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An opportunity to improve

Introduction

The purpose of our review was to look at the quality of GP practice complaint handling, identify good practice and ways that the quality could be improved. Our aim was to provide a snapshot into the quality of complaint handling across England and to work with GPs, practice managers and decision makers to identify what improvements might be required.

Our review aimed to:

  • set out where practices were performing well and where they were falling short of what was required; 
  • understand how practices were using what they had learned from complaints to improve services and patient experience;
  • review how practices were performing against My expectations more generally – a framework for raising concerns and complaints;
  • consider what the future of complaint handling might look like in general practice in the context of new care models and the scaling up of general practice.

We were also keen to consider what each of the four organisations involved could learn from the review to better support general practice in managing complaints.

Landscape 

Over the past three years, a number of reports about the NHS complaints system have been published.3 Criticism has focused on variation in the quality of complaint handling and issues around attitude such as defensiveness or complaints not being taken seriously. However, criticisms have also focused on cultural issues such as people who use the service (and staff) not always feeling supported to give feedback, raise concerns or complain. 

Work force problems, the growing need and rising expectations of an older population, with more complex health care needs, are all contributing to growing pressures within general practice.4 While satisfaction with GP services was recently rated higher than other NHS services, it’s the lowest score since the survey started in 1983.5  Being responsive to patients is going to be crucial if practices are to ensure improved satisfaction levels and that new ways of working are successful. This will require good management of feedback, concerns and complaints.    

While satisfaction with GP services was recently rated higher than other NHS services, it’s the lowest score since the survey started in 1983.'

GP practices face some unique challenges that make it harder for them to manage concerns and complaints effectively: 

  • Practices will deal with relatively few complaints - annually the average GP practice receives 8.5 complaints.6
  • Practices do not have access to specialised teams to support them - in hospital trusts there is usually a specialist complaints team trained to handle and investigate complaints, Patient Advice and Liaison Services who are able to offer confidential advice, support and information to individuals, and hospital chaplaincy who are able to provide emotional support. 
  • Practices can have a more personal relationship with their patients – GPs told us that this can make complaints feel more personal for practice staff and makes it harder to respond objectively. 
  • Practices are small to medium sized businesses which work in close knit teams – GPs told us that the person investigating and responding to the complaint often has a close relationship with the person being complained about. This makes it hard to investigate and respond and can be perceived as a conflict of interest by the person complaining. 

The Health Select Committee stated that the number of complaints about a provider could indicate an open and positive culture towards complaint handling rather than failures in service.7 However, there are some practices that don’t receive a single complaint; in 2014-15, 12% of GP and dental practices had not received any written complaints in the previous 12 months; this compares with 30% the previous year.8 9 It is unclear why we don’t see more complaints from general practice.

In 2014-15, the Health and Social Care Information Centre (HSCIC) recorded 67,012 complaints about general practice.10 Roughly 20% of these were investigated by NHS England. 5,086 complaint enquiries reached the Parliamentary and Health Service Ombudsman and of these, 696 (14%) were investigated. Of the 696 complaints investigated by the Parliamentary and Health Service ombudsman, 32% were upheld.


3 Health Select Committee (2015), Complaints and Raising Concerns. 
Right Honourable Ann Clwyd MP and Professor Tricia Hart (2013), A Review of the NHS Hospitals Complaints System Putting Patients Back in the Picture. 
Robert Francis QC (2013), Public Inquiry into the Mid Staffordshire NHS Foundation Trust. Robert Francis QC (2015), Freedom to Speak Up, An independent review into creating an open and honest reporting culture in the NHS.
4 Nuffield Trust (2015), Is General Practice in Crisis?
5 The Kings Fund (2016), Public satisfaction with the NHS in 2015.
6 Health and Social Care Information Centre (2015), Data on Written Complaints in the NHS 2014 – 2015
7 Health Select Committee (2015), Complaints and Raising Concerns.
8 Health and Social Care Information Centre (2014), Data on Written Complaints in the NHS, 2013 – 2014, Health and Social Care Information Centre (2015), Data on Written Complaints in the NHS 2014 – 2015.
9 2013- 2014 was the first year that this data was collected from individual practices; previously, data was collected via the Primary Care Trust. The response rate was 77% for GPs and 43% for dentists.  
10 Health and Social Care Information Centre (2015), Data on Written Complaints in the NHS 2014 – 2015.