Complaints Policy

Review

This policy is in line with current legislation at the time of writing and is subject to periodic review.

In the event of any incident linked to this policy; findings of an audit that identifies a gap or a need for a review or a change of legislation impacting on this policy, the policy will be updated and will supersede this policy. Unless there are changes to regulations that affect this policy then this policy will be reviewed on a regular basis.

Introduction

Policy statement

The purpose of this document is to ensure all staff at Hall Green Health understand that all patients have a right to have their complaint acknowledged and investigated properly. This practice takes complaints seriously and ensures that they are investigated in an unbiased, transparent, non-judgemental, and timely manner.

The practice will maintain communication with the complainant (or their representative) throughout, ensuring they know the complaint is being taken seriously.

In accordance with Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 (Regulation 16), all staff at Hall Green Health must fully understand the complaints process.

Status

The practice will aim to design and implement policies and procedures that meet the diverse needs of our service and workforce, ensuring that none are placed at a disadvantage over others, in accordance with the Equality Act 2010. Consideration has been given to the impact this policy might have regarding the individual protected characteristics of those to whom it applies.

This document and any procedures contained within it are non-contractual and may be modified or withdrawn at any time. For the avoidance of doubt, it does not form part of your contract of employment. Furthermore, this document applies to all employees of the practice and other individuals performing functions in relation to the practice such as agency workers, locums, and contractors.

Principles of this policy

Legislation and guidance

Every provider of NHS healthcare is required to have a complaints procedure. This process must detail how to complain about any aspect of NHS care, treatment, or service, and this is a requirement that is written into the NHS Constitution.

Complaints management team

The Medical Director is responsible for the supervision of the complaints procedure and for making sure that action is taken in light of the outcome of any investigation.

The Quality Assurance Officer is responsible for managing all non-clinical complaints procedures and must be readily identifiable to service users.

Formal or informal?

NHS England defines that a concern is something that a service user is worried or nervous about and this can be resolved at the time the concern is raised whereas a complaint is a statement about something that is wrong or that the service user is dissatisfied with which requires a response.

It should be noted that a service user could be concerned about something and raise this matter, however, should it not be dealt with satisfactorily, then they may make a complaint about that concern.

It is the responsibility of the Quality Assurance Officer to consider whether the complaint is informal and therefore early resolution of an issue may be possible. If the Quality Assurance Officer believes an issue can be resolved quickly then our practice will aim to do this as early as possible, with the agreement of the enquirer, we will categorise this as a concern and not a complaint.

However, if the enquirer is clear that they wish to formalise the complaint, then the practice will follow this complaints policy in full.

Complaints information

Hall Green Health has prominently displayed notices in the reception detailing the complaints process. In addition, the process is included on the practice website, with a complaints leaflet.

A duty of candour

The duty of candour is a general duty to be open and transparent with individuals receiving care at our practice.

Both the statutory duty of candour and professional duty of candour have similar aims, to make sure that those providing care are open and transparent with the individuals using their services whether or not something has gone wrong. 

Parliamentary and Health Service Ombudsman (PHSO)

The Parliamentary and Health Service Ombudsman’s role is to make final decisions on complaints that have not been resolved locally by either the practice or the Integrated Care Board (ICB). The Ombudsman will look at complaints when someone believes there has been injustice or hardship because an NHS provider has not acted properly or has given a poor service and not put things right.

The Ombudsman can recommend that practices provide explanations, apologies, and financial remedies to service users and that they take action to improve services.

Complainant options

The complainant, or their representative, can complain about any aspect of care or treatment they have received at our practice through the Quality Assurance Officer or directly to the ICB – Primary Care Complaints Team Office of the West Midlands.

As of 1 July 2023, the patient (or their nominated representative) may now submit a complaint either to the Birmingham and Solihull ICB or to the organisation that has been commissioned by the NHS to provide a service.

Should a complainant have an ongoing complaint that was submitted to NHS England prior to 1 July 2023, they will receive a letter explaining that their complaint will continue to be investigated by ICB – Primary Care Complaints Team Office of the West Midlands.

If NHS England receive a complaint on or after 1 July 2023, the complainant will receive a letter advising that the ICB will be handling their complaint along with details of their case handler.

Information on how to make a complaint to the ICB – Primary Care Complaints Team Office of the West Midlands can be sought from its webpage ICB – Compliments, concerns and complaints.

As complaints also come directly to our practice, we have adopted a patient-focused approach to complaint handling.

Complaints are not escalated to the ICB following the practice’s response. A Stage 1 complaint is made to either the practice or to the ICB.

If dissatisfied with the response from either ICB or our practice, then the complainant may wish to escalate their complaint to the PHSO (Parliamentary and Health Service Ombudsman).

See below image that further explains the route of any complaint:

• Stage 1 – The complainant may make a complaint to either the practice or to ICB. This is classed as a local resolution.
• Stage 2 – If dissatisfied with the initial Stage 1 response, the complainant may then escalate this to the PHSO.

It should be noted that neither our practice nor the ICB will investigate any complaint should this have been responded to by the other.

The complainant should be provided with a copy of the complaints leaflet at Annex D – Complaint relating desktop aide-memoire detailing the complaints process.

Timescale

The time constraint for submitting a complaint is 12 months from the occurrence giving rise to the complaint or 12 months from the time that the complainant becomes aware of the matter about which they wish to complain.

If, however, there are good reasons for a complaint not being made within the timescale detailed above, consideration may be afforded to investigating the complaint if it is still feasible to investigate the complaint effectively and fairly.

Should any doubt arise, further guidance should be sought from the Quality Assurance Officer.

Responding to a concern

Should the Quality Assurance Officer become aware that a patient, or the patient’s representative, wishes to discuss a concern, then this is deemed to be less formal and will be dealt with by the QA officer, to achieve a local resolution.

Whilst each concern will warrant its own response, the outcome will always be to ensure that the best response is always provided.

Responding to a complaint

The complainant has a right to be updated regarding the progress of their complaint. The Quality Assurance Officer will provide an initial response to acknowledge any complaint within three working days after the complaint is received.

All complaints are to be added to the complaints log in accordance with the section Logging, reviewing, and retaining complaints.

There are no timescales when considering a complaint, simply that it must be investigated thoroughly, and that the complainant should be kept up to date with the progress of their complaint.

At Hall Green Health, should any response not have been provided within six months, we will write to the complainant to explain the reasons for the delay and outline an approximate time frame within which they can expect to receive the response.

Meeting with the complainant

If necessary, to support the complaints process, a meeting may be arranged between the complainant and the complaints lead.

Verbal complaints

If a patient wishes to complain verbally and should the patient be content for the person dealing with the complaint to deal with this matter and if appropriate to do so, then complaints should be managed at this level. After this conversation, the patient may suggest that no further action is needed.

Should this be the case, then the matter can be deemed to be closed.

The acknowledgement of the verbal complaint will be deemed sufficient, and the Quality Assurance Officer will not be required to respond in writing. However, the verbal complaint must be recorded in the complaints log so that any trends can be identified and, if necessary, service improvements can be implemented.

Further information on logging complaints can be sought in the section Logging, reviewing, and retaining complaints.

Note a verbal complaint may simply be a concern. Should this be a less formal concern and, in agreement with the enquirer, then the process in the section Responding to a concern should be followed.

Written complaints

The complainant has a choice to either write or verbalise their concerns.

To facilitate recollection of the reported facts and events, the staff receiving the verbal complaint may write down the complaint verbatim on the complainant’s behalf, using Annex C – Verbal Complaint Form.

Therefore, complainants are not persuaded or dissuaded from putting it in writing and whether verbally or in writing, if it is of appropriate significance, requiring further investigation, it will be documented in writing, investigated, and responded to in writing as a ‘written complaint.

Who can make a complaint?

A complaint can be filed by any of the following: patients, former patients, or a representative of the patient, or anyone who has been or is likely to be affected by the acts, omissions, or decisions of people employed by our practice.

If the complaint is submitted by someone acting on behalf of a patient, the complainant is required to fill out the designated form Annex B – Patient’s Representative Complaint Form the following conditions must be met:

• Is a child (an individual who has not attained the age of 18)
  In the case of a child, there must be reasonable grounds for the complaint being made by a representative of the child and furthermore that the representative is making the complaint in the best interests of the child.
• Has deceased
  In the case of a person who has deceased, the complainant must be the legal representative of the deceased.
  Where appropriate, we may request evidence to substantiate the complainant’s claim to have a right to the information.
• Has physical or mental incapacity
  In the case of a person who is unable by reason of physical capacity or lacks capacity within the meaning of the Mental Capacity Act 2005 to make the complaint themselves, the practice needs to be satisfied that the complaint is being made in the best interests of the person on whose behalf the complaint is made.
• Has given consent to a third party acting on their behalf.
  In the case of a third party pursuing a complaint on behalf of the person affected the complaint information will be documented in the file pertaining to this complaint and confirmation will be issued to the patient affected.
• Has delegated authority to act on their behalf, for example in the form of a registered Lasting Power of Attorney which must cover health affairs.
• Is an MP, acting on behalf of and by instruction from a constituent.

Should the Quality Assurance Officer or the Medical Director believe a representative does or did not have sufficient interest in the person’s welfare, or is not acting in their best interests, they will discuss the matter with either the patient or appropriate authorities.

Complaints advocates

Independent advocacy services include:

• Local Health Watch – a volunteer organisations
• POhWER – a charity that helps people to be involved in decisions being made about their care. POhWER’s support centre can be contacted via 0300 456 2370.
• Advocacy People – gives advocacy support. Call 0330 440 9000 for advice or text 80800 starting message with PEOPLE.
• Age UK – may have advocates in the area. Visit their website or call 0800 055 6112.
• Local councils can offer support in helping the complainant to find an advocacy service.

The PHSO provides several more advocates within its webpage titled Getting advice and support.

Investigating complaints

The practice will ensure that complaints are investigated effectively and in accordance with legislation and guidance. The complainant will have a single point of contact in the practice and be contacted by the QA officer, for updates and further information.

Investigation time scale can vary depending on the complexity of the complaint and available resources of the practice to investigate.

Conflicts of interest

The Quality Assurance Officer and the Medical Director investigating the clinical concern must consider and declare whether there are any circumstances by which a reasonable person would consider that their ability to apply judgement or act as a clinical reviewer could be impaired or influenced by another interest that they may hold.

Should such circumstances arise, the practice should seek to appoint another member of the practice as the responsible person with appropriate complaint management experience.

Final formal response to a complaint

A final response should only be issued to the complainant once the letter has been agreed by the Medical Director, or the Quality Assurance Officer, for non-clinical matters.

Following this, and upon completion of the investigation, a formal written response will be sent to the complainant.

Confidentiality in relation to complaints

Any complaint is investigated confidentially, and all associated documentation will be held separately from the complainant’s medical records.

Complaint confidentiality will be maintained, ensuring only managers and staff who are involved in the investigation know the particulars of the complaint.

Persistent and unreasonable complaints

Persistent, unreasonable, or vexatious complaints will be reviewed by the Practice Executive Team, and the complainant will be informed about the outcome.

Complaints citing legal action

Should any complaint be received and the content states that legal action has been sought then, prior to any response, consideration will be given to contacting the defence union for guidance.

Multi-agency complaints

The practice has a duty to co-operate in multi-agency complaints.

If a complaint becomes multi-agency, the practice should seek the complainant’s consent if a joint response is required.

Complaints involving external staff

Should a complaint be received about a member of another organisation’s staff, then this should be brought by the complainant to the attention of the other organisation complaints manager at the earliest opportunity.

Complaints involving locum staff

Hall Green Health will ensure that all locum staff, irrespective of their appointed role within the practice are aware of the complaints process and that they will be expected to partake in any subsequent investigation, even if they have left the practice (keeping in mind the 12-month time frame to complain).

Learning events

When a complaint is raised, it may prompt other considerations, such as a Learning event (LE). LEs are an excellent way to determine the root cause of an event so we can improve process to minimize the risk of further events recurring.

Fitness to practise

When a complaint is raised, consideration may need to be given to whether the complaint merits a fitness to practise referral and advice may need to be sought from the relevant governing body.

In our practice, the Medical Director will be responsible for firstly discussing the complaint with the clinician involved prior to seeking any guidance from the relevant governing body if applicable.

Staff rights to escalate to the PHSO

It should be noted that any staff who are being complained about can also take the case to the PHSO. An example may be that they are not satisfied with a response given on their behalf by a commissioning body.

Logging, reviewing, and retaining complaints

The Practice logs and retains records of all formal complaints.  An annual submission of compliance for complaints is submitted to NHS by the Operational Manager within the KO14b complaints report and published by NHS Digital. Any reporting period covers the period from 1 April until 31 March.

The management of complaints at Hall Green Health is used as a learning tool in the practice with individual complaints being discussed as learning events where necessary or appropriate.

All complaints will be anonymised and analysed on an annual basis.

There will be a regular review of the complaint register in order to identify the potential for non-compliance. The Responsible Person will identify ways for the practice to return to compliance.

Use of complaints as part of the revalidation process

Outlined processes

As part of the revalidation process, GPs must declare and reflect on any formal complaints about them in tandem with any complaints received outside of formal complaint procedures at their appraisal for revalidation. These complaints may provide useful learning.

The Royal College of General Practitioners (RCGP) has produced appraisal guidance for this purpose.

Nurses may also wish to use information about complaints as part of their NMC revalidation. This feedback can contribute towards submissions about organisation related feedback, and it can also be part of a written reflective account. Likewise, pharmacists and other healthcare professionals may wish to consider using complaints and their management as part of their revalidation process.

The General Pharmaceutical Council (GPhC) revalidation process can be sought here and information relating to the Healthcare Professionals Council (HCPC) revalidation process can be found here.

CQC regulatory complaint assessment during inspection

Overview

The CQC will inspect the practice to ensure it is safe, effective, responsive, caring and well-led under the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 (Regulation 16) and expect all staff to fully understand the complaints process.

When assessing complaints management, the CQC will seek to be satisfied of the following, as directed within the GP Mythbuster 103 – Complaints management:

• People feel comfortable, confident and are encouraged to make a complaint and speak up.
• The process is easy to use so people understand how to make a complaint or raise concerns.
• The practice offers help and support where necessary, using accessible information.
• The complaints process involves all parties named or involved in the complaint and they have an opportunity to be involved in the response.
• The complaints are handled effectively, including:
• o Ensuring openness and transparency
• o Confidentiality
• o Regular updates for the complainant
• o A timely response and explanation of the outcome
• o A formal record
• Systems and processes protect people from discrimination, harassment, or disadvantage.
• Complaints are monitored to assess trends that are used for learning and shared with the wider team or externally as appropriate to make changes and drive continuous improvement.

The Quality Assurance Officer will advise the complaints procedure to the complainant or their representative. In many cases, a prompt response and, if the complaint is upheld, an explanation and an apology will suffice and will prevent the complaint from escalating (an apology does not constitute an admission of organisational weakness).

Further information

Further relevant information is available within both:

• The Data Protection Act 2018
• Public Interest Disclosure Act 1998

Summary

The care and treatment delivered by our practice are done so with due diligence and in accordance with current guidelines.  However, it is acknowledged that sometimes things can go wrong.

By having an effective complaints process in place, this practice can investigate and resolve complaints in a timely manner, achieving the desired outcome for service users whilst also identifying lessons learned and ultimately improving service delivery.