An opportunity to improve

Executive summary

Complaints matter – to individuals, to health and social care services and to the four organisations involved in conducting this review into the quality of general practice complaint handling. They matter to people who use the services, who deserve an explanation when things go wrong and want to know that steps have been taken to prevent the same mistakes from happening again. They matter to health and social care organisations, because every concern or complaint is an opportunity to improve services. 

General practice forms 90% of all NHS interactions with the general public. While satisfaction with general practice services was recently rated higher than other NHS services, it’s the lowest score since the survey started in 1983.1 Workforce issues, the growing need and rising expectations of an older population, with more complex healthcare needs, are creating demand pressures on general practice.2 Therefore, how will practices make sure that, amongst other things, pressures do not translate into a poorer patient experience? 

The key to improving satisfaction levels is being responsive to feedback. What are practices doing to encourage feedback and concerns to make sure improvements in care and patient experience are made possible? Driven by the scale of the challenges general practice is facing and a genuine, shared desire across all four organisations to help, our review provides some in-depth insights into what’s working well and where there are areas for improvement. This includes examples of good and poor practice and top tips for general practices on complaint handling.

For the first time, we have collectively reviewed our intelligence to look at a representative sample of 137 closed complaint cases from November 2014 to November 2015, to identify ways that the quality of complaint handling within general practice can be improved.  Overall, we found that the quality of complaint handling was highly variable; over half of the cases were either good (46%) or outstanding (9%). However, over a third required improvement (36%) and a tenth were inadequate (10%). 

There are five areas where we believe general practice has the most scope for improvement:

1. Listening culture: ask for feedback

Practices need to do more to encourage feedback, concerns and complaints, and to reassure people that their care will not be compromised if they complain. Our review found that some practices are falling short of providing basic information about how to complain including signposting to sources of support.

2.  Regulations: make sure practice staff understand what is expected of them

Practices need to do more to understand statutory duties. Our review found that some practices have a poor understanding of their statutory duties to comply with basic requirements contained within the Department of Health complaints regulations (2009). In some cases, practices are removing patients from their lists without following regulations, which raises patient safety concerns. 

3. Values: be professional

Practices need to do more to make sure there is a professional approach to complaint handling. In some cases a failure to do this has resulted in poorly led local resolution meetings and patients are not always kept up to date about their complaints in a timely manner.

4. Attitude: apologise where appropriate and be open and honest when things go wrong

Practices don’t always provide apologies and when they are given, they sometimes appear insincere. Practices need to be open and honest and communicate clearly to help individuals understand what happened. A third of cases in our review lacked adequate explanations and many others contained factual inaccuracies or no acknowledgement of mistakes, despite the introduction of the Duty of Candour, which requires openness. 

5.    Learning: listen, respond and share

To prevent the same issue happening to someone else, general practices need to learn from mistakes and share this with other practices. General practices also need to share what has been learned with their patients. However, Care Quality Commission inspectors found that practices do not routinely consider themes emerging from different sources of feedback. Sometimes Clinical Commissioning Groups (CCGs) miss opportunities to share what has been learned across general practice.

We recognise that there are some genuine reasons why general practice might find it more challenging to manage complaints. For example, practices handle few complaints and do not have access to the same support as other healthcare professionals would in a hospital setting. 

This is why we have worked alongside GPs, practice managers and other key decision makers to develop some solutions in three areas:

1. Education and training: there is a need to support GPs through education before and after they qualify. NHS England is committed to exploring training options more broadly for those working within general practice. 
2. Sharing what has been learned: CCGs and local medical committees could share how practices have dealt with complaints with other practices in the area. Time should also be provided for staff in practices to review feedback from patients to improve the service provided. Likewise, individual staff appraisals are an opportunity to reflect on learning from a concern or complaint raised. 
3. Communication: an apology is not about accepting blame but an important part of providing closure; we believe the defence unions, such as the Medical Defence Union or the Medical Protection Society have an important role in encouraging apologies. Similarly, clarification of the regulations from NHS England and the Department of Health in an accessible format for practices is welcomed.

To improve satisfaction levels, all practices will need to adopt a strong learning attitude.  Until feedback, concerns and complaints are regularly welcomed and better use is made of them, practices will not be able to improve care, which includes people’s experience of the service. 

Improvements are not the responsibility of just one organisation or one set of professionals; they require a collective effort. With the introduction of new care models and the scaling up of GP practices, we have the opportunity to re-think how complaints are managed in the future.

1 The Kings Fund (2016), Public satisfaction with the NHS in 2015. 
2 Nuffield Trust (2015), Is General Practice in Crisis?