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At the heart of general practice since 1960

Adjudicator to rule on staff funding

Rob Finch finds GPs gravely concerned about a complaints system that is being tipped ever more against them

More patients than ever are complaining to the NHS about its

services. But a faster rising statistic must surely be the number of doctors and other NHS staff complaining about the way those complaints are being handled.

There can hardly be a doctor, manager or patient who believes the NHS complaints system is working.

GPs' faith in it is being undermined by a steady increase in trivial or vexatious complaints which drag on because PCTs are unable or unwilling to deal with them properly.

This increase, GPs believe, is being encouraged by ministers who constantly talk about giving patients more rights but say little about

patients' responsibilities.

Dr Jane Bowskill, a GP in Kingston, Surrey, says GPs were now 'paranoid' because of this shift.

She says: 'GPs are very much in the front line and whatever the problem we get the flak. The bullies and the shouters will always get their way. There's nobody with any teeth to deal with them.'

New complaints procedures introduced last year have, if anything, made the situation worse.

The reforms, intended to create a 'more patient-led system' essentially make it easier for patients to lodge a complaint and extend the amount of time they have to do so.

They are also supposed to speed up handling of cases and ensure more are dealt with locally.

But they have had the opposite

effect. The Healthcare Commission, which took over the second,

independent review stage of the procedure last July, has seen the number of cases treble. The commission has been overwhelmed, leading to a huge backlog and long delays.

Marcia Fry, head of operational development for the commission, blames PCTs for having 'sat on complaints' until it took over.

'The ideal is that no complaints come to us,' she says. 'Everyone tells us that what patients want is quick resolution at a local level.'

The Healthcare Commission has now threatened to name and shame PCTs unless they improve their

performance.

In the meantime it has had to fork out for a private contractor to tackle the backlog of 'low risk' cases, most of which could have been dealt with locally.

A further concern for GPs is the prospect of 'multiple jeopardy'

because of the numerous organisations to which patients can take their complaint (see above right).

This fear deepened at the start of this month when the National Patient Safety Agency took on responsibility for the National Clinical Assessment Authority as part of the Government's arm's length bodies review.

In her latest report, the Health Service Ombudsman, Ann Abraham, condemned this fragmentation and called on the Government to 'address the failings in the current system'.

Dr Melanie Wynne-Jones, a GP in Marple, Cheshire, says: 'Dealing with complaints is taking up more and more time, and with so many agencies involved it feels very threatening.'

She adds: 'I do believe in a complaints system for patients ­ I think it's very important ­ but there are dangers that it's going to divert GPs' time and also demoralise doctors. We shouldn't have to practise looking over our shoulders.'

At present, though, there is little sign of a change of direction from the Government.

It plans further amendments to the complaints system later this year after taking in the findings of the Shipman, Neale and Ayling inquiries.

One of Shipman Inquiry chair Dame Janet Smith's recommendations, for example, is that practices should have to act on complaints within two days. Medical defence bodies say such plans are 'ambitious' and 'impractical'.

Dr Stephanie Bown, head of medical services in London at the Medical Protection Society says: 'We recognise that from the complainant's

perspective the complaint is often a burning issue. To the clinicians, they want time to formulate a considered response.'

The Ombudsman has also warned against giving precendence to time targets over the need for a considered response to a complaint.

Dr Dermot Ryan, a GP in Loughborough, Leicestershire, says a consistent approach is needed.

Managers lurch from 'heavy handed' responses to 'bonkers, exaggerated and inflamed' complaints, to 'sluggish' reactions to more serious cases, he argues.

'Bureaucrats are what gets in the way of clinical care,' Dr Ryan says. 'Until clinicians take back control of the NHS we're going to see a downward spiral.'

GPs will hope the Government listens to their concerns, and those of the Healthcare Commission and the Health Service Ombudsman, before taking up the recommendations of the Shipman Inquiry and shifting the complaints system further in favour of the patient.

If they do not, Dr Wynne-Jones says patients will end up suffering as much harm as doctors.

'Patients' expectations have been so raised that there is a risk of them demanding instant attention that could disadvantage people with greater medical need.'

The many bodies that

can consider patients'

complaints

·GP practice

·PCT

·Healthcare Commission

·Health Service Ombudsman

·General Medical Council

·National Patient Safety Agency

·Police

·Civil courts

·The media

·Local MP/political parties

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