From the outside looking in

One of the biggest hurdles for locums is actually being told about complaints. Here Terri Bonnici, general practice complaints manager, highlights the locum’s role in the complaints investigation process to reduce the risk of this happening

As a locum you are often distanced from the complaints process and may be informed of an adverse event sometime after an investigation has begun. The danger here is that this can prevent you from providing your comments and ensuring that your contribution has been accurately reflected, which in turn can escalate the matter. As one locum recently pointed out: “Practices simply don’t tell us that we’ve had a complaint.” This can lead to a situation that leaves not only locums, but patients in the dark.

The current system

The NHS and social care complaints system aims to be more open and accountable, fair and proportionate and above all patient-focused. Practices must involve locums in handling complaints from the outset, even if they have left the organisation.

If a patient cannot resolve their complaint locally, they can take it forward to the Parliamentary Health Service Ombudsman (PHSO). Often a doctor will only learn of a complaint once it has escalated to PHSO. This is when they contact us for advice.

Handling complaints

At some point in your career you may find yourself the focus of a complaint from an aggrieved patient or member of their family. You should familiarise yourself with the practice’s complaints procedure. There should be one person within the practice who administers the procedure.

The complaints manager

The complaints manager’s role is to ascertain the facts relating to a complaint, assess the evidence and report the findings.

Complaints should:

• Normally be acknowledged within three working days
• Be handled flexibly and responsively in consultation with the complainant if possible 
• Be investigated and resolved as speedily as possible, giving the complainant a full, clear explanation and, if mistakes have been made, an apology 
• Feed into clinical governance and service improvements.

The complaints manager will prepare a report on the findings.

In the document, Listening, Responding, Improving: A Guide to Better Customer Care, the Department of Health states that the manager should have an open dialogue with both parties, so that their final report does not surprise anyone involved.

According to the Department of Health: “Before the report is finalised everyone involved should be given the chance to give their views on what has been said.”

So if a complaint concerning your practice is being investigated, the complaints manager should seek your views if possible, whether you are a locum or a partner. This will probably involve being asked to write a statement or attend a meeting to discuss what happened. If you find yourself in this situation stick to the facts and avoid offering opinion, speculation or defensive justifications.

We would encourage you to see a draft copy of the reply the practice intends to send to check it for factual accuracy.

The locum’s role

At MPS we understand that handling complaints can be time-consuming and stressful for doctors. However, a prompt, well-balanced response to a complaint is often enough to defuse the situation and to prevent it escalating further.

In Good Medical Practice, the GMC says patients “have a right to expect a prompt, open, constructive and honest response, including an explanation and, if appropriate, an apology”. An apology is not an admission of liability so be prepared to meet with the patient, or complainant, and liaise with the complaints manager.

See it as an opportunity to listen to the patient, understand the reasons for the complaint and to ensure the relationship can be improved and any similar problems avoided in the future.

MPS has produced six booklets on complaints handling; one of them is a case study and takes you through the steps for successful complaints resolution. – click here to find out more.

Most complaints are an opportunity for learning, so practices often hold a significant event audit (SEA). If you are involved in the complaint, suggest being involved in any subsequent SEA meetings. This will offer a chance to liaise with the practice team and learn from the complaint.

Record keeping

You should always keep good medical records and this is particularly important if a complaint is made, as this will help you remember what happened and assist you in providing a clear explanation if asked for your comments. In Good Medical Practice, the GMC says: “Keep clear, accurate and legible records, reporting the relevant clinical findings, the decisions made, the information given to patients and any drugs prescribed or other investigations or treatment.” In addition it is helpful to document any follow-up advice.

Good record-keeping is particularly important when you bear in mind that complainants now have 12 months from the occurrence giving rise to the complaint, or from the time that they become aware of the matter, to make a complaint. The complaints manager will retain the discretion to investigate complaints brought later than this if there are good reasons for the delay and it is still possible to carry out the investigation.

Practising empathy

Any complaint should be replied to empathically. Put yourself in the complainant’s shoes, and tailor your responses to their needs. Understand the emotional impact that the events leading up to the complaint may have caused, and be aware that emotions may be highly charged. Keep calm and keep body language neutral during any subsequent complaint meetings. The tone of any responses should be conciliatory.

Claims

While complaints may occur immediately after an adverse incident, claims often take longer to arise. For this reason it is more likely that, if you are involved in a claim, it will be connected with an incident at a previous practice that you worked at. We recommend that you contact MPS if this situation arises so we can help with writing a report or statement, and if you feel vulnerable about your involvement, do not hesitate to contact us.

GMC

You could receive a letter from the GMC about a complaint and again we advise you seek MPS advice before responding to any correspondence.

Future complaints

Only time will tell whether locums feel more involved in complaints handling, but the current system is tighter and less bureaucratic, and the additional guidance implies that complaints against locums cannot be handled effectively without gathering their input, where possible. One thing that is clear is that where a locum is involved in a complaint in an environment where regulators are pressing hard for increased communication, transparency and more accountability, the locum’s viewpoint becomes indispensable.

It is important that you familiarise yourself with the current complaints procedure; MPS has produced a number of resources, e.g, complaints booklets, to help you understand the current guidance and regulations. Access them here.

Please note: Medical Protection does not maintain this article and therefore the advice given may be incorrect or out of date, and may not constitute a definitive or complete statement of the legal, regulatory and/or clinical environment. MPS accepts no responsibility for the accuracy or completeness of the advice given, in particular where the legal, regulatory and/or clinical environment has changed. Articles are not intended to constitute advice in any specific situation, and if you are a member you should contact Medical Protection for tailored advice. All implied warranties and conditions are excluded, to the maximum extent permitted by law.