@P`p 0@P`p 0@P`p 0@P`p 0@P`p 0@P`p8XV~_HmH nH sH tH 8`8 Normal_HmH sH tH DA`D Default Paragraph FontViV 0 Table Normal :V 44 la (k ( 0No List 4@4 Header  9r 4 @4 Footer  9r .)@.  Page NumberPK![Content_Types].xmlj0Eжr(΢Iw},-j4 wP-t#bΙ{UTU^hd}㨫)*1P' ^W0)T9<l#$yi};~@(Hu* Dנz/0ǰ $ X3aZ,D0j~3߶b~i>3\`?/[G\!-Rk.sԻ..a濭?PK!֧6 _rels/.relsj0 }Q%v/C/}(h"O = C?hv=Ʌ%[xp{۵_Pѣ<1H0ORBdJE4b$q_6LR7`0̞O,En7Lib/SeеPK!kytheme/theme/themeManager.xml M @}w7c(EbˮCAǠҟ7՛K Y, e.|,H,lxɴIsQ}#Ր ֵ+!,^$j=GW)E+& 8PK!Ptheme/theme/theme1.xmlYOo6w toc'vuر-MniP@I}úama[إ4:lЯGRX^6؊>$ !)O^rC$y@/yH*񄴽)޵߻UDb`}"qۋJחX^)I`nEp)liV[]1M<OP6r=zgbIguSebORD۫qu gZo~ٺlAplxpT0+[}`jzAV2Fi@qv֬5\|ʜ̭NleXdsjcs7f W+Ն7`g ȘJj|h(KD- dXiJ؇(x$( :;˹! I_TS 1?E??ZBΪmU/?~xY'y5g&΋/ɋ>GMGeD3Vq%'#q$8K)fw9:ĵ x}rxwr:\TZaG*y8IjbRc|XŻǿI u3KGnD1NIBs RuK>V.EL+M2#'fi ~V vl{u8zH *:(W☕ ~JTe\O*tHGHY}KNP*ݾ˦TѼ9/#A7qZ$*c?qUnwN%Oi4 =3ڗP 1Pm \\9Mؓ2aD];Yt\[x]}Wr|]g- eW )6-rCSj id DЇAΜIqbJ#x꺃 6k#ASh&ʌt(Q%p%m&]caSl=X\P1Mh9MVdDAaVB[݈fJíP|8 քAV^f Hn- "d>znNJ ة>b&2vKyϼD:,AGm\nziÙ.uχYC6OMf3or$5NHT[XF64T,ќM0E)`#5XY`פ;%1U٥m;R>QD DcpU'&LE/pm%]8firS4d 7y\`JnίI R3U~7+׸#m qBiDi*L69mY&iHE=(K&N!V.KeLDĕ{D vEꦚdeNƟe(MN9ߜR6&3(a/DUz<{ˊYȳV)9Z[4^n5!J?Q3eBoCM m<.vpIYfZY_p[=al-Y}Nc͙ŋ4vfavl'SA8|*u{-ߟ0%M07%<ҍPK! ѐ'theme/theme/_rels/themeManager.xml.relsM 0wooӺ&݈Э5 6?$Q ,.aic21h:qm@RN;d`o7gK(M&$R(.1r'JЊT8V"AȻHu}|$b{P8g/]QAsم(#L[PK-![Content_Types].xmlPK-!֧6 +_rels/.relsPK-!kytheme/theme/themeManager.xmlPK-!Ptheme/theme/theme1.xmlPK-! ѐ' theme/theme/_rels/themeManager.xml.relsPK] ,> ++777:4=K34+24:!8@0(  B S  ?,2_csvy~%*:=@D8;/8^aQUlo ' !!n"q"""0'7'A'D'''))i*m*h,n,,,,,,,,,,,,,,,,,,#&2C [ #!!"$%$((1*9*,,,,,,,,,,,,,,3333333333333,,,,,,,,,,,,,,,,-LBV~J@0^`0o(0^`0o(.0^`0o(..0^`0o(... 88^8`o( .... 88^8`o( ..... `^``o( ...... `^``o(....... ^`o(........hh^h`o(^`o(.0^`0o(..0^`0o(...   ^ `o( .... @ @ ^@ `o( ..... `^``o( ...... x`x^x``o(....... HH^H`o(........-LVp5#,,@eeЛee,@UnknownG* Times New Roman5Symbol3. * ArialA BCambria Math"h&&s&%P%P!0x,x,2HX $P#2!xx6LMC Reccomendations for Comlaint Handling by PracticesLMC Dr Anne Hicks  Oh+'0$ <H h t  8LMC Reccomendations for Comlaint Handling by PracticesLMC Normal.dotmDr Anne Hicks2Microsoft Office Word@F#@ {@W꽍@W꽍%՜.+,08 hp  Somerset Health AuthorityPx, 7LMC Reccomendations for Comlaint Handling by Practices Title !"#$%&')*+,-./0123456789;<=>?@ACDEFGHILRoot Entry F0LNData  1Table(#WordDocument.>SummaryInformation(:DocumentSummaryInformation8BCompObjy  F'Microsoft Office Word 97-2003 Document MSWordDocWord.Document.89q