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At the heart of general practice since 1960

Co-proxamol ban is big mistake

If you receive a complaint, tell your defence body and get advice, say Roy Lilley and Dr Paul Lambden

Complaints are on the increase across the whole spectrum of health care. Most complaints received by GPs are dealt with within the practice.

Every practice should have a nominated complaints manager, usually the practice manager, and he or she should be skilled, trained and really good at handling problems. Only a relatively small number of complaints go on to become a claim or are lodged with the GMC.

Receipt of a complaint is an important event. It must be handled effectively. Some authorities say that complaints are good and should be treated as a learning exercise. Others think they are a nuisance to be cleared as quickly as possible. Whatever the viewpoint, a dissatisfied complainant can cause a lot of trouble for a GP.

Best practice suggests the following principles should always be adopted:

1. Keep your medical defence insurer informed The defence organisation medicolegal advisers are used to dealing with complaints. It is often the case that the person to whom the complaint has been directed is the last person to respond in a calm and rational manner. You should telephone the advice line to find out the best course of action. You should receive advice on the reply and a review of your draft response letter to make sure it uses appropriate wording. If you don't, change your insurer!

2. Do not ignore complaints

A complaint does not go away. Do not put it in a drawer and hope that you will not hear any more. You will, and next time it will be more aggressive and difficult to deal with.

Health care professionals are expert at talking to patients, especially when the patients are cross or upset. Unless there is a good reason not to talk to someone, it is well worth the effort. If you do, do so in a relaxed atmosphere, offer them a cup of tea, have someone present (a receptionist or practice manager) taking notes (and who will give a copy of the notes to both you and the patient afterwards) and talk through the problem. Talk through the strategy with the medical defence insurer beforehand.

3. Act quickly and speak to the patient The evidence is that a speedy response is much more likely to resolve a problem than a slow one peppered with delays. Although speaking to the patient is not ideal in every case, it is held that doing so may contribute to resolving the problem.

Talking to people ­ communicating ­ is what all health care professionals do and you should be very good at it. It is also important not to forget that complainants may have some justification for complaint and you never know, you might even learn something. However time-consuming meeting with a patient might be, it will probably be a lot quicker than the hours spent otherwise dealing with a protracted dispute.

4. Do not write aggressive responses Telling a patient what you think of them in a complaint response may make you feel better, but the feeling will be shortlived. The patient is likely to write again, this time more aggressively, and will also be more prepared to complain to others, such as the GMC.

If you are going to respond aggressively you must be sure you are absolutely right and that you have no regard for any consequences ­ such as regulatory body interest, bad publicity or damage to your reputation.

Take into account not only to whom the letter is written but also who else may see it. Although it may be addressed to an individual who has complained, the likelihood is that it will be shown to others: friends, relatives, Citizens' Advice Bureaux, etc.

The complainant may even agree (at least privately) with what you have said but it may not sound so good to others who were less personally involved.

5. Do not miss out difficult bits

It is often the case that a complaint letter raises a number of issues. Even if one or more of the matters is embarrassing or difficult, it is unwise to leave it out in the hope that detailed answers to more minor complaints will distract the patient from the key issue. It will not. You will simply receive a further letter specifically directed to the difficult complaint, which will then be more awkward to answer effectively.

6. A conciliator Sometimes complaints are complex or have many facets and they may become bogged down in a morass of correspondence that may become acrimonious. In such circumstances a conciliator may be very helpful.

Available through the PCT, the conciliator will seek agreement from both parties to be involved. He or she will then visit the complainant and establish the fundamental issues, visit the GP and explain the patient's concerns and seek answers from the practitioner and then return to see the patient, give the information and try to achieve a resolution. This is often successful in complaints that seem inexorable.

7. Don't get cross This is really the ultimate sign of failure. If you lose your temper everything will break down and the complainant may well pass the issue on to someone else. That 'someone else' may be the GMC or a really ugly lawyer.

8. Do not go to an independent review on your own If a patient successfully applies for an independent review of the complaint, you should not attend on your own. Take someone from your LMC, from your defence insurer, or a senior colleague.

Your 'friend' (who incidentally cannot be a solicitor) can watch out for your interests while you answer questions and can make sure that some amateur Perry Mason doesn't try to trick you into remarks that might have adverse consequences later.

9. The ombudsman may be a valuable resource If a doctor feels badly treated by an independent review an application can be made to the ombudsman to review the case. The ombudsman is not there just for the patient.

10. It's OK to say sorry Listening to a complaint, sympathising and saying sorry is a simple and effective way of diffusing criticism. 'I'm sorry you've had the pain', or 'I'm sorry you had to go through all that', is simple and sincere. You don't have to say you are an idiot and got it all wrong. It can be that your chosen course turns out to be wrong. If you've done your honest best, it is not the end of your professional world. If your decisions are reviewed by other GPs and they agree you've done your best and acted appropriately, just as they might have done, then your world will keep turning.

What you must do is to use your professional skills to make a reasonable assessment of the patient and to provide the standard of care an ordinarily skilled GP would have provided.

No one comes to work, intent on getting it wrong, but in the course of a GP's professional life, like any other profession, something will go wrong.

It is the measure of the person how they respond.

Top 10 tips for complaint handling

1 Keep your defence body informed

2 Do not ignore complaints

3 Act quickly and speak to the patient

4 Do not write aggressive responses

5 Do not miss out difficult bits

6 A conciliator may help

7 Do not get cross

8 Don't go to an independent

review alone

9 The ombudsman is independent

10 It may be OK to say sorry

This article is an adapted chapter from the book 'Making Sense of Risk management, a workbook for primary care' (second edition) by Roy Lilley and Paul Lambden, published by Radcliffe

Publishing Ltd

www.radcliffe-oxford.com

Roy Lilley is an independent health policy analyst, writer, broadcaster and former NHS trust chair

Paul Lambden

is a former

GP and NHS trust chief executive who now works at Howden Medical Insurance Services

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