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An opportunity to improve General practice complaint handling across England

Updated on 31 March 2016, 638 views

Original Document

This document was published on March 18th and comes with the imprimaturs of CQC, NHSE, Healthwatch England and the Parliamentary & Health Service Ombudsman. The latter looked into 5,086 complaint enquiries about general practice in 2014-15, investigated only 696 and upheld only 223 or 32% of these. In contrast 44% of investigated complaints against acute trusts were upheld. Delving into how complaints are actually handled by practices, using pooled information from CQC and NHSE, found that 55% of practices involved in 137 complaints were doing a good job which was defined as “dealing with complaints swiftly, taking them seriously and being open and honest.” This document is trying to be helpful. It sets out that 90% of all NHS patient contacts are within primary care and that there are “demand pressures” on general practice. But practices are asked how they can “make sure that…pressures do not translate into poorer patient experience?” One answer might be that primary care be properly funded and resourced and that something be done to curb patient demand. However, as the age of miracles is past, the main points of this report are that:

  1. Practices should do more to encourage feedback, concerns and complaints, reassure patients that their care will not be compromised if they complain and to provide more basic information about how to complain and how they can be supported to do so.
  2. Practices need to make sure that staff understand their statutory obligations. Surprisingly many were not familiar with the Department of Health Complaints Regulations 2009. One should not, of course, remove any patient from a list under any circumstances without following due process.
  3. Practices should always be professional to avoid, for example, local resolution meetings proceeding poorly or patients becoming annoyed about not being kept up to date with the progress of their complaint.
  4. Practices should always apologise when appropriate and be open and honest when things go wrong. This is not the same as admitting liability or accepting blame and we should in any case be mindful of the introduction of the statutory Duty of Candour since April 2015.
  5. Learn from complaints and share the learning within practices, including with patients, and with other practices via the CCG and LMC.

In all seriousness we are sure that Somerset practices are conscious of, and act upon, the GMC standard that “patients who complain…have a right to expect a prompt, open, constructive and honest response including an explanation and, if appropriate, an apology” (Good Medical Practice 2015). It is interesting to note that the biggest number of complaints examined concerned staff and GP attitude and behaviour (23%). Clinical matters given as failure to diagnose (or delay to diagnose), refer, treat or misdiagnosis all added up to about half of all complaints. The rest were mostly about repeat prescriptions (22%) and the rarest cause for complaint was about breach of confidentiality. Complaints can indeed be valuable and processes need not be burdensome. That said, there is, of course, no mention in this document of any vexatious complaint or unreasonable behaviour by any complainant. The cynic might even say that, from the evidence presented here, nothing but abject surrender on the part of the practice and practitioners is acceptable to the Ombudsman. She is, however, the people’s representative. Even in the absence of any sense of balance from the GP perspective there is much that is useful and interesting here. One anecdote from the CQC speaks of a practice which declared that no complaints had been received in the past year. In fact, there had been complaints but these had been dealt with exclusively by the practice manager who had not recorded the process or shared it with colleagues. The practice was judged inadequate but whether for this reason alone was not stated. Another had received some 30 complaints all of which had been dealt with in exemplary fashion to the satisfaction of all parties and the practice was judged outstanding. We do perhaps fear complaints too much? But, as the report makes clear, practices do have a more personal relationship with patients compared with, say, an acute trust and this can make it harder to react objectively. New ways of working, super practices, Accountable Joint Ventures and Multispecialty Community Providers could therefore make it easier for both patients to make valid complaints and for more professional and objective responses. Whether this will compensate for the corresponding loss of familiarity remains to be seen.

Dr Barry Moyse

Deputy Medical Director