- It's important to know how to set out your response and what to include.
- Make sure you follow the correct procedure for signing off responses.
Most doctors will be involved in complaints investigations and clinical governance procedures as part of their practice, and you're likely to have a professional interest in the procedure.
Even if you're not the subject of a complaint, you might be involved in investigating and responding to one, giving independent clinical advice, or considering complaints as part of the appraisal or revalidation processes.
The main purpose of the complaints procedure is to address the complainant's concerns, to resolve the complaint, and to help you identify any changes needed to improve your practice.
A thorough and detailed first response should help minimise the risk of the complainant asking for clarification, and therefore the risk of any further medico-legal complications as well.
- If you receive a formal complaint, first discuss your response with the practice or trust complaints manager.
- If a complaint is made to a primary care organisation rather than to a GP practice, the doctor(s) involved should be fully consulted and have the opportunity to give statements of their involvement. The organisation might also seek independent expert advice on the complaint's clinical aspects.
- In secondary care, a written response can be sent from the chief executive or from a responsible person on their behalf.
In all cases you should ask to be involved in the response and your comments should be fairly represented. If you don't think this is the case, contact us for advice.
Responding to the complaint
The tone of your response needs to be professional, measured and sympathetic. You also need to take into account the following points.
If a complaint is from the patient's representative, you need to check the patient has given consent before you can disclose clinical information to a third party. This can be complex, particularly if the patient is a child or an adult without capacity, so don't hesitate to seek expert advice from the MDU if needed.
Investigate and respond to complaints promptly. If it seems likely there will be a delay in forwarding a response to the complainant, you or the complaints manager will need to explain the reasons to them in advance and make sure they are informed of progress.
Typed responses are more legible than handwritten ones. Use headed paper if possible, or include your full postal address and work phone number.
Give your registered name and GMC reference number, and describe your relationship with the patient (eg GP, consultant, registrar, locum). If the complaint involved several doctors, make it clear how you were involved in the patient's care.
Addressing the complaint – what to include
The following points will help you set out the response. Remember that the designated responsible person will need to sign off on the response and take responsibility for ensuring the practice learns from it.
The response should be capable of standing on its own
Don't assume the reader has any knowledge of the case. Several people may read your response apart from the complainant, like their relatives or advisers.
Give a detailed report of the part you played
Include a factual chronology of events as you saw them, describing every consultation or telephone contact and referring to the clinical notes if you need to. Also include:
- relevant medical history
- your working diagnosis or your differential diagnoses
- whether you saw the patient alone or with someone else
- that person's name and status.
Say which details of your account are based on memory, contemporaneous notes or usual or normal practice
No-one expects you to make copious clinical notes of every last detail, nor will you be expected to remember every detail of a consultation that at the time appeared to be routine.
It's acceptable to quote from memory, but if you can't remember the details of a case, say what your 'usual' or 'normal' practice would have been in those circumstances.
Say what you found, but also what you looked for but didn't find
If your evidence is challenged, it might be because you failed to put yourself in a position to make an adequate assessment. Your response should clearly describe the full extent of the patient's history and your examination.
Respond to every concern
Address each point raised by the complainant, including your opinion of what happened. Sometimes you can combine this with the chronology of events, but it's often better to deal with one and then the other.
Many complaints come from a misunderstanding, and a detailed description of the pathophysiology involved can help, although take care to do this in a way that the patient or complainant will understand.
Complaints involving more than one clinician
If a complaint involves more than one clinician, or both social care and healthcare, it's almost never appropriate to give an opinion on the acts or omissions of a colleague, unless they are under your direct supervision.
Each clinician or care provider involved should comment on the parts of the case they were involved with, and it's usually best to combine the comments into a single response. If this isn't possible, the complaints manager's response should be written so as to help the complainant understand how the individual accounts relate to the complaint.
Say sorry where appropriate
No doctor can get it right every time. Medicine is a life-long learning experience and every doctor can learn something from every complaint. Complainants often simply want an apology and an assurance that what happened to them will not happen to anyone else.
Saying sorry is not an admission of liability. This is recognised in section 2 of the Compensation Act 2006 which says:
'An apology, an offer of treatment or other redress, shall not of itself amount to an admission of negligence or breach of statutory duty.'
Enclose a photocopy of the clinical notes
If the handwriting is not clear, you might need to provide a typewritten transcript, with abbreviations written out in full.
Don't alter the notes
This may sound obvious, but it can lead to more serious trouble than the original complaint. If the patient records have been amended because there was a mistake in the original, this should be clearly marked, dated and legibly signed. Similar procedures should be followed for electronic records, where alterations can be seen on an audit trail.
The practice or hospital is expected to analyse each complaint in order to learn, identify concerns and decide what action (if any) needs to be taken.
The response should include what you have done, or intend to do, to remedy the concerns identified and make sure the problem doesn't happen again.
How you give your response is as important as what you put in it. Consider the following point to make sure your position is clear.
Avoid jargon or medical abbreviations
Many lay people will understand something like 'BP' for blood pressure, but something like 'SOB' for shortness of breath could be misinterpreted.
- Write all medical terms out in full.
- If you mention a drug, give an idea of what type of drug it is (antidepressant, antihypertensive, and so on).
- Also give the full generic name, dosage and route of administration.
Write in the first person
When reading about your part in the proceedings, the reader should have a good idea who did what, why, when, to whom, and how you know this occurred.
- Example: instead of saying, 'The patient was examined again later in the day', it's far more helpful to say, 'I asked my registrar, Dr Jim B, to examine the patient and the notes show that he did so.'
You could also include an offer to meet the patient to discuss the report and answer any questions they might have.
Finally, the response should be signed off by the organisation's responsible person, or someone authorised on their behalf.
The response letter should:
- answer the complaint
- explain how it has been investigated
- detail what action will be taken as a result
- clearly advise that the complainant can take the case to the Ombudsman if they are still dissatisfied.
Remember, most complaints are resolved successfully at the first stage, but a good response takes time and careful thought. It's worth the effort.
This guidance was correct at publication 04/11/2019. It is intended as general guidance for members only. If you are a member and need specific advice relating to your own circumstances, please contact one of our advisers.