Complaints Policy

Introduction

This practice encourages feedback because we use it to improve services as part of a learning culture.  We welcome your views; positive comments are good for staff morale and if you have a complaint we may learn from it, and sometimes change the way we do things to ensure our patients get the best possible service.

All our patients (or their representatives) who have cause to complain about their care or treatment can have freely available access to our complaints process, which this document explains, and can expect a truthful, full and complete response and an apology where appropriate. Complainants have the right not to be discriminated against as the result of making a complaint and to have the outcome fully explained to them. The process adopted in the practice is fully compliant with the relevant NHS Regulations (2009) and guidance available from defence organisations, doctors’ representative bodies and the Care Quality Commission. 

The general principle of the practice in respect of all complaints will be to regard it first and foremost as a learning process, however in appropriate cases and after full and proper investigation the issue may form the basis of a separate disciplinary action.  In the case of any complaint with implications for professional negligence or legal action, the appropriate defence organisation must be consulted immediately.

Procedure

Who should a complaint be made to?

Who can make a complaint?

A complaint can be made by or, with consent, on behalf of a patient (i.e. as a representative); a former patient, who is receiving or has received treatment at the Practice; or someone who may be affected by any decision, act or omission of the practice.

A representative may be:

• either parent or, in the absence of both parents, the guardian or other adult who has care of the child; a person duly authorised by a local authority to whose care the child has been committed under the provisions of the Children Act 1989; or a person duly authorised by a voluntary organisation by which the child is being accommodated.
• someone acting on behalf of a patient/ former patient who lacks capacity under the Mental Capacity Act 2005 (i.e. who has Power of Attorney etc.) or physical capacity to make a complaint and they are acting in the interests of their welfare.
• someone acting for the relatives of a deceased patient/former patient.

In all cases where a representative makes a complaint in the absence of patient consent, the practice will consider whether they are acting in the best interests of the patient and, in the case of a child, whether there are reasonable grounds for the child not making the complaint on their own behalf.  In the event that a complaint from a representative is not accepted, the grounds upon which this decision was based must be advised to them in writing.

Health Advicates

Health advocates can work with a patient to help understand their rights or act as their representative. The local Healthwatch - Healthwatch Oxfordshire - can help to find an independent NHS complaints advocacy services in the area.

Independent advocacy services include:

Who is responsible at the practice for dealing with complaints?

Verbal complaints arising in reception may often be dealt with satisfactorily by the Patient Services Manager. The HR Manager will deal with written complaints or any verbal complaints that cannot be resolved by the Patient Services Manager.

All complaints must be managed in accordance with the NHS Regulations, ensuring that lessons learned are fully implemented, and that no Complainant is discriminated against for making a complaint. The HR Manager has been delegated responsibility by the Partners for managing the complaints procedure and ensuring adequate investigations are carried out.  

Time limits for making complaints

A complaint must be made within 12 months of the date of the event that is the subject of the complaint or the date that the matter came to the complainant’s attention. The practice has discretion to extend these limits if there is good reason to do so and it is still possible to carry out a proper investigation.

The collection or recollection of evidence, clinical guidelines or other resources relating to the time when the complaint event arose may also be difficult to establish or obtain. These factors may be considered as suitable reasons for declining a time limit extension, however that decision should be able to stand up to scrutiny.

Action upon receipt of a complaint 

Verbal complaints:

It is always better to try and deal with the complaint at the earliest opportunity and often it can be concluded at that point. A simple explanation and apology by staff at the time may be all that is required.  

The practice will record verbal complaints for the purposes of monitoring trends or for Clinical Governance and that record will be kept and monitored by the Practice Manager. Verbal complaints not formally recorded will be discussed when trends or issues need to be addressed and at least annually, with minutes of those discussions kept.

If a verbal complaint is dealt with immediately or within one working day and has been dealt with to the satisfaction of the complainant, it need not be responded to in writing for the purposes of the Regulations. If the complainant informs the practice that their verbal complaint is not resolved to their satisfaction and requests for it to be investigated further, the Complaints Manager (or their representative) will set down the details of the verbal complaint in writing and provide a copy to the complainant within three working days from this request. This will ensure that each side is well aware of the issues for resolution. The process followed will be the same as for written complaints.

Written complaints:

On receipt of a written complaint, an acknowledgement will be sent within three working days which offers the opportunity for a discussion (usually by telephone) on the matter.  This is the opportunity to gain an indication of the outcome the complainant expects and also for the details of the complaint to be clarified. In the event that this is not practical or appropriate, the initial response should give some indication of the anticipated timescale for investigations to be concluded and an indication of when the outcome can be expected.

It may be that other bodies (e.g. secondary care/community services) will need to be contacted to provide evidence. If that is the case, then a patient consent form will need to be obtained at the start of the process and a pro-forma consent form included with the initial acknowledgement for return.

If it is not possible to conclude any investigations within the advised timescale, then the complainant must be updated with progress and revised time scales on a regular basis. In most cases these should be completed within six months unless all parties agree to an extension.

The Investigation

The practice will ensure that the complaint is investigated in a manner that is appropriate to resolve it speedily and effectively and proportionate to the degree of seriousness that is involved.
The investigations will be recorded using the complaints form. No patient identifiable data should be included but initials and Emis number should be used.

A separate record is created specifically for each incident and where appropriate should include evidence collected as individual explanations or accounts taken in writing by completing the appropriate section on the form.

Final Response

This will be provided to the complainant in writing and will be signed by the Complaints Manager under delegated authority. The letter will be on headed notepaper and include:

• An apology if appropriate (The Compensation Act 2006, Section 2 expressly allows an apology to be made without any admission of negligence or breach of a statutory duty)
• A clear statement of the issues, details of the investigations and the findings, and clear evidence-based reasons for decisions if appropriate
• Where errors have occurred, explain these fully and state what has been or will be done to correct these or prevent repetition. Clinical matters must be explained in accessible language
• A clear statement that the response is the final one and the practice is satisfied it has done all it can to resolve the matter at local level
• A statement of the right, if the complainant is not satisfied with the response, to refer the complaint to the Parliamentary and Health Service Ombudsman

The final letter should not include:

• Any discussion or offer of compensation without the express involvement and agreement of the relevant defence organisation(s)
• Detailed or complex discussions of medical issues with the patient’s representative unless the patient has given informed consent for this to be done where appropriate. 

Confidentiality

All complaints must be treated in the strictest confidence and the practice must ensure that individuals are made aware of any confidential information to be disclosed to a third party (e.g. NHSE).

The practice must keep a record of all complaints and copies of all correspondence relating to complaints. Correspondence about a patient’s complaint will be kept separate from the patient’s medical record (with the exception of information that is directly relevant to the patient’s clinical care).

Unreasonable or Vexatious Complaints

Where a complainant becomes unreasonable or excessively rude or aggressive to staff in their promotion of the complaint, some or all of the following formal provisions will apply (which will be communicated to the patient by the Practice Manager or other Responsible Person in writing):

• The complaint will be managed by one named individual at senior level who will be the only contact for the patient
• Contact will be limited to one method only (e.g. in writing)
• Place a time limit on each contact
• The number of contacts in a time period will be restricted
• A witness will be present for all contacts
• Repeated complaints about the same issue will be refused unless additional material is being brought forward
• Only acknowledge correspondence regarding a closed matter, not respond to it
• Set behaviour standards
• Return irrelevant documentation
• Detailed records will be kept of each encounter

Complaints involving Locums

It is important that all complaints made to the practice regarding or involving a locum (Doctor, Nurse or any other temporary staff) are dealt with by the practice and not passed off to a Locum Agency or the individual locum to investigate and respond. The responsibility for handling and investigating all complaints rests with the Practice.