The Complaints Procedure


The MRCGP course organisers have written some quick reference tools to help you pass your MRCGP CSA exam and aid you in your consultation skills. We recommend using and adapting them into your daily consultations to improve your communication skills. All the articles and headings below are covered on the MRCGP course in detail and role-played in the group



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  • Principles of patient’s complaints
    • If the patient is unsatisfied with your attempts to explain to them why something went wrong you can encourage them to make a formal written or verbal complaint
      • I am sorry that you are still unhappy. Did you want to make a formal complaint?
    • Understanding why patients make a complaint will often make it easier to address them amicably and without escalation.
    • Patients usually complain to air their grievance.
    • They wish to receive an honest apology if a mistake has been made and want to make sure procedures are in place to prevent such errors occurring in the future to themselves or others. 
    • Offer patients a choice of options of where to complain i.e. locally at practice level or if necessary, to escalate to a higher level – local Healthwatch or NHS England. Where possible, offer to firstly deal with complaints locally. 
    • Patients are less likely to complain against doctors who have developed rapport with them over a period of time and are more likely to complain against those they are not familiar with. They are also more likely to escalate complaints if there is a delay in contacting the patient or apologising.
  • NHS complaints procedure
    • Use vocabulary that is sharing such as ‘we’: ‘How about if we organise an x-ray … or we can…’ 
    • An official complaint should be forwarded to the complaint manager, often the practice manager.
    • Complaints should be date
    • Verbal complaints should be recorded in writing. 
    • An official complaint should be acknowledged in writing within 48 hours of receipt.
    • The practice should agree an acceptable duration to investigate, usually 10 days. If a longer period is required, up to 6 months, then an explanation should be offered.
    • You may offer a recommendation to have a conference to discuss the matter further, a written apology or steps taken to prevent future recurrences.
    • If local complaints resolution fails the patient may be directed to the local CCG complaints officer or to NHS England or to CQC directly.
    • Alternatively the patient may refer their complaint to an independent review panel (ICAS) or the patient’s ombudsman can be alerted who is answerable to parliament.
    • Patients may be guided to PALS (Patient Advice & Liaison Service), ICAS (NHS Complaints Independent Complaints Advocacy Service) at any step.
    • If concerns about medical professionalism are raised. The case can be fast tracked to the GMC.
  • Avoid 
    • Defensive - Avoid acting defensively attempting to deny responsibility. 
    • Blaming - Avoid shifting responsibility to colleagues or towards your patients 
      • My colleague should have not done that. 
      • Well... if you had taken the medicines as advised this may not have happened.
    • Evasive - Do not be evasive to their questions or appear to be covering up mistakes. A lack of explanation may appear evasive.
    • Reflect body language – Avoid emulating or reflecting upon the patient’s body language or emotional state
      • You look very angry at the moment!
  • Offer an apology to the patient 
    • Apologise even if you feel the complaint was not warranted and this should be offered as early as possible where appropriate. 
    • This will demonstrate empathy and often diffuses hostile patients…
      • I am sorry for the experience you have had…
      • I offer my sincerest apologies…
      • I am sorry that happened to you… Tell me more about that
  • Acknowledge & empathise with the complaint 
    • Acknowledge the complaint & empathise with the distress it has caused. 
    • Show appreciation to the patient for raising the complaint if it is of a serious nature
      • I can see that must have been very distressing for you…
      • I can imagine that it must have been quite difficult for you…
      • It must have been very hard for you…
      • I can understand why you are angry about it…
      • I am grateful that you have brought this to my attention.

  • Clarify the patient’s expectations
    • Clarifying with the patient what they were hoping for from the complaint
      • How were you hoping we could address this problem?
      • Was there anything in particular you were hoping to happen?

  • Offer an explanation if appropriate
    • Provide an honest explanation summarising the series of events. 
    • If a mistake had happened then inform the patient as to how and why it occurred. 
    • If there are some mitigating circumstances surrounding the mishap then these can be stated without justifying the mistake. 
  • Preventing the complaint from happening again
    • State what immediate measures you have taken to rectify things and minimise the distress caused to the patient. This may include preventing the mistake from happening again i.e. significant event analysis, practice audit, practice protocol, education event/retraining for the clinician, etc.
      • Do you want me to speak to the person (doctor) directly?
      • I can raise this at our practice meeting as a significant event.
      • How about if we have a conference with everyone involved including the practice manager to discuss this matter further?
      • I will set up a practice protocol or audit to prevent this from happening again.
      • We will update the computer so this error cannot occur again.
  • Offer to escalate to complaints procedure
    • If the patient is still angry explain the practice’s complaints procedure to the patient.





ESTABLISH THE COMPLAINT & APOLOGISING
I am really sorry for what has happen. Please tell me more about it so that I can help you…
I am sorry for the experience you have had or I apologise this has happened to you…

EMPATHISING AND ESTABLISHING EXPECTATIONS
I can imagine that it must have been quite difficult for you…
How were you hoping we could address this problem?

MANAGING THE COMPLAINT 
I can imagine that it must have been quite difficult for you…
You mentioned… it is possible that it happened because…
We can try to prevent this from happening again by…
If you still feel upset by it I am happy to run through the complaints procedure with you



By Nazmul Akunjee & Muhammed Akunjee

03.07.2014