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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.