- It's important to know how to set out your response and what to include.
- Make sure you follow the correct procedure for signing off responses.
Most doctors will be involved in complaints investigations and clinical governance procedures as part of their practice, and you're likely to have a professional interest in the procedure.
Even if you're not the subject of a complaint, you might be involved in investigating and responding to one, giving independent clinical advice, or considering complaints as part of the appraisal or revalidation processes.
General principles
The main purpose of the complaints procedure is to address the complainant's concerns, to resolve the complaint, and to help you identify any changes needed to improve practice.
A thorough and detailed first response should help minimise the risk of the complainant asking for clarification or escalating the complaint, and therefore risk any further medico-legal complications as well.
- If you receive a formal complaint, first discuss your response with the practice or trust complaints manager. Don't try to deal with it on your own.
- If a complaint is made to a primary care organisation rather than directly to a GP practice, the doctor(s) involved should be fully consulted and have the opportunity to give statements of their involvement. The organisation might also seek independent expert advice on the complaint's clinical aspects.
- In secondary care, a written response can be sent from the chief executive or from a responsible person on their behalf.
- Contact the MDU for expert advice and support at an early stage.
In all cases you should ask to be involved in the response and your comments should be fairly represented. If you don't think this is the case, contact us for advice.
Responding to the complaint
The tone of your response needs to be professional, measured and sympathetic. You also need to consider the following points.
Patient confidentiality
If a complaint is from the patient's representative, you need to check the patient has given consent before you can disclose clinical information to a third party. This can be complex, particularly if the patient is a child or an adult without capacity, so don't hesitate to seek expert advice from the MDU if needed.
Timescale
Investigate and respond to complaints promptly. After acknowledging the complaint, if it seems likely there will be a delay in forwarding a full response to the complainant, you or the complaints manager should explain the reasons to them in advance and make sure they're informed of progress.
Professional response
Typed responses are more legible than handwritten ones. Use headed paper if possible or include your full work postal address and work phone number. Never use your personal contact details.
Identify yourself
Give your registered name and GMC registration number, and describe your relationship with the patient (eg GP, consultant, registrar, locum). If the complaint involved several doctors, make it clear how you were involved in the patient's care.
Who should the response come from?
If a complaint has been made to an NHS body, it is the responsibility of that body to respond. In which case, the response letter should be signed off by the person responsible for complaints in that organisation (who also takes responsibility for ensuring any lessons are learnt from the complaint).
If you are the subject of the complaint, you should have an opportunity to contribute to the response. You will probably be asked for either a statement of your involvement, or for a letter that can be sent on as part of the organisational response.
Writing in a style that addresses the patient as "you" can lend a more personal tone to your response. This sort of personalised response can be embedded into an organisational letter.
For example: "…as part of our investigation, we have asked Dr X to respond to your concerns and he has written the following account of his consultation:
'My name is Dr Y and we met at your consultation on 25 May 2022. I was very sorry to read about your concerns and I can understand this has been a very difficult time for you…'"
What to include when addressing the complaint
The response should be capable of standing on its own
Don't assume the reader has any knowledge of the case. Several people may read your response apart from the complainant, like their relatives or advisers.
Give a detailed report of the part you played
Include a factual chronology of events as you saw them, describing every consultation or telephone contact and referring to the clinical notes and your recollection of events if appropriate. Also include:
- relevant medical history
- your working diagnosis or your differential diagnoses
- your management plan and follow-up advice, including safety netting
- whether you saw the patient alone or with someone else
- that person's name and status.
Detail your account to the best of your ability
Say which details of your account are based on memory, contemporaneous notes or usual practice. No one expects you to make copious clinical notes of every last detail, nor will you be expected to remember every detail of a consultation that at the time appeared to be routine.
It's often helpful to mention features that you would have looked for as part of your assessment but did not find in this particular case. It's acceptable to quote from memory, but if you can't remember the details of a case, say what your 'usual' or 'normal' practice would have been in those circumstances.
Many complaints come from a misunderstanding, and a detailed description of the pathophysiology, or the usual treatment for a particular condition involved can help. Make sure to do this in a way the patient or complainant will understand. Avoid or explain medical terminology and abbreviations.
Respond to every concern
Address each point raised by the complainant, including your opinion of what happened and your reflections. Sometimes you can combine this with the chronology of events, but it's often better to include a chronology and then follow with a response and reflection to each point of concern. It can be helpful to mention any discussions you've had as part of your reflection on the case, and any personal learning points.
Complaints involving more than one clinician
If a complaint involves more than one clinician, or both social care and healthcare, it's almost never appropriate to give an opinion on the acts or omissions of a colleague, unless they are under your direct supervision.
Each clinician or care provider involved should comment on the parts of the case they were involved with, and it's usually best to combine the comments into a single response. If this isn't possible, the complaints manager's response should be written to help the complainant understand how the individual accounts relate to the complaint.
Say sorry where appropriate
Nobody can get it right every time. Medicine is a life-long learning experience and every doctor can learn something from every complaint. Complainants often simply want an apology and an assurance that what happened to them will not happen to anyone else.
Saying sorry is not an admission of liability. This is recognised in section 2 of the Compensation Act 2006, which says:
"An apology, an offer of treatment or other redress, shall not of itself amount to an admission of negligence or breach of statutory duty."
We would encourage you to say sorry, whenever you believe an apology is due - but take care to avoid 'hollow' apologies. For example, saying "I'm sorry you felt your care was not good" or "Sorry for any inconvenience" can sound insincere.
Enclose a printout of the clinical notes
It can sometimes be helpful to include photocopied notes with a complaint response. If you use handwritten notes or have recorded calls, this might include a typewritten transcript.
However, this should not be a substitute for writing out a chronology of events using language the complainant can understand. You could also offer to go through the notes with the complainant, if appropriate.
Don't alter the notes
This may sound obvious, but it can lead to more serious trouble than the original complaint. If the patient records have been amended because there was a mistake in the original, this should be clearly marked, dated and legibly signed. Similar procedures should be followed for electronic records, where alterations can be seen on an audit trail.
Read our case scenario here.
Analyse complaints
The practice or hospital is expected to analyse each complaint in order to learn, identify concerns and decide what action (if any) needs to be taken. It can also be an opportunity to identify good practice.
The response should include what you have done, or intend to do, to remedy the concerns identified and make sure the problem doesn't happen again.
Style
How you give your response is as important as what you put in it. Consider the following points to make sure your position is clear.
Avoid jargon or medical abbreviations
Many lay people will understand something like 'BP' for blood pressure, but something like 'SOB' for shortness of breath could be misinterpreted.
- Write all medical terms out in full.
- If you mention a drug, give an idea of what type of drug it is (antidepressant, antihypertensive, and so on).
- Also give the full generic name, dosage and route of administration.
Write in the first person
When reading about your part in the proceedings, the reader should have a good idea who did what, why, when, to whom, and how you know this occurred.
- Example: instead of saying, "The patient was examined again later in the day", it's far more helpful to say, "I asked my registrar, Dr Jim B, to examine the patient and the notes show that he did so."
- If your letter is going to be sent directly to the complainant, use the patient's name to give it a more personal tone.
You could also include an offer to meet the patient to discuss the report and answer any questions they might have.
Response sign-off
Finally, the response should be signed off by the organisation's responsible person, or someone authorised on their behalf.
The response letter should:
- answer the complaint
- explain how it has been investigated
- detail what action will be taken as a result
- clearly advise that the complainant can take the case to the Ombudsman if they are still dissatisfied and include information about sources of support.
Remember, most complaints are resolved successfully at the first stage, but a good response takes time and careful thought. It's worth the effort.
How we can help
Contact us for further advice if you've received or are involved in a complaint and are unsure what to do. We can help review your response before you send it.
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This page was correct at publication on 25/05/2022. Any guidance is intended as general guidance for members only. If you are a member and need specific advice relating to your own circumstances, please contact one of our advisers.