NHS complaints: local investigation and resolution

Stage one of the NHS complaints procedure involves resolving complaints at the local level. In most instances that will be in the GP practice or hospital concerned.

The NHS complaints procedure emphasises on resolving complaints as quickly as possible, and we strongly support this principle of local resolution. Speed, sympathy and a willingness to listen are often all that are needed.

Remember:

  • complaints can be made to the organisation or individual providing the service (eg, GP/practice, hospital/foundation trust), OR to the commissioning body - not both
  • if a complaint is made to an organisation or individual and the complainant is unhappy with the response, the complainant can ask the Ombudsman to review the complaint.

For more general information, see our introduction to the NHS complaints procedure.

Regulations and responsible bodies

Local resolution is governed by the Local Authority Social Services and National Health Service Complaints (England) Regulations 2009. All NHS bodies and organisations are referred to in the regulations as 'responsible bodies'.

Responsible bodies must have a publicly accessible complaints manager, as well as a 'responsible person' who makes sure the organisation complies with the complaints procedure. They, or someone authorised to act on their behalf, must sign all complaints responses.

Where a complaint relates to more than one responsible body, the regulations include a 'duty to cooperate'. The responsible bodies concerned must then work together, giving a single agreed response and coordinating how it's given to the complainant.

Oral complaints resolved within 24 hours

All complaints must be acknowledged within three working days. The only exception is oral complaints that can be resolved to the complainant's satisfaction within one working day of being received.

  • It might be possible to resolve simple oral complaints within 24 hours, and front-line staff should be encouraged to do so.
  • If you can do this and the patient is satisfied, you don't have to give a formal written response, although you can confirm the discussion in writing if you want.
  • Make a note of the complaint and your response, and keep these on a complaint file separate from clinical records.

Oral complaints resolved within 24 hours don't fall within the regulations, so GP practices don't need to include them in their monitoring or annual report on complaints. However, this doesn't stop you considering them under your clinical governance procedures.

If oral complaints can't be resolved in 24 hours, they then fall within the regulations and must be treated in the same way as all other complaints.

How to respond to complaints

Even if you're not responsible for running your organisation's complaints procedure, the following principles are helpful when responding to a complaint.

  • Make sure all complaints are investigated thoroughly. You can only respond effectively once all the facts are established. Speak to all the staff involved and/or get their written accounts for more complex complaints.
  • Be flexible when handling complaints. Take account of the seriousness of the concerns raised, the lessons learned and make sure the response is balanced and proportionate.
  • Have a clear investigation plan for each complaint. This normally includes an estimate of the timescales needed to investigate and respond. It should be clear what the complaint is about and what the complainant wants as an outcome.
  • Consider who reviews the complaint. Receiving a complaint about your care can be distressing, and it can be difficult to be entirely objective. Where possible, complaints should be reviewed by someone directly involved in the circumstances leading up to the complaint, but who isn't the subject of the complaint itself.
  • Give a prompt and complete written response. Keep the complainant updated so they understand the reasons for any delays. The regulations require you to tell complainants about any delays of more than six months in providing a response, as well as explaining why.
  • Be open and honest. Acknowledge mistakes and apologise where appropriate, checking that the response to a particular complaint is proportionate.
  • Give the complainant the chance to discuss an agreed approach to the complaint. Confirm the details of how the complaint will be handled, and when the complainant can expect a response.
  • Have a system for reviewing and learning from complaints. You're required to tell the complainant what action has been taken to stop the same problem happening again. This can often help resolve the complaint.
  • Explain how the complaint was investigated and what conclusions were reached. Identify anything that needs remedial action and explain whether this is planned or has already taken place.
  • Explain the complainant's right to take the matter further. They can go to the Ombudsman within 12 months if they're dissatisfied with the response.
  • Tell complainants about any support services available to them. These include the NHS customer service team or Patient Advice and Liaison Service (PALS).

For more detailed information, see our separate guide on how to respond to a complaint.

Compensation

In our view, compensation should only be paid if negligence has been proven and should have no part in the complaints procedure. We suggest you seek our advice if the question of any payment to the complainant comes up.

Holding a meeting

It can help to offer the complainant a meeting as part of your investigation, even if you have already met to decide on the general approach to the complaint. Here are some things to think about when planning a meeting.

  • Agree the areas for discussion in advance as well as who will attend. The complainant could bring a friend or someone from an advisory/advocacy service, and you'll need to let the complainant know in advance who else might attend from your side.
  • In most circumstances it would be appropriate to hold the meeting in the practice or hospital, but there may be rare occasions when it would be better to find a neutral venue.
  • Take full minutes and make sure all parties agree on them afterwards. Outcomes should be fed into the response and any learning points from investigating the complaint.

If the complainant still isn't satisfied after you've responded to the complaint, you could offer a further meeting to explore the patient's remaining concerns. This may help to resolve the matter locally, and again, it may be helpful for a conciliator to be present.

Hospital doctors

If you're a hospital doctor, it's unlikely you'll be writing the response yourself, but you will need to give an account of what happened to help the complaints manager write a response. You may also be asked to discuss the complaint, which could include meeting with the complainant.

GPs

GPs have contractual responsibilities to check there are appropriate arrangements to manage complaints effectively, and might themselves take on the role of complaints manager at the practice.

Monitoring and reporting

A responsible body should:

  • keep a record of complaints
  • record any lessons that have been learnt
  • consider and monitor complaints as part of its clinical governance procedures
  • provide an annual report which should be available on request (primary care providers should also send it to the commissioning body).

Record keeping

Make records of what action was taken in response to a complaint and keep them separate from patients' records. They should include:

  • all communication with the complainant (as well as the letter of complaint and the final response)
  • the name of the complainant
  • the subject matter
  • the date on which it was made.

Keeping careful records will help manage the complaint and should also provide evidence of effective complaints handling if the complaint is ever reviewed by the Ombudsman.

If you want help with any part of the local resolution process, including advice on drafting a response, don't hesitate to contact us.

This guidance was correct at publication 04/05/2017. 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.

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