Complaints Policy

Introduction

The purpose of the policy is to ensure that all patients (or their representatives) who have the cause to complain about their care or treatment can have freely available access to the process 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. Everyone in the practice is expected to be aware of the process and to remember that everything they do and say may present a poor impression of the practice and may prompt a complaint or even legal action.

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 informed immediately.

Strawberry Hill Medical Centre Policy

The practice will ensure that there are notices advising on the complaints process conspicuously displayed in all reception/waiting areas and that leaflets containing sufficient details for anyone to make a complaint are available without the need to ask. The practice website and any other public material (Practice Leaflet etc.) will similarly provide this information and also signpost the complainant to the help available through the NHS Complaints Advisory Service.

The Practice will take reasonable steps to ensure that patients are aware of:

• The complaints procedure.
• The time limit for resolution.
• How it will be dealt with.
• Who will deal with it.
• Lead GP handling complaints.
• The right of appeal.
• Further action they can take if not satisfied.
• The fact that any issues will not affect any ongoing treatment from the practice and they will continue to be treated.

Who can a formal complaint be made to?

In the event of anyone not wishing to complain directly to the practice, they should be directed to make their complaint to NHS England

In those cases where the complaint is made to NHS England, the practice will comply with all appropriate requests for information and co-operate fully in assisting them to investigate and respond to the complaint.

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 also be:

• By either parent or, in the absence of both parents, the guardian or other adult who has care of the child; by 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 by 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 a complaint from a representative is not accepted, the grounds upon which this decision was based must be advised to them in writing.

Who is responsible at the practice for dealing with Complaints?

• The Lead GP Partners for complaints handling are Dr Imogen Caffery and Dr Alice Waldock.
• The Non-Clinical Complaints Manager for the Practice is Sabrina Mann, Practice Manager.

The practice "Responsible Person" GP Leads as detailed above. They are charged with ensuring complaints are handled in accordance with the regulations, that lessons learned are fully implemented, and no Complainant is discriminated against for making a complaint.

The practice "Complaints Manager" is the Practice Manager, and they have been delegated responsibility for managing complaints and ensuring adequate investigations are carried out.

The Procedure

Receiving of complaints

The Practice may receive a complaint made by, or (with his/her consent) on behalf of a patient, or former patient, who is receiving or has received treatment at the Practice, or:

(a) where the patient is a child:

• By either parent, or in the absence of both parents, the guardian or other adult who has care of the child;
• By a person duly authorised by a local authority to whose care the child has been committed under the provisions of the Children Act 1989;
• By a person duly authorised by a voluntary organisation by which the child is being accommodated

(b) where the patient is incapable of making a complaint, by a relative or other adult who has an interest in his/her welfare.

Period within which complaints can be made

The period for making a complaint is normally:

• 12 months from the date on which the event which is the subject of the complaint occurred; or
• 12 months from the date on which the event which is the subject of the complaint comes to the complainant's notice.

Complaints should normally be resolved within 6 months. The practice standard will be 25 working days for a response. The Complaints Manager or Lead GP has the discretion to extend the time limits if the complainant has good reason for not making the complaint sooner, or where it is still possible to properly investigate the complaint despite the extended delay.

When considering an extension to the time limit it is important that the Complaints Manager or the GP takes into consideration that the passage of time may prevent an accurate recollection of events by the clinician concerned or by the person bringing the complaint.

The collection 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 reason for declining a time limit extension.

Action upon receipt of a complaint

Complaints may be received either verbally or in writing and must be forwarded to the Complaints Manager (or one of the lead GP if the Complaints Manager is unavailable), who must:

• The practice will always try and deal with the complaint at the earliest opportunity and often it can be concluded at that point either by phone or in person.
• If it is not possible or the outcome is not satisfactory the patient is asked to put the complaint in writing where appropriate. This ensures that each side are aware of the issues for resolution.
• If the patient refuses to put it in writing, then it is advisable for the practice to put it in writing and check that the patient is happy with the detail of the complaint.
• On receipt of a written complaint, acknowledge in writing within the period of 5 working days beginning with the day on which the complaint was made or, wherethat is not possible, as soon as reasonably practicable. If necessary, include an offer to discuss the matter by phone. The discussion will include agreement with the patient as to how they wish the complaint to be handled.
• Advise the patient of potential timescales and the next steps ie further response will be sent within 25 working days following an investigation.
• If it is not possible to conclude any investigation with in the 25 working days then the patient should be updated with the progress and possible time scales.
• Ensure the complaint is properly investigated. Where the complaint involves more than one organisation the Complaints Manager will liaise with his / her counterpart to agree responsibilities and ensure that one coordinated response is sent;
• Where the complaint has been sent to the incorrect organisation, advise the patient within 3 working days and ask them if they want it to be forwarded on. If it is sent on, advise the patient of the full contact details;
• Provide a written response to the patient as soon as reasonably practicable ensuring that the patient is kept up to date with progress as appropriate. Where a response is not possible within 25 working days provide an update report to the patient with an estimate of the timescale.

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 in a complaints file created specifically for each incident and where appropriate should include evidence collected as individual explanations or accounts taken in writing.

Final Response

This will be provided to the complainant in writing either by email or by post and the letter will be signed by the Responsible Person or Complaints Manager under delegated authority.

The letter will be on headed notepaper and will include:

• An apology if appropriate (The Compensation Act 2006, Section 2 expressly allows an apology to be made without any admissions of negligence or breach of statutory duty).
• A clear statement of the issues, investigations and the findings, giving clear evidence-based reasons for decisions if appropriate. 
• Where errors have occurred, explain these fully and state what will be done to put this right, 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.
• The letter will include the next step in the process if the complainant is still not satisfied. This could be an offer of a meeting with the Lead GP and Practice Manager to try further reconciliation if appropriate.
• If at this point resolution is still not achieved, then either side can refer the matter to the Health Commissioner.

A statement of the right, if they are not satisfied with the response, to refer the complaint to the Parliamentary and Health Service Ombudsman.

Alternatively, may call the PHSO Customer Helpline on 0345 015 4033 from 8:30am to 5:30 pm, Monday to Friday or send a text to their ‘call back’ service 07624 813 005.

Unreasonable or Vexatious Complaints

Where a complainant becomes aggressive or, despite effective complaint handling, unreasonable in their promotion of the complaint, some or all of the following formal provisions will apply and will be communicated to the patient by the 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.
• 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.

Locum staff should however be involved at an early stage and be advised of the complaint in order that they can provide any explanations, preferably in writing. It would not be usually appropriate for any opinions to be expressed by the Practice on Locum staff. Providing their factual account along with any factual account from the practice is the best way to proceed.

The practice will ensure that on engaging any Locum, the Locum Agreement will include an assurance that they will participate in any complaint investigation where they are involved or can provide any material evidence. The practice will ensure that there is no discrepancy in the way it investigates or handles complaints between any Locum staff and either practice Partners, salaried staff, students or trainees or any other employees.

Annual Review of Complaints

The practice will complete an annual complaints report (usually at the end of March) – this will be electronically completed and sent to the NHSE and will form part of the Freedom of Information Act Publication Scheme. Incorporating a review of complaints received, along with any learning issues or changes to procedures which have arisen.

This report is to be made available to any person who requests it and may form part of the Freedom of Information Act Publication Scheme.

This will include:

• Statistics on the number of complaints received,
• The number considered to have been upheld.
• Known referrals to the Ombudsman,
• A summary of the issues giving rise to the complaints
• Learning points
• Methods of complaints management
• Learning points that came out of the complaints and the changes to procedure, policies or care which have resulted.

Care must be taken to ensure that the report does not inadvertently disclose any confidential data or lead to the identity of any person becoming known.

Confidentiality

All complaints must be treated in the strictest confidence and the practice must ensure that the patient etc. is 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, but such records must be kept separate from patients' medical records and no reference which might disclose the fact a complaint has been made should be included on the computerised clinical record system.

Further Information

Further information can be found in the Suggestions, Comments and Complaints Information leaflet.

Complaints to NHS England

If a complainant has concerns relating to a directly commissioned service by NHS England, then the first step is, where appropriate, for complaints and concerns to be resolved on the spot with their local service provider.

This is called by NHS England ‘informal complaint resolution’ and is in line with the recommendations of the Complaints Regulations of 2009. If it is not appropriate to raise a concern informally or where informal resolution fails to achieve a satisfactory outcome, the complainant has the right to raise a formal complaint with either the service provider or the commissioner of the service NHS England.

A complaint or concern can be received by mail, electronically or by telephone.

See the NHS England website for details

All complaints to NHS England will be acknowledged no later than 5 working days after it has been received by telephone, email or letter, to consider how to progress the complaint;

• Complainant’s expectations and desired outcomes
• Agreed timescales to respond to complaint
• Explain the complainants’ rights as they are defined in the NHS Constitution
• Complaint Action Plan
• Whether and independent advocacy service is available in the complainant’s area
• Consent for NHS England to handle the complaint if it requires input or investigation from organisations or parties that are not part of NHS England

The complainant will be kept up to date with the progress of their complaint by NHS England staff members, in their preferred method of communication (e.g. by email, telephone or written letter). If the complainant is not satisfied with the outcome, then they will have the right to progress this further based on the complaints procedure that NHS England will provide to them during this process.

As part of the guidance on protecting data and personal information, if the complaint involves several organisations then the complainant will be asked for their permission to share or forward a complaint to another body, and further consent will be required to forward the complaint to any provider.