AI, A&G and Amazon Prime: Why patient complaints are growing

A new white paper from Pulse and Management in Practice is looking at how we can reform the complaints and regulatory systems, with practices struggling to stay on top of complaints and GPs warning that they are practising defensive medicine out of fear of them being escalated. In the first part of the serialisation of the report, Jaimie Kaffash asks why complaints are increasing

The white paper is supported by Medical Protection

There has been an increase in complaints in general practice. NHS England figures show a 71% rise in complaints from 2020/21 to 2024/25. This wasn’t a consequence of a dip during Covid – the number of complaints were relatively flat from 2016 to 2021 (see Chart 1). 

Some of this increase is due to genuine patient grievances as a result of the pressures in general practice. This could be access problems, which are getting worse (even if the blame should be on the continued underfunding of general practice). These pressures also mean that what may have been minor issues are not being addressed in time within the practice, and are subsequently becoming official complaints and perhaps even being escalated to local commissioners, the CQC or even the GMC.

Such complaints are, sadly, a symptom of a broken system. And, while GPs and their teams would be justified in arguing that these are systemic issues that practices only have limited ability to address, it is of little surprise that patients are more likely to raise this.

Chart 1: Total written complaints about GPs

But there are also an increasing number of complaints that are not related to worsening standards of care in their practice. Some complaints are due to GPs being the ‘lighting rod’ of the NHS’s problems, facing the brunt of patients’ frustrations with secondary care, for example. But some are due to wider societal issues that are lowering the threshold around what patients will complain about.

A&G and secondary care pressures

Pulse’s survey reveals that practices are increasingly dealing with complaints that are about hospitals or other parts of the NHS – complaints that might meet normal thresholds, but are not relevant. Of the 822 GPs who responded, 80% agreed (with 42% strongly agreeing) with the statement that ‘the number of complaints made against GPs that are really about secondary care or community care issues is increasing’.

Chart 2: ‘The number of complaints made against GPs that are really about secondary care or community care issues is increasing’

As one GP put it: ‘What I certainly have noticed increasingly are complaints or criticism of hospital services – especially long waiting times but also poor communication regarding appointments and, sadly, the perceived attitude of some of the medical staff. This can result in me having to contact secretaries or medical staff and also spending time explaining hospital letters.’ Another had a similar sentiment: ‘Often complaints are brought against practices due to poor performance of other areas of the NHS, mostly secondary care, but also the ambulance service and out of hours care.’

Rebecca Curtayne, external affairs manager at Healthwatch and author of its report on complaints, says that this is in part due to a lack of information: ‘A lot of those complaints should be going up to the ICBs. Patients don’t get it that they can complain to the GP or the ICB. They don’t always have to go to the practice if they don’t want to.’

Trusts also have their own patient and advice liaison service (PALS) – although GPs told us that they are hearing more reports from patients about a lack of response from these organisations. One GP said: ‘The reason we get a lot of complaints is that GPs are seen as part of the same system. We’re seen as someone they can access. Some of our local hospitals, you can’t find the contact number, PALS services are now overwhelmed. If they do have a complaint and they want to take it to secondary care, they give up.’

There is a lack of support from local commissioners, too. One practice manager told us: ‘I had a recent example where the patient wrote in desperation to the ICB to help her but they passed it back to the surgery. The patient isn’t frustrated with us but wanted the ICB to find out what the hospital has done with her referral.’

In England, the expansion of advice and guidance is set to exacerbate these problems. With general practice set to retain responsibility for services they would not have done in the past. More than 80% of GPs agreed that this is likely to lead to more complaints – with 51% strongly agreeing (Chart 3).

Chart 3: ‘The increase in the use of advice and guidance/rationing of referrals is likely to lead to more complaints against GPs’

As one GP put it: ‘In the current climate this is increasingly problematic with both referrals and radiology requests being screened by secondary care and many are refused. This ends up taking even more time explaining to a demanding and unhappy patient why we can’t do as we have been asked.’

Amazon Prime culture

While these complaints might not be relevant to general practices, GPs acknowledge that they tend to reflect issues around the quality of care that would always have elicited complaints. However, GPs and practice managers tell us that there has been a lowering in the thresholds of what constitutes complaints.

One of the main observations is that there is a growing societal blame culture, and people are becoming accustomed next-day, ‘Amazon Prime’ services.

One practice manager says: ‘There has been a noticeable increase in complaints over recent years. In my experience, many complaints now come from patients aged between their 20s and 40s, or from relatives advocating on behalf of older family members. Expectations around access and response times have increased significantly, and complaints are often regarding relatively minor issues. In some cases, elderly patients themselves appear uncomfortable with the complaints being raised on their behalf.’

Another says: ‘There’s been a definite increase in complaints post Covid. There are noticeable increases following negative media or when the Government unhelpfully announces things to the press and that is the first we hear of it.’

Others have raised the issue of politicians perpetuating a blame culture, raising patients’ expectations with false promises and giving them a licence to criticise the health service with their own damning remarks. One respondent cites Prime Minister Keir Starmer’s September 2024 speech that the NHS must ‘reform or die’ as such an example. Another practice manager said they had seen a spike in complaints in the last eight months, adding: ‘The patients’ expectations of what services we provide have gone up, to the point we’re getting more bits of feedback and complaints. Internally when we talk about it, we do link it to Wes Streeting making the comment that you should be able to contact a GP in the same way that you order a pizza.’

AI-generated complaints

Another new trend identified by GPs and practice managers is the use of AI in composing complaints letters. There are, of course, benefits for this in giving patients who may not have been able to provide feedback before the opportunity to do so. But it has also had the effect of lowering the threshold for what patients will complain about.

If you were to type in ‘complain about a GP being dismissive’ in ChatGPT – one of the most popular AI tools – it will generate a full page complaint letter in less than 10 seconds. Respondents told us that AI is both increasing the volume of complaints and making individual complaints letters longer, more complicated and even more time-consuming to respond to.

One practice manager says a typical three-quarter page letter would be seven pages if generated by AI. Unsurprisingly, respondents also told us that the details in these letters were often inaccurate. Some also contain legal threats which mean practice staff have to spend much more time responding to them and running it past their medical defence organisations. One respondent says a GP partner had recently spent three days reviewing and responding to an AI-generated complaint. Another respondent says AI is the ‘biggest threat’ to their ability to handle complaints due to the increasingly workload.

Lee Bennett, strategic complaints lead at NHS England, who trains practices on the complaints processes, says his team are doing work on AI: ‘Some patients are using it to write their letters and respond to the letters that they get from practices. This is proving quite a challenge across the NHS and other government bodies. It’s making some of the complaint letters overly complicated, confusing and in some cases inaccurate.’

As a response to this trend, the Ombudsman has put a statement on its website that suggests useful prompts as a way of preventing complex letters.

Professor Victoria Tzortziou Brown, president of the RCGP, says: ‘Technology, including AI, may make it easier for patients to raise concerns and improve accessibility for some people, but there is also a risk that it could increase the number of complaints made in the heat of the moment or without full context. Complaints processes still require careful human judgement, and it’s important that concerns are considered fairly, proportionately and on an individual basis.’

Technology has also allowed an increase in unofficial complaints through social media, with Google reviews being a particular issue for practices.

One practice manager says: ‘We find Google reviews to be quite unhelpful at times. They turn into an anonymous forum for complaining, often with comments that are unreasonable but don’t violate Google’s terms and conditions. They also tend to mean that the patient or patient’s representative aren’t actually following the practice’s complaints procedure, which doesn’t help anyone.’

They are ‘more hurtful’ than official complaints, says one GP: ‘I see Google reviews as negative because if a doctor is named on a public platform or social media because, it is professional defamation as anyone can read those. I think they feel a lot worse and are more hurtful than a regular complaint made directly to the practice, simply because it’s on the internet (a public platform) for all to see. I feel that practices should not allow Google reviews – like schools do in the UK.’

Workload implications

This is having an effect on practice workload. A survey by Pulse and our sister magazine Management in Practice of GP partners and practice managers reveals that practices were spending an average of 3.4 hours a week dealing with complaints. But nearly one in five says complaints were taking up more than five hours a week of practice time (Chart 4).

Chart 4: How much time does your practice spend on dealing with patient complaints per week?

One practice manager says: ‘Complaints can be quite demoralising for staff who are already experiencing low morale working in general practice. Complaints are also at times very time consuming and can lead to other work having to be bumped off the agenda. There is also quite a bit of anxiety about complaints escalation – if a patient is unhappy with the response to a complaint, they can choose to take their complaint to NHS England or even the parliamentary ombudsman. This can be very stressful for individuals named in a complaint.’

However, there is another way of looking at this, says Lee Bennett of NHS England: ‘I encourage practices to say thank you to a complainant when acknowledging their complaint. Practices might not feel grateful for a new complaint but when I remind them that a patient could opt to go to the GMC under fitness to practise rather than through the local complaints process, use social media (which is very difficult to respond to publicly) or raise a concern with the CQC.

‘Surely it’s better for practices to have a chance to repair a relationship locally through the complaints process and many practices understand this when we talk it through at the training?’

In the next part of this series, we will look at how the threat of complaints is leading some GPs to practise defensively.

Read our white paper on complaints in general practice in full – download your free copy today