Receiving an angry complaint from a patient or their family which questions your care or actions can be very distressing, particularly when you feel you had done everything possible for the patient. You must acknowledge a formal written response within three days of receiving it, but it pays to write a careful response.
A considered response, perhaps with input from an objective colleague, is more likely to lead to successful resolution for you and your patient. There are three aspects to a good complaint response – Appearance, Content and Tone (ACT).
A well laid out letter with clear, consistent formatting and grammatical accuracy will give the complainant a good first impression before they have even read the content. Make sure you have clearly defined paragraphs and no spelling errors. A professional response should have a professional appearance.
The elements of a good complaint response letter are:
An opening paragraph which places the complaint in context; expresses sentiments of regret and acknowledges the patient’s feelings of distress as a result of what happened, regardless of whether the complaint is justified or not. If the patient has died then condolences should be offered.This is important as the first paragraph sets the tone for the rest of the letter.
A summary of the main issues the patient or their family have raised in their letter.
What action you have taken to investigate the complaint (e.g. spoken to the staff concerned, reviewed records/policies.)
A clear explanation in response to each of the issues raised – what happened and why. When referring to any consultations it is advisable to include:
- The date, the history and symptoms presenting;
- Any examination carried out and the findings;
- Any working diagnosis, your advice, treatment and suggested or arranged follow up;
- Clinical terms and abbreviations should be explained.
Do not include notes of a consultation copied directly from the patient’s records rather than written in a narrative form. This could cause confusion, particularly if contains acronyms, and lead to further questions.
Consider the matter with hindsight and draw conclusions, which, if possible, should be evidence-based with reference to clinical guidelines, where appropriate.
Identify any failings, apologise for these and provide details of any changes that have been made to reduce the risk of the issue happening again.
An invitation to meet or contact you again if they have any further questions.
Details of redress through the next stage of the complaints procedure to the Ombudsman and their right to use the NHS complaints advocacy service.Details of the NHS Complaints Advocacy Service must be offered to the complainant so they can seek the independent support and advice they may need to take their complaint forward. This is also of benefit to practices when dealing with more complex or challenging cases
A reiteration of your apology for what occurred. There is no need to be reluctant to apologise – an apology for the distress caused or for a misunderstanding is not necessarily an admission of fault.
Do not suggest that patients consider moving to another practice – this could be seen as ‘constructive removal’ (when a patient feels pressurised to move practices unnecessarily and inappropriately without following the correct removal procedure).
A full response covering all the main elements can fall at the final hurdle if the tone is defensive and confrontational.
It is our experience that an objective and conciliatory response can defuse a situation and prevent protracted correspondence and escalation to the Ombudsman or even a claim. It may also be worth bearing in mind that the Ombudsman would class a defensively worded complaint as poor complaints handling and thus maladministration, which can attract criticism.
What wording should you use?
You may want to say: ‘I refute the allegation that I did not take you seriously.’
It would be better to say: ‘I am so sorry if I caused you to feel that I had not taken you seriously, and the distress you have experienced as a result. I can assure you that it was not my intention to cause you additional anxiety. Your feedback has given me the opportunity to reflect on the way I handled the consultation. However, I hope this letter has reassured you that I did act appropriately given the symptoms presenting at the time.’
You may want to say: ‘I have to say that I feel that most of the problems that have arisen are as a result of your own demanding and intimidating behaviour towards myself and my staff.’
It would be better to say: ‘At times I have found your approach to myself and the staff quite difficult to manage and, whilst I can understand that when patients are unwell and feeling distressed it can reflect in their manner. I do hope that this is something that you too could reflect on.’
Terri Bonnici and Sue Taylor are medical complaints advisers at the Medical Protection Society