Concluding remarks and recommendations
The findings of our review suggest that the quality of complaint handling, and the culture of some practices towards encouraging feedback in all of its forms, are inconsistent and variable. Practices who are doing this well often go above and beyond, take complaints seriously and provide a quick service to those who have concerns. On the other hand, practices who are doing this badly are failing to get the basics right and making mistakes, such as inappropriately removing patients from lists despite clear guidance and not being open and honest when things have gone wrong.
We believe that the areas for improvement highlighted in this review are issues that can be fixed by general practice so long as there is the will to do so. Many of the good practice cases show how things can be done and we hope these have been helpful.
Many of the tips and recommendations targeted at general practice range from simple things that practices can do, such as involving their PPG, to issues that may take longer to get right either because of training requirements or the need to change established practice. However, general practice is not alone in overcoming some of the challenges we have described in our review; it’s going to require a concerted effort from across the sector. We have each made commitments, so that together, we can play our part.
Without nurturing a culture of listening and learning, general practice will struggle to meet the dual challenge of improving satisfaction levels whilst at the same time preventing growing pressures impacting on patient experience. Together, we are committed to supporting general practice to meet these challenges head on and through the changes to primary care, make the complaints system easier and simpler for all concerned.
We want to show how we have listened and learned throughout this review. We accept that there is further work to be done and through the NHS England Complaints Advisory Group, will continue to have active discussions with the organisations involved. On the next page are the recommendations that we believe will make the most difference to improving the quality of complaint handling across general practice in England.
Recommendations
Education and training
We heard that practice staff would welcome education and training to help them understand how to deal with feedback, concerns and complaints more effectively. In addition to work being led by NHS England to ensure primary care complaint handlers have access to high quality and relevant training, we consider the GMC’s current consultation to be important.35 It has the potential to instil the behaviours and values necessary to nurture an open learning culture across the NHS:
- The GMC’s draft framework for generic professional capabilities makes clear the core expectations and duties of a doctor. The GMC should continue to work with others so that any revised curricula identifies necessary professional values, knowledge, skills and behaviours that would better support doctors to respond, act and learn from feedback, concerns and complaints.
Sharing what has been learned
We heard that GPs and their staff would welcome the opportunity to discuss complaints openly and share what they have learned.
- The National Association of Patient Participation should support PPGs to ensure that the practice complaint policy is clear, understandable and written in an appropriate tone. They should help individuals to understand the feedback and complaints policy and support the practice to use feedback, in all its forms, to improve patient experience.
- The GMC make it clear doctors should reflect fully on complaints as a formal part of revalidation, considering what the information reveals about their practice.36 The Royal College of General Practitioners (RCGP) has recognised the important role of complaints in their revalidation guidance. The RCGP should ensure appraisers place emphasis on the role of learning from complaints in individual appraisals to identify where a GP can develop or change their approach to improve patient care.
- Local Medical Committees, NHS England and CCGs should work with practices to provide time and space for learning from complaints to take place across localities to support service improvements.
Communication
We heard that practice staff would like clarification on the complaints regulations and apologies. In addition to the commitment from NHS England and the Department of Health to produce further guidance, we believe defence unions can play an important role:
- Defence unions should clearly communicate and show a united front on apologies. We expect unions to make it consistently clear that an apology is not an admission of liability but an important part of putting things right.
35 NGMC, (2016) Developing a framework for generic professional capabilities. A public consultation
36 GMC, (2013) The Good medical practice framework for appraisal and revalidation