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How we took the pain out of patient complaints

New research shows complaints escalate if they are poorly handled in the practice ­ Dr Sohail Butt's practice is aware of the problem and has devised various strategies to cope

GPs have always found it upsetting and difficult to deal with complaints and there has been little training in this area. Furthermore, in the traditional model of general practice, complaints were seen as a personal rather than a practice issue. Considering most GPs have approximately 8,000 consultations a year, the one complaint a year the average GP receives seems very reasonable given the risk and complexity of consultations.

The key to changing how your practice handles complaints lies within a change of culture; stop dealing with them on a personal and emotional level and move towards a more businesslike customer care model.

This is what we have tried to do in my practice.

Since April 1, 1996, all practices have been obliged to have a practice-based procedure for dealing with complaints. Practices are advised to adapt procedures to meet their individual needs but they also have to meet certain national criteria as follows:

lprocedures are practice owned

lone person is nominated to administer the complaints procedure

lwritten publicity is available to anyone requesting it

lacknowledgement is normally given within two days

lexplanation is normally given with 10 days.

The new GMS contract offers three quality points if the practice conducts an annual review of patient complaints and suggestions to ascertain general learning points which are shared with the team.

Furthermore, GPs are being encouraged to use complaints and other feedback as material to help build up their personal development plans and contribute to appraisal and revalidation.

In my practice we have developed a number of practical steps to improve complaints handling.

We have a written practice-based complaints procedure that all the primary care team sign up to. It is important the complaints procedure is adhered to by all and we make sure it is. Guidance of a model procedure and useful forms are available from the Department of Health website www.doh.gov.uk/complaints/pbp-gps.PDF

We have appointed a complaints manager ­ in our case the practice manager ­ to administer our complaints system. We have also appointed a clinical lead for complaints ­ we call them the complaints partner ­ as some complaints require clinical input. At our practice the seven partners have been taking this role in turns for a year each. It has been useful to share this responsibility as it is quite time-consuming and stressful, but also a very useful learning experience for the complaints partner. It is the complaints partner's responsibility to deal with any clinical governance issues.

For difficult and complex clinical complaints we arrange a meeting between the complaints manager, the complaints partner and the primary care team members involved. This can be a useful way to establish the facts and agree a response. It also allows the people involved to get any emotions and concerns off their chest before we deal with the complaint in an objective manner.

The GPs and practice manager meet quarterly and look at the quarterly complaints and the outcomes.

This is an extremely useful exercise as it allows us to compare ourselves with our peers. It can also be a useful tool in changing behaviour. Since we have started to do this the number of complaints I have received has been reduced as I have tried to emulate my complaint-free partners.

The practice has organised a suggestions box in the waiting room. This has enabled patients to make suggestions that otherwise may have become complaints. It has also allowed us to assess how changes to appointments and other surgery systems have been received and to modify the systems where necessary. Our feeling is that this has reduced the number of complaints about administrative matters.

The patient survey we carry out annually allows us to focus on the general areas of dissatisfaction and encouraged us to make changes in certain areas such as GP access.

We have made education and training of reception staff a priority and next year we are encouraging members of the reception team to take a national vocational qualification in customer care. This should help improve how reception staff handle patient requests and complaints.

Dealing with complaints that have gone for further review by external agencies such as the PCT, health ombudsman or GMC is an emotionally taxing and time-consuming aspect of general practice.

Moreover I estimate the costs to practices of practice manager and GP time to manage complaints to be:

The time and costs of dealing with patient complaints can be minimised by adopting good procedures in the practice and I hope this is what we have done with our system.

Practice-based complaint - £100-£300

PCT independent review - £300-£600

Health ombudsman review - £400-£800

GMC/medicolegal case - £1,000-£2,000+

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