PC
Domain: Professional
Competency:
C. Understand practice NHS complaints procedures
Recommended for assessment by Deanery:
A copy of practice complaints procedure.
A signed reflective commentary demonstrating understanding of the procedures
Included for assessment:
A copy of practice complaints procedure.
A reflective commentary on the existing NHS complaints procedures/regulations.
Complaints in practice
& NHS complaints procedure.
More recently though there has been increasing recognition of the contribution of complaints to improving practice and preventing mistakes. Any establishment or provider who takes the business or care they provide should deal with complaints in a prompt and open way.
NHS Complaints Procedure.
Much of the information used in this section is a synopsis of the document A guide to better customer care, DOH 2009. The document is based on the legislative changes entitled The Local Authority Social Services and National Health Service Complaints (England) Regulations 2009.
In 2006 it was decided that a single method would be introduced for dealing with complaints. These changes were implemented to give organisations, included dental practices greater flexibility to respond to complaints and encourage a culture that seeks and then uses people’s experiences of care to improve quality.
The problems with the previous system was:
• Process heavy and inflexible
• Impersonal
• Did not encourage learning from mistakes
This new approach was introduced officially in April 2009. The NHS Constitution expresses to patients what exactly they should expect when they complain. In addition to the requirements within the NHS the Care Quality Commission will soon register dentists and require them to investigate complaints effectively and learn from them.
The following is a summary of the three key areas:
Listening
Responding
Improving
Listening
Many suggestions for improvement or complaints are not be voiced because people don’t know how to complain or they feel the organisation will not listen. Subsequently, the document recommends that organisations promote a consistent message across all communications about how to complain or compliment. The message should be engaging and accessible. The document also makes clear that people have the right to complain and gives practical tips on how to get it right from the beginning:
“The people who use health and social care services understand that mistakes sometimes happen. When something goes wrong, often all the person affected wants to know is how it happened, that you are sorry, and that steps will be taken to prevent it from happening again.
The initial contact an organisation has with a person who is unhappy about their service is key. It is crucial to obtain all the information that will allow you to assess someone’s concerns correctly, resolve them quickly if you can and build a good ongoing relationship with them.
Often the reason people give for being unhappy about how their complaint has been handled is poor communication by services.
Things to remember to do when someone says they are unhappy:
● Ask the person how they would like to be addressed – as Mr, Mrs, Ms or by their first name.
● If someone has phoned you, offer to call them back and give them the chance to meet face to face to discuss the issue.
● Ask them how they wish to be kept informed about how their complaint is being dealt with by phone, letter, email or through a third party such as an advocacy or support service.
● If they say by phone, ask them for times when it is convenient to call and check that they are happy for messages to be left on their answerphone.
● If they say by post, make sure that they are happy to receive correspondence at the address given.
Responding
It is made clear that there are different degrees of seriousness of complaint; low, moderate, high and extreme. The document and gives examples (see below).
Low (simple, non-complex issues) Delayed or cancelled appointments. Event resulting in minor harm (eg cut, strain). Loss of property. Lack of cleanliness. Transport problems. Single failure to meet care needs (eg missed call-back bell). Medical records missing. Moderate (several issues relating to a short period of care) Event resulting in moderate harm (eg fracture). Delayed discharge. Failure to meet care needs. Miscommunication or misinformation. Medical errors. Incorrect treatment. Staff attitude or communication. High (multiple issues relating to a longer period of care, often involving more than one organisation or individual) See moderate list. Event resulting in serious harm (eg damage to internal organs). Extreme (multiple issues relating to serious failures, causing serious harm) Events resulting in serious harm or death. Gross professional misconduct. Abuse or neglect. Criminal offence (eg assault). The document encourages organisations to make a plan so that every complaint is dealt with in a similar way. It gives some advice to what should be included within a plan: “What a plan might include The best plans for dealing with complaints are developed with input from those who make them, and those whose job it is to resolve them. The most effective plans also focus on the reactions or observations that can help your service improve. Any plan you agree on needs to be proportionate, achievable and cost-effective, and it is important to update it as the issue progresses. Any action plan also needs to take into account: 1 A person’s legal rights when they make a complaint 2 What your service has agreed to do to resolve the issue 3 A timescale for doing so 4 How and when you will update the person on any progress 5 Any support the person complaining might need 6 The immediate actions staff might take, such as an apology 7 How the complaint is categorised” |
There is also advice on how a complaint may be investigated, what support is available to the patient and recommendations on what to do if the complaint cannot be resolved using local measures. Practical and interesting advice is found on how to deal with unreasonable complaints within this section and include such advice as 'limiting contact time with the complainant.'
Improving.
The final section deals with improving and maintaining a customer care service and how to train frontline staff. It gives some worked examples of a complaint and how they were dealt with. One very relevant section of the document is the following question:
“I am a GP, dentist, optician or pharmacist. Does the new complaints system apply to me?
It applies to all independent contractors that provide NHS services in a primary care setting. We will be publishing a supplement to this guide, to help you provide a bespoke service in your particular setting. However, there are some things you need to consider and implement immediately, including:
● Publicising that you want to receive feedback of various kinds, including complaints
● Ensuring that anyone using your services and their families know how to complain and to whom
● Making someone responsible for handling and responding to complaints
● Acquainting yourself with the new regulations and guidance to ensure.”
The document summarised above gives the principles under which complaints should be handled. But the fine details of the 2009 regulations are found in the document
The Local Authority Social Services and National Health Service Complaints (England) Regulations 2009.
The document not only gives the fine detail and makes it explicit that independent contractors are bound by the regulations and makes specific reference to the “general dental services contractor”.
There are many interesting (and not so interesting!) points within the document. The following are some of the more practical and applicable aspects of the regulations.
• There should be a responsible person within an organisation that is designated as a complaints manager. This person is responsible for ensuring compliance to the regulations.
• Complaints can be made in general 12 months after the incident occurs/the complainant becomes aware of the issue. Complaints can be made after this date if there is a good reason.
• Complaints can be made on behalf of those who are a child or do not have the capacity.
• Oral complaints must be documented and a copy presented to the patient.
• The provider/PCT/responsible body should acknowledge the compliant within 3 working days after the day it is received.
• The body offers to arrange a time convenient to the patient to discuss the complaint and specifies a period of time for the body to investigate, conclude and present findings to the complainant.
• Following this action an prompt investigation must occur, whilst keeping the patient updated on progress. Once completed a written response if given to the complainant.
• If not satisfied with the response, the complainant may refer to the ombudsman.
• All complaints must be recorded along with conclusions and each responsible body must produce and annual report. This includes providers who must send their report to the PCT
Summary
• No one likes to be on the receiving end of a complaint. No one likes to receive poor service or feel not listened to. An effective complaints policy can make the best of a negative experience and potentially reduce the risk of similar incidents happening in the future.
• There are regulations laid before parliament that relate to how complaints are dealt with in the NHS and independent contractors such as dentists are bound by these regulations.
A worked example:
Verbal:
Complaint: A patient complained on reception whilst trying to book an appointment that she could not be booked in with the hygienist within the next 2 weeks before she went on holiday.
Response: An immediate verbal response was given by the receptionist: a prompt apology was issued and the patient was offered to be notified immediately if there were any cancellations.
Outcome: Though the patient was still visibly frustrated with the response, a few days later she saw the hygienist in a cancellation slot. All staff were informed at the next staff meeting to take care to inform patients that hygiene visits are best booked in advance and to continue to deal with people politely and patiently.
Written:
Complaint: A patient complained by letter that at his hygiene visit that he had not had the complete 40 minutes allotted.
Response: Computer records of the appointment showed the patient had an appointment with a duration of 36 minutes. A letter of apology was sent out the same day as receiving the letter and a full refund of the appointment was provided.
Outcome: clinicians were reminded to where possible to ensure patients receive their allotted time.
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