Practices must appoint a complaints manager. Details of the complaint’s manager must be included Patients Complaints Procedure and displayed at the practice. Complaints should be managed following the Patient’s Complaints Procedure, Complaint’s Handling Policy and this overview on Patient’s Complaints Management.
Practices should develop a framework for managing complaints and feedback based on these principles:
These principles were developed by a working group consisting of professionals from 28 organisations. The aim of these principles is to help practices and patients to get the most from feedback and complaints.
The Patients Complaints Procedure must be clearly displayed in the practice where patients can easily see it. GDC standards require that the complaints procedure is available on your website.
Acknowledgement
Most complaints must be acknowledged in writing within a specific time:
A copy of the Patient Complaints Procedure should be enclosed with the acknowledgement.
Local early resolution
In England, Wales and Northern Ireland if a simple verbal complaint can be resolved easily within 24 hours there is no requirement to write to a patient. If a verbal complaint cannot be resolved within 24 hours a written copy of the complaint must be created and sent to the complainant along with an acknowledgement letter.
In both scenarios above a full accurate record must be kept of the complaint.
Recording complaints
All complaints must be recorded on an Event Record and be logged in the Event Register. Complaint records must be treated as confidential, kept separately from clinical records and only be accessible by authorised persons. Any correspondence or investigation records about the complaint must also be stored with the Record and Register.
Handling manner
Patient complaints should be handled politely, showing consideration, by listening to patients and by involving them fully in the process of resolving a complaint.
Timescale of resolution
Aim to resolve a complaint as quickly, effectively and smoothly as possible. Speed is a top priority when handling complaint. The longer you leave a complaint unresolved, the more dissatisfied the patient may become.
GDC Standards for the Dental Team states:
Complaints from patients must be resolved within a specific time:
If a response to a complaint is likely to take longer than anticipated, or if there any other delays, the patient must be informed about the reasons for the delay and the expected date of the full response. In case of a delay, the patient should be given regular progress reports.
Response to a complainant
In a response to a complainant, all the points of their complaint should be addressed, and practical solutions offered for each point if possible. You should try to meet the outcomes requested by the patient. An apology should also be given when appropriate.
The complaints manager may propose practical solutions to the patient in the first response. This can be done by telephone so long as full records of the conversation are kept. If responding verbally, the patient is sent a follow up letter confirming the details of the telephone and verbal conversation with a copy of the Patient Complaints Procedure. In the full response the patient should be invited to a meeting to discuss any suggested solutions and any other aspects of complaint.
In England and Wales, the written response to the complaint must be signed by the ‘responsible person’ for complaints about NHS & Private care and treatment. This is the chief executive, the sole proprietor of the practice, a partner or director.
Once the patient is satisfied and the complaint has been resolved the Event Record should be signed to show that the matter is closed and the entry in the Event Register should also be signed off.
NHS practices in all UK countries must submit an annual complaints report to their primary care organisation and make available their report to any person on request.
The majority of complaints can be resolved if there is a sincere apology. This can avoid lengthy, costly and stressful disputes. An apology does not mean admitting responsibility. It may be necessary to apologise that something has gone wrong, as a way of showing concern and understanding. The GDC for the Dental Team states:
5.3.8 You should offer an apology and practical solution where appropriate.
In England and Wales NHS complaints should normally be made within 12 months of the date of the event, or when the problem first came to the attention of the patient.
Note: Overall patients have 10 years to raise issues related to treatment under general litigation rules. Therefore, it is recommended to keep clinical records 10 years or more. See the overview on record retention.
NHS patients
Ideally a patient would firstly complain to the practice. In England a patient can chose to raise a complaint to NHS England. Patients can also complain to their local Health Board.
If a patient is still dissatisfied with the outcome of their complaint to the NHS, they can request a review by the relevant Ombudsman.
Private patients
Private patients should contact the Practice Manager. If they are not satisfied with the response, they can contact the GDC’s dental complaints service within 12 months of the treatment or within 12 months of becoming aware of the issue.
When a complaint appears to be escalating or is serious, it is best to contact your professional indemnity organisation to help you with it.
Practices in all countries are required to analyse and learn from their complaints. The event record can be used to help practices record their findings. Where appropriate, the results of complaint analysis and any resulting actions should be shared with the team at practice meetings. Regulators look at this aspect of compliance management during inspection.
Regulators, such as the CQC, will investigate a practice before carrying out an inspection. This can include looking at online review sites such as google or NHS choices. Negative online reviews should be treated as an ‘event’ and investigating where necessary.
The following approach has been developed for dealing with online reviews:
Here is an example of a good response where a patient hasn’t left their name:
‘Thank you for your feedback. It’s great to hear you have had a good experience with one of our dentists and we are disappointed this hasn’t been the same with our reception team. How our patients are treated in all areas of the practice is very important to us and we regularly carry out annual team training in customer service skills. If you could take the team either write a letter with the details of the issues you faced and address it to the manager, or call us on 01409 254 354, we can investigate the problems and provide our staff with any appropriate training to ensure your experience is more pleasant in the future’
Managing problems
A problem is any untoward incident that occurs at the practice including staff complaints, late deliveries, management mistakes and equipment breakdowns. Each practice must decide which problems to record to suit its circumstances; otherwise problem reporting could get out of hand. An appointed member of staff such as the Practice Manager should have the authority to determine if a problem needs to be recorded and whether it needs further Significant Event Analysis. For each problem and Event Record is created and recorded on the Event register. When the problem has been resolved the record is closed and the Register entry signed off and closed.
Repetitive or difficult problems
Problems are normally reviewed during the Practice Audits each year. However, if there is a repetitive problem, e.g. a supplier continually delivers late, you may decide to carry out significant event analysis. Problems are considered closed when the issue has been explored, corrective actions have been taken and any necessary preventive action put into place. This may involve changing practice procedures, giving individual training or having a group discussion at a practice meeting.
Safety incidents
A safety incident (referred to as an adverse incident) is any unintended or unexpected incident that could have or lead to harm for one or more patients receiving NHS-funded or private healthcare including an adverse incident or clinical error. Safety incidents can be clinical or non-clinical. It must be reported to the National reporting and Learning system (NRLS) by practices providing NHS treatment in England and Wales.
Serious incidents
If the incident is severe, it may be considered as a serious incident, which will have to be reported to your regional team (England).
The requirements to report incidents vary according to your location. As well as reporting guidelines. Regulatory bodies have their own requirements.
Never events are defined as serious incidents that are entirely preventable if you follow national standards and implement protective measures. Never events are listed In the NHS’s Never Events List published in January 2018. Three of these relate to dentistry:
A further list of Never Events specific to dentistry was published in May 2018, following research led by the University of Edinburgh. The list included the following, which practices may take into consideration when developing clinical procedures:
Investigating and reporting never events
Never events require full investigation, should be reported as serious incidents and notified to your regulator.
A significant event is something good or bad that happens, which impacts on a member of staff, a patient or on the practice. It is an unusual event, rather than an everyday occurrence. Serious Incidents, Safety incidents provides the opportunity of using incidents or near misses as a personal learning opportunity for the healthcare professional or the practice, with the intention that formal reflection on the Event will untimely result in improved safety and/or provision of patient care. You will also need to decide whether or not report the Significant Event elsewhere, for example to the NRLS or the CQC.
Significant Events can be analysed at practice meetings:
In a SEA you can ask these questions:
Agree a course of action at the meeting – use the Record to register the outcome of each SEA discussion, it’s useful to aim to arrive at one of these five categories:
For each Significant Event, the team should agree who will be responsible for taking forward any action points and recommendations, and over what period of time. The team should then review progress at a subsequent meeting. Full records should be kept, including the changes that have been made to improve patient care or service.
Note that any discussions of negative Events should be constructive rather than focusing on who is to blame it’s also important to make sure that the SEA meeting does not become a place to discuss team member’s professional performance or competency.
It is important to record any lessons learned from a Significant Event, any actions taken, and the training given to prevent the Event from happening again. The regulatory bodies are keen to see how you respond to Events and Audits and often to see written details of your completed follow up actions.
The professional duty of candour is part of the GDC standards and is about being open and honest with people who use services when things go seriously go wrong with their care and treatment. England and Scotland have specific notification requirements. In Northern Ireland and Wales, Duty of Candour has not been set in legislation, however practices should have a policy to comply with the GDC regulations. For definitions and notification guidelines see Duty of Candour and Duty of Candour policy. You can use the event record and register to record and manage the incident details and notifications and you may have to follow the SEA and the other notification guidelines in this document.
Care Quality Commission (England)
The Local Authority Social Services and National Health Service Complaints (England) Regulations 2009