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Power to the PCTs under new complaints procedures

GPs may top opinion polls for trusted professionals, but ministers have still asked PCTs to drum up complaints from patients. By Gareth Iacobucci investigates.

By Gareth Iacobucci

GPs may top opinion polls for trusted professionals, but ministers have still asked PCTs to drum up complaints from patients. By Gareth Iacobucci investigates.

When Dame Janet Smith, former chair of the Shipman inquiry, told the BBC she believed that a determined and unscrupulous GP would still be able to get away with murder, the story made headlines in every national newspaper.

On the same day, a survey by Ipsos MORI, the Department of Health's pollster of choice, found that for the 25th year in a row doctors had been voted the professionals the public trusted most. But the media was not interested – such news simply does not sell newspapers.

In that same quarter of a century, GPs have seen at least four different NHS complaints procedures come and go, from independent complaints panels to the Healthcare Commission, while trust from the public has remained consistently above that for academics, judges, teachers and even members of the clergy.

MPs do not figure high in the list.

Yet in its determination to turn patients into customers, the Government is changing the system yet again, this time handing far more power to PCTs.

Trusts have been instructed not only to make the complaints system more accessible to the public but to actively encourage people to express grievances against their GP.

It would sound far fetched, if it wasn't true.

The new rules, to coincide with the launch of the new regulator, the Care Quality Commission, do not come into force until 1 April, but pilots have been up and running now in 25 PCTs for nearly a year.

The results make fascinating reading and some GP leaders are adamant they show PCTs are being given far too much power.

A survey by Pulse of five pilot areas and 23 non-pilot areas – covering more than 1,000 complaints – finds the complaints rate was over a third higher in the pilots, even though some so far only cover GPs employed directly by the trust.

There have been an average of 51 formal complaints in each pilot since the systems were set up in April 2008, compared with an average of 38 complaints in the non-pilot areas.

The findings also reveal subtle yet potentially significant differences in the nature of the complaints received.

The number of complaints over access – the Government's favourite buzzword – have leapt far faster than the numbers in general.

There were 77% more complaints about access in the pilot areas than in non-pilot PCTs, prompting GP leaders to claim the process is in danger of becoming hugely politicised.

The GPC also points out the Government is handing more power to PCTs just as a report shows their handling of complaints is at its most incompetent.

The report, by the soon-to-be defunct Healthcare Commission, is scathing of PCTs' ability to do the job. It claims half of complaints against GPs were mishandled by trusts and that their handling of complaints was the number one issue raised by complainants.

Under the new system, all patients will be given twice as long - up to a year compared with the current six months - to lodge complaint. The most serious complaints will be referred directly to the Health Service Ombudsmen.

Yet otherwise PCTs have been given pretty much a free rein.

The Government says it wants to remove rigid, ‘process-based' arrangements that restrict handling of NHS complaints and instead treat each case ‘according to the complainants' expected outcome'. The focus, it says should be on ‘swift, local resolution'.

The legislation not only allows patients to complain directly to their PCT but seeks to actively ‘encourage and empower [people to come forward with concerns'.

In one of the pilot areas, Heart of Birmingham PCT, the first Dr Vijayakar Abrol knew of the new system was through a call from his PCT informing him a patient had complained about him.

‘I've heard from a few doctors the PCT in certain circumstances has encouraged complaints,' he says.

‘When I heard it, initially I didn't believe it. But when the examples came up, I changed my views. The way complaints are coming, it's apparent there is some collusion with the PCT.'

‘I'm not suggesting we stop patients complaining, but procedures should be fair to both the person complaining and the person complained against.'

Dr Charles Zuckerman, medical secretary of Birmingham LMC, claims PCTs lack the experience or skill to take on the new responsibility.

‘The people involved in handling complaints don't really understand the regulations or the procedure. They can't even handle the existing complaints procedures – who knows what they're going to do with one which is probably going to be developed on the hoof.'

A spokesperson for Heart or Birmingham PCT says the trust ‘has not encouraged patients to make complaints' and has acted ‘in the appropriate manner'.

Samantha Warner, complaints and incidents manager for the trust, says there have been ‘no concerns raised by our GPs,' although Pulse has been contacted by GPs who privately claim they are already coming under far more scrutiny in a manner that is unfair to practices.

Dr Chaand Nagpaul, GPC negotiator, says issues which would previously have been cleared up by practices are now being formally recorded by PCTs under the new process, which he believes will unnecessarily escalate concerns over issues such as access.

‘There is always a risk, if the first point of contact is a third party, that complaints will develop a head of steam,' he warns.

The Department of Health admits PCTs have a lot to learn about handling complaints.

A spokesperson says: ‘The Healthcare Commission report underlines what we have known for sometime. Health care professionals need to listen to and learn from complaints.

‘We believe the new approach will help local organisations to work more in partnership, as well as encouraging a culture that seeks and then uses people's experiences of care to make services more effective, personal and safe.'

The spokesperson said the pilot findings had shown the new approach was leading to ‘real service improvements and more complaints being resolved locally'.

Dr Stephanie Bown, director of communications for the Medical Protection Society, points out it is not the first time changes in complaints procedures have caused anxiety in the profession, although she admits the switch to more PCT control could ‘open up the floodgates'.

‘Whenever we are looking at a change, it's understandable people should be concerned. We've had complaints reform time and time again.

‘Practices should be encouraged to make sure they've got their own ways of dealing with complaints, so as to keep PCTs where they belong, as a place to go if there is difficulty or if – for example - the complaint concerns a single-handed GP.

‘But it will take a lot of work to make sure it actually delivers.'

But the workload for many is not the main concern. The big question is whether complaints are not only to be resolved locally, but to be actively stirred up locally, as PCTs go about their latest orders from the Government with their usual mixture of enthusiasm and incompetence.

Who says what about complaints process?

‘Listening and responding to patient experience is at the heart of our work to improve quality. That is why the current complaints processes are being simplified to encourage patient feedback and make services, safer, more effective and personal.

Health minister Lord Darzi

‘It is concerning that around half of complainants received an inadequate response from the trust when they first complained. It is clear trusts are not always systematically learning from complaints and improving their services for the future.'

Anna Walker, chief executive of the Healthcare Commission

‘This is a shift to a more customer-focused process. People who will find it most difficult are the ones who are resistant to engaging with it. Be ready for this change.'

Dr Stephanie Bown, director of communications for the Medical Protection Society.

'It seems to be going back to the adversarial way we previously got rid of. I think the in-house procedure is working well, working with patients. Bringing the PCT back into it makes me full of dread. It will cause apprehension and concern, and will revoke resources, manpower and capacity which isn't there.'

Dr George Rae, secretary of Newcastle and North Tyneside LMC


How will the process change?
PCTs will take on a bigger role in handling complaints, with patients able to complain to trusts as well as practices. Complainants now have 12 months to complain rather than six. Second-stage complaints will now be referred directly to the Ombudsman rather than an external regulator.

When will the new system come in?
It is being introduced to coincide with the new Care Quality Commission from 1 April. All trusts are expected to implement changes to their complaints systems by this date, but are being given the flexibility to develop their own systems.

What will GPs have to do?
GP practices will have to send formal confirmation to PCTs of all complaints that are not resolved on the spot. Practices will also have to submit annual reports of the number of complaints received; a summary of complaints; whether they were upheld; any record of referral to Ombudsman; plus significant issues learned and action taken.

Rate of complaints one-third higher in areas trialling the new system

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