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Researchers call for overhaul of 'confrontational' NHS complaints process

Researchers have called for ‘significant changes’ to NHS complaints handling processes as evidence suggested the current system is 'unnecessarily confrontational'.

The study by academics at Imperial College London, published in BMJ Open, found just 6% of doctors described a complaint as a 'learning process', while around half felt negativity, powerlessness and emotional distress - all of which potentially impacts patient care.

One of the chief complaints and suggested improvements was addressing the lack of neutrality and transparency in inspections. The authors said that doctors feel ‘complaint processes do not offer procedural fairness'.

When respondents were asked how they felt complaints investigation processes could be improved, almost half called for them to be resolved within a shorter time frame.

Others wanted more neutrality in investigations, as these were often seen to favour the complainant. More than a third said there should be sanctions or some form of consequences for vexatious or baseless complaints.

The survey sampled 100 representative responses from more than 3,000 doctors who had received some form of complaint, or were currently going through complaint proceedings and completed the survey.

The major 'themes’ reported by doctors undergoing complaint were negativity towards those managing it and the complainant (48%), impotence and powerlessness (45%) and emotional distress (42%).

Ten per cent of respondents said that complaints had had an impact on their career, including one example of a GP principal who became salaried. Others reported becoming much more defensive in their practise.

Almost all of the respondents (93%) gave suggestions on how complaints investigations could be improved, with the authors saying they believe the majority of the suggestions were both ‘rational and deliverable’.

This included:

1. Greater transparency, neutrality and a more time-efficient procedure (41%)

2. A policy for vexatious complaints, baseless or unnecessary complaints (27%)

3. Improved open dialogue with patients and supervising bodies (23%)

4. More support for physicians during the process (14%)

5. Open, less formal approach (11%)

The study said: ‘Doctors in general wanted the processes to be reformed, not to be given support to deal with a system they do not appear to have confidence in...

'Currently it is not unreasonable to argue that there is a risk that rather than providing feedback and an opportunity to improve, complaints cause psychological damage to doctors and lead to worse patient care.

'Based on this study and our previous quantitative research we would suggest that significant changes must be made in a system that the evidence suggests is both unnecessarily confrontational and damaging to all parties.'

Lead author Professor Tom Bourne, from the Department of Surgery and Cancer at Imperial, said: 'The number of patient complaints against doctors has risen dramatically in recent years - with complaints against GPs doubling between 2007 and 2012. Yet this study suggests the complaint process causes huge distress for doctors, and may have a real impact on patient care.'

GPC deputy chair Dr Richard Vautrey told Pulse: 'These findings resonate very strongly with the experiences for every single GP, it’s very much a heart-sink moment when you receive a complaint and that can live with you, and eat away at you for weeks and months.

'There are situations where errors do take place, and where GPs would welcome a more supportive environment, learning from those situations and changing their practise as a result. We really need a no-fault compensation sort of arrangement, so it isn’t seen to be a blame culture, or about seeking financial compensation.'

Focus on resilience

The study comes as suggested improvements have tended to focus on support for GPs. The GMC pledged last year to introduce 'resilience training’ similar to that offered to soldiers in Afghanistan in order to be prepared for the 'occupational hazard’ of a GMC investigation.

This followed its investigation into 28 cases where doctors had committed suicide while under investigation by the GMC. The report also stressed the need to foster a culture where doctors feel they are innocent until proven guilty, and in April 2016 the GMC introduced further reforms which will spare GPs with mental health problems full investigation ‘wherever possible’.

But the Imperial College London study shows that when doctors themselves are asked, receving more 'support' is the suggestion of just 14% of respondents.

Readers' comments (9)

  • or leave the country . don't see System changing

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  • We need a culture change within our society for this to happen. It's not just doctors this happens to. The public love a good sacking whenever someone puts a foot wrong

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  • GMC v medical profession=confrontation
    CQC v medical profession=confrontation
    Government v Doctor=confrontation
    NHSE vs medical profession= confrontation
    CCG vs member =confrontation
    Patients and their ambulance chasing lawyers vMedical profession+what do you think eh?
    We are a profession under siege
    They want us to be underpaid ,superhuman ,over worked salaried minions who follow protocols.
    What do they expect.
    Those of us with an ounce of self respect with confront them until there is no profession left or there is no fight left in us.
    Or R.E.L.P. of course.

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  • Patients demands are increasing exponentially.Less funding by government.Doctors are taking the brunt.GMC,CQC are concerned about themselves as they fear their own collapse.The royal colleges are interested only in their membership fees.The trust is concerned about running the service.
    Also these days patients are after easy money.
    I think the whole system has to change particularly the culture of suing for financial gains.People at the top should start doing something before it gets too late.

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  • Our practice has a vexatious complainer with a fixed delusion about his care. Has been through Ombudsman - no case to answer but the CCG (delegated powers) & our MDO won't let us de-list him. Each new complaint has to be addressed, even though they are just variants of the same delusion. The workforce hours dealing with him must add up to several weeks. It is not the patient's fault - he is delusional. But the system enables him to waste NHS resources to no one's benefit.

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  • All complaints should be directed to the subject of the complaint in a personal letter first. If that does not resolve it, direct them to practice manager/ unit manager, then escalate via health authority, eventually to GMC if need be.
    GMC needs to offer service of inquisition and mentoring - perhaps at a cost to the subject of the complaint. Only f that does not resolve the matter is the legalistic approach needed.

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  • Fat chance. The UK is full of angry nasty selfish entitled 'I pay my taxes' brexity chavvy tossers.
    There should be no money in complaining or sueing its perverse.

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  • There are protocols being looked at by trusts in the NHS around vexacious complaints, which are wrong and time consuming.

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  • Posted last bit too early. I don't know anyone who has sued their GP, only people who have sued hospitals etc. Whilst some complaints are vexacious, actually many of them are not, and the experience I have of people who have raised issues at their GP surgery are that they have been told "This is the complaints procedure" when actually a 20 minute meeting with a member of staff would have sorted the issue out. Most people have jobs, families, homes, and are not nasty or angry generally (although they might be if treated by someone who has a very low opinion of them, which would come through in consultations. More than 50% of the population voted exit so I am pretty sure some of them were in the medical profession and I am also sure they are not all chavvy either. I agree the I pay my taxes bit is sometimes hard to swallow, but there is an element of something in there: it is taxes that fund the NHS, and I suspect its more a cry of frustration that a cry of I want my moneys worth

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