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At the heart of general practice since 1960

Dreading that first inevitable complaint in general practice? GP trainer Dr Tanvir Jamil offers reassurance

Take if from me. When you get your first complaint (and it is a matter of when, not if) you will feel awful, frustrated, unappreciated and even a little afraid.

We live in an increasingly litigious world with spiralling patient demand.

 · Grievances against GPs last year rose 12 per cent.

 · The future looks bleak ­ with predictions of at least a three-fold increase in complaints over the next decade.

 · Three-quarters of all complaints are over the way clinical decisions are made and communicated to patients and relatives.

While 'experts' say these figures suggest the NHS is giving a worse service, they also point out patients are getting more assertive and finding it easier to complain.

Complaints may range from the trivial ­ refusing to prescribe antibiotics for a two-day viral illness ­ to the serious, such as refusing a visit that resulted in the patient becoming more ill.

What to do

Talk to somebody, ideally one of your senior partners. They will have been through this situation before and can advise you accordingly. Most complaints are first dealt with by an 'in-house' procedure that falls within our terms of service:

lacknowledge a complaint within three days of receiving it

lprovide a summary of the 'investigation' within 10 days

ladvise the patient of their right to take matters to the PCO within 28 days if they are not satisfied.

Good news is the vast majority of complaints can be dealt with satisfactorily this way. Most patients just want an apology for a genuine mistake and want to know if their complaint has made a difference to the way the practice and you organise yourself.

Take a few days to settle before you write the letter. Be conciliatory, not adversarial. Try to put yourself in the patients' shoes.

Is their complaint understandable? I often start off by saying something like 'Dear Mrs Jones, I'm sorry you were upset after your daughter's illness and felt that you had to write in.' This has a calming effect on the complainant and the doctor and starts to rebuild their relationship.

Talk about the problem, giving all the facts ­ remember to refer to the notes and gives dates and exact times if you can. I also explain practice procedure and what is 'normally' done.

If you got it wrong this time ­ why not admit it? Say what you and the practice have learnt and what changes, if any, you will make.

Remember to show the letter to a senior partner and get their opinion. You should also contact your medical defence organisation. They will read your letter and advise if appropriate.

If you feel a complaint was unjustified (refusing a home visit to a child with earache) be conciliatory and sympathetic but explain practice procedure and why you follow it.

When you don't want to say sorry

Sometimes you will feel there is no way you want to apologise. Why should you? Most doctors would have done what you did and what's more there is evidence to prove what you did was correct.

At times like these you have to ask yourself: do I swallow my pride a little, apologise and let the matter rest there, or shall I stand my ground and risk the patient taking it further, generating reams of paperwork for months on end? Only you can decide.

Occasionally the patient may take the complaint to the PCO. It will write to your trainer (as its contract is with them). Both of you should contact your medical defence body.

They are incredibly supportive and will advise you on all matters legal and medical pertaining to the case. The LMC and the BMA also provide useful advisory roles.

If you are unlucky, the complaint may go further to an independent review, ombudsman, reference committee or even the GMC. Sometimes a patient will go straight to a lawyer who may write directly to you or via the senior partner.

From April 2004 the new Commission for Healthcare Audit and Inspection will take over this process.

How to avoid complaints

The best way of dealing with a complaint is of course not to get one in the first place. So how do you minimise your chances? Here are some helpful suggestions.

 · Always be polite: if you make a mistake patients will probably forgive you.

 · Keep good contemporaneous notes ­ especially if you refused to visit or refer.

 · Never write anything in notes you would not want the patient to see.

 · Never alter notes.

 · If a patient is angry, listen carefully and follow up with a full explanation and, if necessary, an apology.

 · Never criticise other doctors.

 · If a hospital doctor has commented

on your medical care or competence, don't take the patients' word for it ­ talk to the doctor or his consultant and get the facts.

 · Commonest complaints are due to failure to visit, failure to refer, failure to diagnose and poor communication to patients and patients. Make sure your clinical skills are up to date and that you have a system to avoid forgetting referrals and informing patients of abnormal results. Always try to involve patients (and relatives ) in management decisions ­ remember your MRCGP videos.

 · An apology can go a long way to ending a complaint and carries no admission of guilt.

 · Seek support early from partners and defence organisations.

Always be polite ­ if you

make a mistake patients will probably forgive you.

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