This guidance only applies to England. There are some differences in the way the NHS complaints procedure operates elsewhere in the UK.

What is the PSO?

The Public Service Ombudsman (PSO) is an independent body that investigates complaints about the NHS in England, along with complaints about other public organisations and UK government departments.

If someone isn't satisfied with the response to their complaint after the first stage of the NHS complaints procedure in England, they can refer their complaint to the PSO for investigation. This is stage two of the procedure.

Complaints should normally be referred to the PSO within 12 months of when the complainant first knew about the issue. The PSO can decide whether to investigate complaints outside this time frame.

NB: For complaints relating to incidents from 1 April 2019 onwards, NHS Resolution asks that practices report any PSO correspondence to them (and their medical defence organisation) within one week of receipt.

Screening process

The PSO considers each complaint and decides whether to investigate.

It won't consider a referred complaint just because the complainant isn't satisfied with the initial response, but will investigate if:

there is an indication that the NHS organisation made mistakes, acted unfairly, or gave a poor service. The terms used for this are 'service failure' and 'maladministration'. You can read the PSO's page on 'How we deal with complaints' for more information on this.
there is an indication that the mistakes or poor service caused suffering or affected the people involved (in a way that was more than 'relatively minor' - see note below) and
If the NHS organisation has finished their local process but has not responded appropriately or put matters right.

If the PSO considers there is more the organisation could do, it will contact the organisation about taking more action locally. If the complainant remains dissatisfied, the PSO will then look at the case again.

If it decides not to investigate a complaint, it will write to the complainant to explain why.

It's worth noting that since March 2024, the PSO investigates only the more serious cases. It does review all cases and will resolve those that can be done so quickly. For those that cannot be resolved quickly but where the impact was relatively minor, it will not investigate.

Complaint standards

When reviewing cases, the PSO will look at how well the complaint has been handled locally, as well as the subject matter of the complaint.

Because of this, it's important for all NHS organisations to meet NHS complaint standards. The PSO has provided detailed guidance to help NHS organisations meet these complaint standards.

If you are asked to do more locally

As part of its triage, the PSO will consider whether there is more that could be done locally. For example, it might recommend an apology or reimbursement (of a prescription charge, for instance).

If you are able to agree, this might prevent the need for an investigation by the PSO. As an MDU member, you can call us for advice on your own circumstances.

Investigation

If the PSO decides to investigate, you (the NHS organisation) will be sent a summary of the complaint with an opportunity to comment. You can tell the PSO if you think there is more you could do to resolve the complaint at a local level, and if there have been any changes in the organisation that could be relevant to the complaint.

You do not have to respond at this stage, but it can be very helpful to do so. Please call us for advice, even if the investigation is about a complaint that you did not ask for MDU help with, at the local stage.

While investigating a complaint, the PSO has access to all the paperwork from the local investigation, and can order the disclosure of documents and may interview witnesses.

For complaints about clinical care, the PSO uses the Ombudsman's Clinical Standard to establish what would have been good care in the situation being complained about.

The PSO will share a draft report containing provisional views with the complainant and doctor. It is seeking comments:

if the decision has been explained clearly or if something needs more detail
if any of the facts are wrong or anything has been missed
if there is any new information that has not been looked at.
If you think the investigation has not been done fairly.

We encourage members to contact us for advice at any time they are contacted by the PSO.

The final report and decisions

The PSO's final report on the case is sent to the complainant, the organisation and any person complained about.

A case summary is sometimes published in an anonymised form on the PSO's website.

The decisions open to the PSO are to fully uphold, partly uphold or not uphold the complaint. The PSO has specific definitions of these terms, which you can read on its site: What happens if someone complains about your organisation.

Recommendations

If a complaint is upheld (or partly upheld), the PSO can make recommendations. This might be acknowledging mistakes, apologising, making changes to working practices or making a payment.

Compliance with recommendations can't be enforced, but in practice doctors usually adopt recommendations that have been made.

Self-reporting

Any communication from the PSO triggers the duty to report to NHS Resolution within a week.

Depending on the circumstances, you may need to self-report criticism in the PSO's final report to the GMC and, if you are a GP, to fulfil your Performers' List obligations.

If you need individual advice with anything discussed in this guide, please call our helpline.

Complaints: the Public Service Ombudsman (PSO)

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