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At the heart of general practice since 1960

Complaints revamp will fail GPs

New plans for dealing with accusations against GPs won't fix the faults in the current system, says Steve Ainsworth

New plans for dealing with accusations against GPs won't fix the faults in the current system, says Steve Ainsworth

Confident and conciliatory, angry and unrepentant, bothered and bewildered. For more than 30 years I've observed the different ways in which GPs respond to complaints made about them.

But however a GP reacts to a complaint, none can find the experience pleasant. And a small number have found the process so distressing they have even taken their own lives.

There have been calls to change the way the NHS deals with complaints about GPs ever since the ink was dry on the act setting up the health service.

And now more change is in the air: the Healthcare Commission is to be shorn of its role in handling second stage complaints ­ those that GPs are unable to resolve locally.

In June the Department of Health launched a consultation paper ­ Making Experiences Count ­ outlining a new approach to dealing with complaints in health and social care.

According to the department, 'the new approach will make the whole experience of making a complaint easier, more user-friendly, co-operative and much more responsive to people¹s needs'. The consultationperiod closes on 17 October 2007.

A key component of this plan B is to remove the Healthcare Commission¹s responsibility for dealing with appeals from individual complainants and allow it to step back to take a broader view of complaints in general ­ while leaving the ombudsman to pick up the poisoned chalice.

Whether or not GPs will consider the proposed new arrangements 'easier, more user-friendly, co-operative and much more responsive to people's needs' remains to be seen. The ombudsman certainly can¹t do much worse than the commission.

A history of injustice

GP in-house complaints systems have been around for decades ­ informally since the 1970s, contractually since 1990 ­ but for complaints that could not be so easily resolved, more formal processes existed. These included: from 1948 Medical Service Committees, Independent Review Panels in the 1990s and most recently in the 21st century, review by the HealthcareCommission.

Sadly neither complainants nor GPs have been getting fair treatment. How could they, when through its entire existence the commission has only fully investigated half a dozen complaints?

Incredibly, on only six occasions has it chosen to convene any kind of panel to actually interview complainants and those being complained about.

All the many thousands of other complaints have been dealt with as desk exercises, with no opportunity for GPs to challenge the accusations made against them, or to be questioned themselves by experienced GPs.

The reason for this startling state of affairs is the vast and overwhelming number of complaints the Healthcare Commission found itself dealing with.

But though that may be an explanation, it does not excuse the disservice to both GPs and those who have complained about them.

But will handing over this task to the ombudsman make things any better?

Of the thousands of complaints made about NHS care, many are frivolous or vexatious, others result from obvious misunderstandings and still more can be resolved simply by inviting those complained about to try a little harder to explain themselves.

But each year there will always remain a few hundred cases that appear sufficiently serious to merit serious investigation.

The Healthcare Commission has failed to address these cases. If the task is passed to the ombudsman, it is likely that the ombudsman too will fail, and for the same reasons: the scale of the problem and its distance from the issues surrounding the complaint.

Patients need to see independent lay people undertaking investigations locally, and GPs need to be confident that such lay panellists are being independently advised by doctors drawn from a pool of real-life working GPs.

Anything less is surely an insult to both public and profession.

Steve Ainsworth qualified as a chartered secretary and as a member of the Institute of Healthcare Management. He has chaired NHS independent review panels and was a lay panel member and associate case manager with the Healthcare Commission. He is currently a lay reviewer for the Royal College of Surgeons

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