The information in this section
is an abridged version of an RCGP Information
Sheet
Complaining and
Commenting in General Practice. Please access
that publication if you require further detail.
Contents
Making a Complaint
Required Standards of
Care
Patients are often unaware of what constitutes acceptable practice
and the duty of care that is incumbent upon a doctor. The
General Medical Council (GMC) issues guidance on the duties that a
doctor has to his patients and on good medical practice
generally. This gives a benchmark to doctors and patients
on the standards of behaviour and care that are expected and
acceptable.
Based upon these core standards
the Royal College of General Practitioners (RCGP), in association
with the British Medical Association (BMA), publishes Good
Medical Practice for General Practitioners. This document
outlines the standards that a GP must uphold in order to retain his
or her license to practise. As well as outlining "unacceptable"
standards it highlights those levels of care which would be
identified as "excellent".
Although presently under review
it is likely in the near future that a GP, via the process
known as revalidation, will need to prove to the GMC every
five years that (s)he is up to date and fit to practise and has
been practising medicine in line with Good Medical Practice for
GPs.
The general principles outlined
in
Good Medical Practice are supplemented by more detailed
guidance on specific ethical areas of the doctor-patient
relationship, such as confidentiality and consent. Both
the GMC – which maintains the standards that the public should
expect of doctors – and the BMA, the trade union for doctors,
publish guidance in these areas. The RCGP has launched a free
Ethical
Guidance Database which
brings together the
key guidance in UK medical ethics and makes it accessible to
patients and doctors via a simple interface.
The UK health and social care
regulators jointly publish a leaflet -
Who Regulates Health and Social Care
Professionals? - which outlines for the public
the responsibilities of each professional regulatory body in
ensuring that health and social care professionals are
competent and meet certain standards.
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Advisory and Support Services
Patient Advice and
Liaison Services (PALS) have been set up in Primary Care
Trusts (PCTs) to provide information and confidential advice to
patients. Although not part of the NHS complaints procedure, PALS
are often able to help resolve any minor problems that patients are
having with their NHS care without making a formal complaint. PALs
will feedback patient comment to the PCT in order to inform
service improvement.
Patients who would be more
comfortable talking to someone outside of the NHS should contact
the Independent Complaints Advocacy Service. This
is a free, confidential and independent service which supports
patients in making formal complaints about their NHS
experience, and provides information on the various options
and routes available. The ICAS serves a vital role in
advising patients on how serious their complaint is and therefore
which body to refer it to.
Action against Medical
Accidents (AvMA) is an independent, UK-wide charity that
campaigns for justice for people affected by medical accidents. It
also works for better patient safety and provides free advice on
the medical and legal issues connected with medical accidents. The
AvMA helpline number is 0845 123 2352.
RCGP
Role
The RCGP is neither a statutory
nor a regulatory body, and as such has no powers to reprimand or
discipline individual GPs over performance issues. We may comment
on a general principle or highlight relevant guidance but
cannot issue advice regarding an individual complaint or the
circumstances of such a complaint.
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As well as reading the advice
below patients may also like to have a look at
the
public
information leaflet, published by the Department
of Health, which provides the public with details of the NHS
complaints procedure. The leaflet is currently being translated
into a range of foreign languages.
A complaint can be made by any patient or person affected or likely
to be affected by the actions or decisions of a practitioner.
Complaints should be made within six months of the event(s)
concerned or within six months of becoming aware that there is
something to complain about. Practitioners and complaints managers
have the discretion to waive this time limit if there are good
reasons why a patient could not complain earlier. A complaint can
also be made by someone acting on behalf of the patient or person,
with their consent.
i. Local Resolution
For most
complaints, patients should
initially contact the GP surgery to attempt local
resolution. GPs are required to operate a practice complaints
procedure, and must publicise its procedure - including how and to
whom to complain and what will happen as a result. Generally it
will be the practice manager who is the first point of contact for
complaints.
A practice will log every
complaint and an acknowledgement should be sent within 2 days,
generally to explain that the complaint is being
investigated. Within 10 working days it will write again with a
report or to set up a meeting with the complainant. It may also ask
for more time to investigate the complaint. Any response to a
complaint about clinical care must come from the doctor.
The complaints procedure will
generally involve a face-to-face meeting with the patient, perhaps
with the help of a lay conciliator supplied by the local Primary
Care Trust (PCT). Voluntary conciliation practices, although not
universally applicable, can be particularly useful where there are
multiple issues involved or where the doctor-patient relationship
has already broken down significantly. Conciliators can also ensure
a structured approach to conflict resolution, and unlike
arbitration, suggestions made during conciliation are not binding
on the parties involved.
Patients can ask for a
conciliator to be involved, and might wish to bring
along support, possibly a member of the Patient Advise and
Liaison Service (PALS). Meetings will be businesslike, but should
be relatively informal and non-threatening, with the patient
treated with respect and fairness.
If the patient is not satisfied
with the GP practice response and would like to continue with the
complaint, or if s(he) would prefer not to deal directly with the
practice involved, then the local PCT Complaints
Manager should be contacted in writing (including
e-mail).
GP practices will supply
information about the PCT complaints procedure. A response should
be received within 10 working days of notifying the PCT or within
20 working days from the Chief Executive of the PCT.
ii. Independent Review
If a patient is unhappy with the
way their complaint has been dealt with by the practice or PCT the
patient, carer or relative can refer it to the Healthcare
Commission for independent review. Complaints will be reviewed
by the following process:
Initial Review: A case
manager will undertake an initial review of the case, with the help
of expert advice if necessary, to determine whether there needs to
be further investigation. A letter, outlining the outcome of the
initial review will be sent to the complainant and the
organisation or practitioner about whom they are complaining.
Investigation: If
further investigation of the complaint is necessary, the Healthcare
Commission will agree the terms of reference with the complainant
and the organisation or individual about whom the complaint has
been made. Both will receive a full report of the Healthcare
Commission’s findings at the end of the investigation, including
recommendations.
Panel Review: Those who
are unhappy with the outcome of the investigation have the right to
request an independent panel, consisting of three members of the
public, who are not connected to the NHS but who have been
specially trained to deal with NHS complaints.
Healthcare Commission
FREEPOST NAT 18958
Complaints Investigation Team
Manchester
M1 9XZ
Complaints Helpline: 0845 601 3012
iii. Health Service Ombudsman
If a patient
is unhappy with the decision of the Independent
Review s(he) can also refer the matter to the Health Service
Ombudsman. The Ombudsman is completely independent of the NHS and
Government.
Health Service Ombudsman
Millbank Tower
Millbank
London
SW1P 4QP
Tel: 0845 015 4033
iv. Role of the General Medical Council
The General Medical Council (GMC)
regulates doctors in the United Kingdom, and has the power to stop
or limit a doctor’s right to practise medicine, or issue a warning
where the doctor’s fitness to practise is not impaired but there
has been a significant departure from good practice.
Although patients are entitled to
take a complaint directly to the GMC it is often better in the
first instance for patients to raise their concerns through local
complaints procedures with the NHS Hospital Trust, Primary Care
Trust or private healthcare body.
If the GMC feels that a complaint
received directly from a patient is not serious enough to
question a doctor's ability to practise safely but is of concern,
it will refer that complaint to the local PCT. Those who wish to
complain to the GMC directly can do so via:
GMC Fitness to Practise Directorate
St James’s Buildings
79 Oxford Street
Manchester
M1 6FQ
Referring
a Doctor to the GMC: a guide for patients
(includes complaint form)
v. Complaining in the Rest of the UK
*
NHSScotland has also
published guidance -
Can I Help You? Learning from Comments, Concerns and
Complaints - setting out how the NHS in
Scotland should deal with the comments, concerns and complaints of
the people who use its services.
vi. Complaining about Private
Healthcare
The
Healthcare Commission is responsible for the
regulation and inspection of private healthcare providers in
England. Patients should contact the Commission on 020 7448
9200 if they have concerns about a private healthcare
provider.
The BMA has produced a
code of conduct, setting out recommended
standards of practice for NHS consultants in England regarding
their private work.
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Patient Safety
National Patient Safety Agency (NPSA)
The National Patient Safety Agency (NPSA) co-ordinates the
reporting of mistakes and problems effecting patient safety and
helps the NHS learn from these incidents. The NPSA promote the
Being Open policy, which is part of a
national drive to encourage healthcare staff and organisations to
be more honest and open with patients if things go
wrong.
Although the NPSA cannot investigate individual complaints,
patients can report any unexpected suffering or harm they have
experienced resulting from contact with NHS services via its
Please
Ask website.
Medicines and Healthcare products Regulatory
Agency (MHRA)
If patients experience unwanted side effects from
medicines or herbal remedies they can report it to the Medicines
and Healthcare products Regulatory Agency (MHRA) via a
Yellow Card. The MHRA is a government agency and the
official medicines safety watchdog. Yellow Card reporting forms can
be picked up from GP surgeries or downloaded from the
MHRA website.
Patients who have experienced a safety problem with a
particular medicine OR medical device may also wish to contact
the
MHRA Information Centre directly on
020 7084 2000 (weekdays, 9 a.m. to 5 p.m.) or 020 7210 3000 (at
other times).
National Clinical Assessment Service
(NCAS)
The
NCAS
gives confidential advice to the NHS on how to manage doctors
whose performance gives cause for concern. If a difficulty becomes
apparent, the employer, contracting body or the practitioner can
contact NCAS for help. The aim of NCAS is to work with all parties
to clarify the concerns and make recommendations to help the
practitioner deliver a high-quality and safe service for
patients.
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Commenting and Getting Involved
Patient Experience Questionnaires
The vast majority of practices
consider the views of patients by asking them to complete
patient experience questionnaires. This creates an opportunity for
practices to assess patients’ views, and be alerted to strengths
and weaknesses in their set-up. The practice is financially
rewarded for (a) conducting questionnaires, (b) analysing results,
and (c) using these to influence positive changes in
procedure.
Questionnaires are either
administered by post, or after consultations in the surgery. They
allow patients to comment on numerous aspects of their care
including:
- Physical environment.
- Convenience and accessibility of
services.
- Practice/patient
relationship.
- Helpfulness of support staff.
- Appropriateness and timeliness of
the whole episode of care.
Please ask the local surgery
about their questionnaire arrangements. Details of the two
accredited questionnaires can be found below:
Starting in 2006 a new national patient experience
survey will be conducted in general practices in England. The
survey results will provide a measure of practices’
achievements in delivering improved access to services and offering
a choice of secondary care provider when referring patients to
hospital.
Patient Participation Groups
Practices have a duty to involve
patients when changes in the practice are made, and
Patient Participation Groups (PPGs) are often the means by which
patients are engaged. As well as taking part in discussions about
practice procedures, PPGs often start
patient initiatives independently - such as transport
schemes for elderly or disabled patients or self help groups,
for example weight watcher sessions.
The initiative to start a PPG
often comes from patients themselves. It may be a permanent group
meeting at regular intervals or a focus group brought
together to examine a single issue. It generally works in
partnership with the practice, but is run by
patients with decisions about aims/activities made
independently. Most PPGs register as charities.
The
National Association for Patient
Participation (NAPP) campaigns to establish
PPGs in every practice, and maintains a volunteer network of
officers who train practices in setting up Groups in their
locality. NAPP publishes an information pack called
Setting Up a
Patient Participation Group in a GP
Surgery.
National Association for Patient Participation
FREEPOST (SEA 14774)
Aston
Sheffield
S26 2ZZ
Tel: 0114-287-4035
Patient Experience Websites
Another less formal way of expressing dissatisfaction with NHS
services is via a new website called
Patient
Opinion. Patient Opinion is an enterprise founded
by Paul Hodgkin, a GP in Sheffield, who wanted to make the wisdom
and insights of patients available to the NHS and other patients.
The website allows patients to rank health services and share the
story of their care. Patient Opinion sells this data to Trusts and
PCTs and is structured as a not-for-profit social enterprise.