How can we improve the complaints and regulatory system to benefit all?
In the final part of our series of articles on the complaints and regulatory process in general practice, Jaimie Kaffash discusses how we can make improvements that benefit patients and practices alike
This is the third and final part of the serialisation of our new white paper, supported by Medical Protection, on improving the complaints and regulation processes
It is clear that a strong complaints process benefits everyone. It gives patients the chance to provide constructive feedback and, where appropriate, have a form of redress. For practices, it can help them improve their processes and their care. It also prevents escalation – either to local commissioners, the ombudsman or even the GMC/litigation.
Yet pressures within general practice mean that not every practice is able to prioritise their complaints system, even though they acknowledge it would help. For many practices, it is another burden that needs to be added to their workload. The sheer volume of complaints means that something has to give, and practices may simply look to fulfil their legislative requirements.
Many would see issues around the management of complaints and their escalation as a symptom of the state of general practice, arguing that not much can be done without overall investment into general practice, with an increase in the number of GPs and practice staff. This is undoubtedly the case. But increased funding into general practice goes without saying, and it is a wider issue. Until funding into general practice is increased there are other changes that could be made – maybe sticking plaster solutions, but ones that could support patients and practices nonetheless.
Settling issues before they become full complaints
For non-severe complaints (such as those not involving fitness-to-practise issues, deficient processes, potentially criminal actions), it is widely considered that the best course of action is for feedback to be raised informally with a swift response that resolves the issue and changes systems where applicable. This is far helped when there are high levels of continuity of care and a practice culture that encourages feedback.
But this is dependent on adequate staffing levels – both administrative and clinical. At a time of pressure on general practice, and an increasing volume of complaints, this might slip down the list of priorities for practices, despite the benefits. While communications promoting such a culture would help, if there is no capacity to swiftly respond to feedback, promising such a culture without delivering is likely to exacerbate problems. And while practice managers know the importance of a strong feedback procedure, a focus on this might require focus being taken away from other important aspects of their role.
One potential solution might be for practices or networks to establish mini patient advice and liaison services, supported by local commissioners and staffed by people who have a customer service background. Again, this would require funding, which is scarce, but time saved for practices might make this worthwhile. It is likely that the move to a neighbourhood model will involve such a structure anyhow.
Appropriate triaging of complaints
One of the major issues is that practices are dealing with complaints that are not relevant to them. The legislation is clear that practices are under no obligation to deal with complaints that relate to secondary care or wider parts of the NHS. Yet, for practice managers, such complaints still take up valuable time – and it is often not as easy as a template letter. Many patients’ complaints are valid, if misdirected and – having had problems getting through to secondary care services – their GP practice is an option where they know they will get a response. Directing them to the right place through a template letter will be frustrating for patients.
While it is a good thing that patients are able to use any route to contact their practice, there are issues around allowing this. Similar to the October 2025 access changes – which required practices to allow patients to contact them on the phone, online or walk-in throughout routine hours – this doesn’t reflect the reality of modern general practice.
An online triage system for all written complaints would be able to direct patients to the appropriate organisation first time round, thereby reducing the sheer number of irrelevant complaints practices receive around wider NHS services. This will become all the more important with the expansion of advice and guidance (A&G), which will see GP practices retaining responsibility for cases they would have previously referred to secondary care – although this would also require clear lines of responsibility to be defined around A&G, which is essential in itself.
There would have to be provisions in place for patients who are uncomfortable with online services – but this is not an unusual concept, especially for government and NHS services.
Narrowing the scope of official complaints
Following on from an extra effort to resolve issues before they become complaints, and triaging complaints to the right place, there is a need to limit the scope of what counts as an official complaint, with the responsibilities for practices to respond within certain timeframes once new legislation is introduced. Currently, anything can count as a complaint, and this is part of the problem – the range of severity, relevance and justification for a complaint is completely variable.
But by narrowing the scope of complaints, there can be more quality resolutions. For example, this would involve a new framework in place that will determine whether there is an issue with systems or processes or communication, whether there are concerns around clinical care – fundamentally, whether there are learnings that could take place. Such a framework would require careful consideration, but a commitment to such a framework in the new reforms will be welcome.
Mitigating the effects of technology
Patients’ ability to provide the type of complaints that will lead to better processes or safer processes is essential. However, practices – and, ultimately, patients – would benefit from mitigating the effects of AI and unofficial public complaints channels, such as social media and Google reviews.
The use of AI is an issue for many public sector organisations. GP practices, being smaller than most, are particularly affected. GPs and practice managers say that letters that used to be less than a page are now seven pages, with inaccuracies and potential legal threats. While it is impossible to stop people from using whatever means they want to help their writing, some of the effects can be mitigated – for example, by imposing a word limit on complaints, or for the online complaints triage tool suggested above to have a proforma.
At the same time, while freedom of speech precludes any action around social media, there should be a ban on Google reviews of GP practices in the same way there are for schools. There is a downside for practices, in that some benefit from positive reviews; but, like schools, GP practices are not normal businesses. A GP may be unpopular with a patient for not prescribing certain medication in line with clinical guidance – this kind of interaction does not exist in normal customer services.
There are also so many official ways for patients to provide feedback on services – such as the Friends or Family Test, or the GP Patient Survey, which presents feedback in the aggregate. A lightly moderated public forum for patients to rate their GP practice is not in the best interests of patient care.
A new approach to fitness to practise
The threat of a GMC investigation and litigation is leading to GPs practising defensive medicine – which is harmful to patient care. The GMC is undoubtedly making efforts to improve the process for all doctors, but GPs say it is not going far enough. There is still fear around receiving the letter from the GMC, and – despite efforts to improve the language – they tell us that the letters still carry a presumption of guilt.
There have been cases where sanctions against doctors have seemed misplaced, such as the cases of Dr Hadiza Bawa-Gaba and Dr Manjula Arora. But, on the whole, the major concerns for GPs around the GMC’s processes are not about who is removed from the register or facing other sanctions, because they are relatively uncommon. The problem is that it the processes don’t acknowledge that the vast majority of those investigated lead to no sanction whatsoever. In other words, the GMC should be moving to a presumption of innocence and this should be the starting point of the whole process. The regulator has been moving closer to this, but there is still a way to go.
The positive aspects of complaints and regulation reform is that all parties are more or less in agreement of what would be beneficial. Patients being able to provide feedback that improves patient care, with swift responses that do not necessarily need to go through formal channels, with only those whose practice is unsafe (or criminal behaviour) facing the full brunt of the regulatory organisations. Such a system is achievable. Of course, to truly create a system that is constantly improving, what is needed is adequately funded general practice. But, in the continued absence of that, reform will go some way to help.
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