AN OPPORTUNITY
Our 3-year corporate strategy,1 published earlier this year, sets out our ambition to increase our partnership work with health professionals, including GPs, to improve NHS services, especially frontline complaint handling. When things go wrong we support NHS organisations to learn from mistakes. Good complaint handling is not about blame and ‘pointing the finger’, but rather learning how to enable those working in the NHS to provide the very best service possible.
Complaints are a valuable source of feedback that can be used to evaluate the service your practice is providing. Handling them well not only shows patients that you are listening, but also allows you to recognise where standards are not being met.
The importance NHS staff place on good patient experience and continuous improvement is admirable, and they should be commended more often than they are for their dedication to helping patients. Encouraging patients to speak up when things have gone wrong can prevent problems from escalating, save money by avoiding formal complaints, and identify areas in need of improvement.
THE CURRENT PICTURE
We know that complaint handlers across the NHS, despite their limited resources, deal effectively with thousands of complaints every year and GPs provide excellent care to millions of people, day in and day out. Nevertheless, mistakes happen where professional judgement is exercised. As recent judicial reviews2 have demonstrated, this applies just as much to the Ombudsman as to NHS clinicians. More than one in five (22%) of our NHS cases relate to complaints about GP practices. This suggests that there may be significant variation in the way complaints are handled.
Our 2016 report3 found that, although more than half of practices are handling complaints well, others are falling short, leading to missed opportunities to improve patient care. The report highlights that some practices are not doing enough to welcome feedback and sets out areas where GPs can and should improve their complaint handling.
GOOD PRACTICE
Throughout our casework history, we have seen many examples of exemplary complaint handling. One GP practice ensures its complaint service is well promoted and visible throughout the surgery. The practice acknowledges all concerns and complaints within 24 hours to demonstrate that they want to resolve the matter as quickly as possible. The staff have a monthly meeting to review actions from past complaints to prevent any issues reoccurring and they undertake an annual complaints review to identify any long-term themes or trends.
Leadership set a strong example by sharing the complaints they have received and the action taken to rectify the situation with staff. Complaints tutorials are run for new trainees to ensure they view complaints as a way to improve, and staff are fully supported throughout the complaints process as they recognise the potential for complaints to damage confidence or result in over-management of a patient.
HELP AND ADVICE
We have several resources on our website that GPs can use to help improve their practice’s complaint handling. There is also information specifically for NHS complaint handlers in our guide,4 and a page on carrying out good local investigations.
When responding to a complaint consider the following points. First, clearly set out the issues raised by the person complaining, how you have investigated the matter, and what evidence you have considered. Second, explain what happened, with reference to the evidence and after listening carefully to their experience. Third, explain what should have happened, quoting relevant regulations, standards, policies, and published guidance, and if they were met.
Ensure that the response meets the requirements of the Local Authority Social Services and National Health Service Complaint (England) Regulations 2009. Finally, if there is a shortfall between what actually happened and what should have happened, then give an explanation of why this was the case and how it will be put right for both the person that has complained and your future patients. In cases where a complainant raises concerns about the standard of care and treatment given, it is important to seek a clinical opinion from a suitable clinician who has not previously been involved in the care complained about.
A POSITIVE APPROACH
Making a complaint takes courage. Patients often fear that speaking up could affect their care, so be clear that this is not the case and that you welcome complaints as a means to improve your service.
Show patients that complaining makes a difference by promoting changes already made in response to feedback. People are more likely to raise their concerns if they know they will be listened to. Always look beyond the complaint to understand what may have led to it. This will help you to get to the root of the problem and identify wider concerns, issues, or themes.
Finally, the cornerstone of good complaint handling is to accept that there is always room for improvement. We all make mistakes but what is important is that we learn from them, to minimise their future reoccurrence.
- © British Journal of General Practice 2018