Q1. Do we need to rewrite our complaints procedure after 1 April or can we use the current one?
You will need to check that your procedures comply with the new Regulations and the guidance and principles issued by the Department of Health and the Ombudsman.
It is also suggested that you make sure ALL staff within the practice are aware of the new process. Your PCT may be able to help with training.
Click here to access the Regulations
Click here for the Department of Health guidance
Click here for the Ombudsman's principles of complaints handling
Paragraph 3 (in relation to arrangements for the handling and consideration of complaints) of the Regulations states:
- Each responsible body must make arrangements in accordance with these Regulations for the handling and consideration of complaints.
- The arrangements for dealing with complaints must be such as to ensure that -
- complaints are dealt with efficiently;
- complaints are properly investigated;
- complainants are treated with respect and courtesy;
- complainants receive, so far as is reasonably practical -
- assistance to enable them to understand the procedure in relation to complaints; or
- advice on where they may obtain such assistance;
- complainants receive a timely and appropriate response;
- complainants are told the outcome of the investigation of their complaint; and
- action is taken if necessary in the light of the outcome of a complaint.
Flexibility is the key to the new complaints handling procedures and members may find it helpful to review Ombudsman's publication Principles of Good Complaint Handling. In summary, the six principles are:
- getting it right
- being customer focused
- being open and accountable
- acting fairly and proportionately
- putting things right
- seeking continuous improvement.
Q2. What do the various terms in the Regulations mean?
Within the Regulations:
- Responsible body means a local authority, NHS body, primary care provider or independent provider.
- Primary care provider means a person or body who is a general dental services contractor or provides primary dental services in accordance with arrangements made under section 107 of the 2006 Act.
- NHS body means a Strategic Health Authority, a Special Health Authority or a Primary Care Trust.
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Q3. Who is responsible for the practice complaints procedure?
Paragraph 4 of the Regulations (in relation to responsibility for complaints arrangements) states that:
- Each responsible body must designate -
- a person, referred to as a responsible person, to be responsible for ensuring compliance with the complaints arrangements, and in particular ensuring that action is taken if necessary in the light of the outcome of a complaint.
The responsible person is to be - - the person who is the sole proprietor of the responsible body;
- where the responsible body is a partnership, a partner; or
- in any other case, a director of the responsible body, or a person who is responsible for managing the responsible body.
This could be the practice owner, or a partner in the practice, or in the case of a corporate the manager of the practice. The Regulations focus on not only responding to complaints but also learning from complaints and members will be aware that this is something which Dental Protection has already been advocating as a matter of risk management. This also fits comfortably with the Ombudsman's view in "Principles of Good Complaints Handling" that complaints should be should be part of the process resulting in continuous improvement by:
- Using all feedback and the lessons learnt from complaints to improve service design and delivery.
- Having systems in place to record, analyse and report on the learning from complaints.
- Regularly reviewing the lessons to be learnt from complaints.
- Where appropriate, telling the complainant about the lessons learnt and changes made to services, guidance or policy.
In looking at complaints there are two separate issues. The first is that of managing the patient's concerns in terms of the focus of the complaint. The second is having the appropriate audit loop in place so that all of those involved in the complaint can learn from it. A patient needs to be informed of any changes which have been made and the loop could be closed effectively when the patient receives notification of changes which have been made as a result of their input. This may also have the effect of enhancing the relationship between the patient and the practice.
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Q4. Do we need a complaints manager?
Paragraph 4 of the the Regulations (in relation to responsibility for complaints arrangements) states:
- Each responsible body must designate a complaints manager, to be responsible for managing the procedures for handling and considering complaints in accordance with the arrangements made under the Regulations. The complaints manager may be -
- a person who is not an employee of the responsible body;
- the same person as the responsible person;
- a complaints manager designated by another responsible body.
The complaints manager may be the practice manager, one of the dentists or another suitable person. The complaints manager and the responsible person can also be one and the same person. It may be helpful if the complaints manager is someone who is normally present in the dental practice so that any verbal complaints captured can be resolved at an early stage. Patients can become dissatisfied when they ask to speak to the appropriate person, only to be advised they are not available. Accessibility and availability of the complaints manager are important factors, as are the appropriate complaints handling and communication skills.
Some practices have more experience than others in handling complaints. Small practices may not have a team member who is best suited to be the complaints manager. The old system of the dentist's spouse carrying out this role may be unsuitable in some circumstances and there is nothing to prevent practices from grouping together to share a complaints manager, provided that they ensure the issue of accessibility and availability is addressed. Some LDCs may also be able to assist with this.
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Q5. Who can complain?
Paragraph 5 of the Regulations states:
- A complaint may be made by -
- a patient who receives or has received services from a responsible body;
- a person who is affected, or likely to be affected, by the action, omission or decision of the responsible body which is the subject of the complaint;
- someone acting on behalf of a patient who is unable to make the complaint themselves or who has requested the person to act on their behalf.
- Where a representative makes a complaint on behalf of a child, the responsible body to which the complaint is made -
- must not consider the complaint unless it is satisfied that there are reasonable grounds for the complaint being made by a representative instead of the child; and
- if it is not so satisfied, must notify the representative in writing, and state the reason for its decision.
Within the regulations "child" means an individual who has not attained the age of 18. This does not fit with the legal definition in which a person attains their majority at the age of 16. The dentist in considering the situation may also wish to consider the competence of the child and whether it is appropriate that any response is provided to them, with perhaps the invitation that they share it with the complainant should they wish to do so.
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Q6. Can a patient complain to the PCT?
Paragraph 7 of the Regulations (in relation to complaints about the provision of health services) states:
- This regulation applies to a complaint which is -
- made to a Primary Care Trust in accordance with these Regulations on or after 1st April 2009;
- about the services provided by a provider under arrangements with the Primary Care Trust; and
- not specified in regulation 8(1).
- In this regulation, "provider" means an NHS body, primary care provider or independent provider.
- Where a Primary Care Trust receives a complaint to which this regulation applies-
- the Primary Care Trust must ask the complainant whether the complainant consents to details of the complaint being sent to the provider; and
- if the complainant so consents, the Primary Care Trust must as soon as reasonably practicable send details of the complaint to the provider.
- If the Primary Care Trust considers that it is appropriate for the Primary Care Trust to deal with the complaint-
- it must so notify the complainant and the provider; and
- it must continue to handle the complaint in accordance with these Regulations.
- If the Primary Care Trust considers that it is more appropriate for the complaint to be dealt with by the provider, and the complainant consents -
- the Primary Care Trust must so notify the complainant and the provider;
- when the provider receives the notification given to it under sub-paragraph (a) -
- the provider must handle the complaint in accordance with these Regulations; and
- the complainant is deemed to have made the complaint to the provider under these Regulations.
The patient can complain to the Primary Care Trust or to the practice. Where a patient complains to the Primary Care Trust, the PCT must ask the patient if they consent to the complaint being passed to the provider. This is a change to the previous procedure where complaints were automatically forwarded to the practice. However if the patient does not agree to their complaint being passed to the practice, or if the Primary Care Trust considers that it is appropriate for the PCT to deal with the complaint then the PCT will investigate the complaint and respond to the complainant.
It would therefore be helpful if the practice is in a position to demonstrate to patients that their complaints procedure is simple, clear and accessible and that complainants will be listened to and that complaints will be handled fairly, promptly and sensitively. Patients need to know that the practice will acknowledge mistakes and apologise where appropriate, and provide prompt, appropriate and proportionate resolution. Patients may be reassured to know that their comments and feedback will used by the practice in its process of continuous improvement and that, where appropriate, the complainant will be advised about the lessons learnt by the practice and changes made as a result.
More practices may find it helpful to have a feedback system in place so that patients can choose to use this to be heard rather than feeling that they need to make a verbal or written complaint about some issues in the practice. Patients may be reassured if they know that the practice will review feedback appropriately at regular intervals.
In addition to this it is not yet entirely clear how the Ombudsman will deal with complaints. However they will expect the practice to demonstrate that they have an appropriate complaints procedure in place and that they have followed the procedure appropriately.
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Q7. What if the patient makes a verbal complaint?
Paragraph 8 of the Regulations states:
The following complaints are not required to be dealt with in accordance with these Regulations -
- a complaint which is made orally and is resolved to the complainant's satisfaction not later than the next working day after the day on which the complaint was made.
- a complaint which has previously been investigated.
This can have the effect of speeding up and simplifying the complaints procedure, particularly if a practice has the complaints manager who is available and accessible to patients. Very often taking the time to sit down and listen to a patient goes a long way to resolving their concerns. This requires the complaints procedure to be well publicised, the team to be fully aware of the procedures, and the complaints manager to be available and accessible.
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Q8. Is there a time limit for the patient making a complaint?
Paragraph 12 of the Regulation states:
- Except as mentioned in paragraph (2), a complaint must be made not later than 12 months after -
- the date on which the matter which is the subject of the complaint occurred; or
- if later, the date on which the matter which is the subject of the complaint came to the notice of the complainant.
- The time limit in paragraph (1) shall not apply if the responsible body is satisfied that -
- the complainant had good reasons for not making the complaint within that time limit;
and - notwithstanding the delay, it is still possible to investigate the complaint effectively and fairly.
The time limit may be waived by the subject of the complaint. This may be fair if the complainant has genuine reasons for being unable to raise a concern within the appropriate time period. If the responsible body believes that the complaint is still able to be investigated it should do so and this fits with the view taken by the GDC.
In addition to this the Regulations do not indicate a time limit for the patient taking their complaint to the Ombudsman, or a time limit for the Ombudsman to investigate and respond.
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Q9. I've received a complaint - do I need to acknowledge it?
Paragraph 13 of the Regulations states:
- A complaint may be made orally, in writing or electronically.
- Where a complaint is made orally, the responsible body to which the complaint is made must -
- make a written record of the complaint; and
- provide a copy of the written record to the complainant.
- Except where regulation 6(5) or 7(1) applies in relation to a complaint, the responsible body must acknowledge the complaint not later than 3 working days after the day on which it receives the complaint.
- Where paragraph (5) of regulation 6 applies, and a responsible body ("the recipient body") receives a complaint sent to it by another responsible body in accordance with that paragraph, the complaint must be acknowledged by the recipient body not later than 3 working days after the day on which it receives the complaint.
- Where regulation 7(1) applies to a complaint-
- the Primary Care Trust which receives the complaint must acknowledge the complaint not later than 3 working days after the day on which it receives it; and
- where a responsible body receives notification given to it under regulation 7(5)(a), it must acknowledge the complaint not later than 3 working days after the day on which it receives the notification.
- The acknowledgement may be made orally or in writing.
- At the time it acknowledges the complaint, the responsible body must offer to discuss with the complainant, at a time to be agreed with the complainant -
- the manner in which the complaint is to be handled; and
- the period ("the response period") within which -
- the investigation of the complaint is likely to be completed; and
- the response required by regulation 14(2) is likely to be sent to the complainant.
- If the complainant does not accept the offer of a discussion under paragraph (7), the responsible body must -
- determine the response period specified in paragraph (7)(b); and
- notify the complainant in writing of that period.
If the practice receives a complaint either directly from the patient or via the Primary Care Trust then it must acknowledge the complaint not later than 3 working days after the day on which it receives it. At the same time an offer must be made to discuss with the patient the handling of the complaint and the likely period for the investigation and response.
Patients should have acknowledgment and a clear outline of the process of the complaint handling stages at a very early stage as it is often the absence of this that creates the problem.
There is also the opportunity at this stage to offer to meet with the patient, once all of the appropriate information is to hand, by way of conciliation. Some patients and practitioners prefer to sit down face to face to discuss the issues. Some prefer to use the services of a trained conciliator to assist. A number of PCTs have trained conciliators and it is not clear at this stage whether they will be provided free of charge as in the past or whether PCTs will charge for this service.
The sooner you engage with the complainant the better. Waiting for a response to an invitation to discuss the complaint included in the acknowledgement letter may cause delay.
The discussion does not have to be face to face see what is the most convenient for both parties.
Can you contact the complainant by phone?
YES
- Speak to the complainant
- Have a template plan that you complete to ensure that you cover all necessary issues during the discussion
- Send a copy of the plan to the complainant
NO
- You may want to consider sending a draft proposed plan with the acknowledgement, inviting discussion but placing a time scale for response in the acknowledgement letter. For example, if we have not heard from you by (allow a week from expected receipt) we will commence the investigation along the lines suggested.
You can start gathering together evidence whilst you are waiting for the complainant to make contact.
Where the patient is unreasonable or verbally aggressive then the complaints manager and dentist will need to exercise their people skills in managing the situation. The Guidance also has advice on dealing with unreasonable complainants.
The acknowledgement letter could include, the agreed complaints plan if already discussed or a draft proposed plan with an invitation to discuss within a time scale.
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Q10. I've received a complaint - what do I do about investigating it?
Paragraph 14 of the Regulations states:
- A responsible body to which a complaint is made must -
- investigate the complaint in a manner appropriate to resolve it speedily and efficiently; and
- during the investigation, keep the complainant informed, as far as reasonably practicable, as to the progress of the investigation.
- As soon as reasonably practicable after completing the investigation, the responsible body must send the complainant in writing a response, signed by the responsible person, which includes -
- a report which includes the following matters -
- an explanation of how the complaint has been considered; and
- the conclusions reached in relation to the complaint, including any matters for which the complaint specifies, or the responsible body considers, that remedial action is needed; and
- confirmation as to whether the responsible body is satisfied that any action needed in consequence of the complaint has been taken or is proposed to be taken;
- where the complaint relates wholly or in part to the functions of a local authority, details of the complainant's right to take their complaint to a Local Commissioner under the Local Government Act 1974(a); and
- except where the complaint relates only to the functions of a local authority, details of the complainant's right to take their complaint to the Health Service Commissioner under the 1993 Act.
- In paragraph (4), "relevant period" means the period of 6 months commencing on the day on which the complaint was received, or such longer period as may be agreed before the expiry of that period by the complainant and the responsible body.
- If the responsible body does not send the complainant a response in accordance with paragraph (2) within the relevant period, the responsible body must -
- notify the complainant in writing accordingly and explain the reason why; and
- send the complainant in writing a response in accordance with paragraph (2) as soon as reasonably practicable after the relevant period.
The complaints procedure is reasonably flexible in relation to the investigation and response. Early resolution of a complaint is important, but speed of response should not be the only factor considered. Getting the right result slightly more slowly is often far more helpful (to all parties) than a quick fix that only partially addresses or resolves the issues. Less prescriptive timescales to respond to a complaint will allow practices to assess and deal appropriately with complaints, allowing for proper consideration of any learning and service development issues.
If the investigation is taking time then the patient should be kept informed and this may avoid the patient feeling the need to enter into further correspondence in the interim period. Past experience has shown that some patients extend their complaint in additional correspondence, and this may be as a result of their feeling that their complaint is being overlooked, when, in fact, it is in the process of being investigated.
Possible tools for investigation may be:
- Conciliation/mediation
- Second opinion
Smaller practices may wish to link with others in similar locations to share their complaints handling, particularly if a second opinion is required.
The Guidance advises that the seriousness of the complaint should be assessed along with the potential risks and that any response provided should bear this in mind. This links with the expectation that there should be learning from complaints.
The responsible person has to "sign off" the response to the patient. This may be straightforward in some circumstances. However, this assumes good lines of communication exist between the responsible person and the subject of the complaint. Past experience has shown that this is not always the case. The turnover of dentists in some practices can be high, and complaints may be received after the dentist has left the practice, sometimes following a dispute with the practice owner. Providing a response will require a degree of cooperation between all parties to allow a response to be agreed and provided in a timely fashion.
You may wish to consider including the following elements in a response letter, also being mindful of the plan you agreed with the complainant:
- an apology and some acknowledgement of distress
- a summary of the main issues they have raised in their letter (this may also help you focus your response)
- what action you have taken to investigate the complaint (eg spoken to the staff concerned, reviewed records/policies)
- a clear explanation in response to each of the issues raised. If this relates to a consultation, refer to the history you took; any examination and findings; treatment provided; advice given and any follow up.
- what action the practice are taking as a result of the complaint to reduce the risk of a similar occurrence
- an invitation to meet or contact you again if they have any further questions
- details of their redress through the complaints procedure to the Ombudsman and their right to use the Independent Advocacy Service.
- A reiteration of your apology for what occurred.
Patients must be advised of their right to complain to the Ombudsman. Consideration may be given to the following wording:
"We believe that we have fully investigated your concerns and done everything we can to resolve them. We have also looked at how we can learn from the points you have raised and we aim to prevent a similar situation arising in the future. However if you remain dissatisfied we would invite you to contact the practice to discuss your concerns, or alternatively you may contact: The Parliamentary and Health Service Ombudsman, Millbank Tower, Millbank, London SW1P 4QP, telephone 0345 015 4033."
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Q11. Can I respond by email?
Paragraph 15 of the Regulations states:
- Any communication which is required by these Regulations to be made to a complainant may be sent to the complainant electronically where the complainant -
- has consented in writing or electronically; and
- has not withdrawn such consent in writing or electronically.
- Any requirement in these Regulations for a document to be signed by a person is satisfied, in the case of a document which is sent electronically in accordance with these Regulations, by the individual who is authorised to sign the document typing their name or producing their name using a computer or other electronic means.
Many patients have access to email. If the patient agrees to receive email correspondence and the practice is able to correspond in this way then this may expedite matters. However care should be taken to ensure that any correspondence is sent in the appropriate format from the appropriate person. There is sometimes the temptation for a well meaning instant response to be provided which it later transpires is incomplete or inappropriate in some way. It can also be tempting, in order to strengthen the response, to cc another party such as Dental Protection but this can sometimes be counter productive. Appropriate care should also be taken in relation to the confidentiality of any response sent by email, some email addresses are more public than others.
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Q12. How will patients know about our complaints procedure?
Paragraph 16 of the Regulations states:
Each responsible body must make information available to the public as to -
- its arrangements for dealing with complaints; and
- how further information about those arrangements may be obtained.
A patient is less likely to complain to the Primary Care Trust if they are aware of the practice complaints procedure and they feel that the complaints manager is accessible and approachable and that their complaint will be investigated and that any lessons learnt will be implemented. This requires a simple, clear and accessible system which indicates that patients will be listened to and that complaints will be handled fairly, promptly and sensitively. Patients need to know that the practice will acknowledge mistakes and apologise where appropriate, and provide prompt, appropriate and proportionate resolution. Patients may be reassured to know that their comments and feedback will used by the practice in its process of continuous improvement and that, where appropriate, they will be advised about the lessons learnt by the practice and changes made as a result.
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Q13. Do I have to provide complaints information to the PCT?
Paragraph 17 of the Regulations states:
- For the purpose of monitoring the arrangements under these Regulations each responsible body must maintain a record of the following matters -
- each complaint received;
- the subject matter and outcome of each complaint; and
- where the responsible body informed the complainant of -
- the response period specified in regulation 13(7)(b); or
- any amendment to that period, whether a report of the outcome of the investigation was sent to the complainant within that period or any amended period.
Paragraph 18 of the Regulations states:
- Each responsible body must prepare an annual report for each year which must -
- specify the number of complaints which the responsible body received;
- specify the number of complaints which the responsible body decided were well-founded;
- specify the number of complaints which the responsible body has been informed have been referred to -
- the Health Service Commissioner to consider under the 1993 Act; or
- the Local Commissioner to consider under the Local Government Act 1974; and
- summarise -
- the subject matter of complaints that the responsible body received;
- any matters of general importance arising out of those complaints, or the way in which the complaints were handled;
- any matters where action has been or is to be taken to improve services as a consequence of those complaints.
- In paragraph (1), "year" means a period of 12 months ending with 31st March.
- Each responsible body must ensure that its annual report is available to any person on request.
- This paragraph applies to a responsible body which is -
- an NHS body other than a Primary Care Trust; or
- a primary care provider or an independent provider, and which in any year provides, or agrees to provide, services under arrangements with a Primary Care Trust.
- Where paragraph (4) applies to a responsible body, the responsible body must send a copy of its annual report to the Primary Care Trust which arranged for the provision of the services by the responsible body.
- Each Primary Care Trust must send a copy of its annual report to the Strategic Health Authority whose area includes any part of the area of the Primary Care Trust.
- The copy of the annual report required to be sent in accordance with paragraph (5) or (6) must be sent as soon as reasonably practicable after the end of the year to which the report relates.
This requires the appropriate information to be captured and recorded as part of the complaints procedure. The report is to be submitted to the Primary Care Trust and must be available to any person on request. It is not clear at this stage what PCTs will do with this information. Raw complaints data is not necessarily a clear indicator of performance.
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Q14. Why has the Healthcare Commission passed a patient complaint on to the Ombudsman without first investigating it?
The Healthcare Commission ceases to exist on 1 April. Therefore it is already passing existing complaints on to the Ombudsman. It is also advising complainants to take their complaint to the Ombudsman, the Healthcare Commission is not accepting any new complaints under the old three stage procedure at this time.
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