Complaints in General Practice SHAHKUR SHABIR GP HALF DAY RELEASE PRESENTATION 2 nd March 2011

Initial Steps If a patient is not happy with the treatment they have received, they have a right to complain. As a first step, you could talk to: your GP, or the practice manager at your GP surgery. In many cases, the problem can be solved straightaway, and you won’t need to take your complaint any further.

Help and advice If you don't feel comfortable about talking to your GP or practice manager, you may want to seek advice. All NHS trusts and Primary Care Trusts (PCTs) have a complaints manager who can advise you about making a complaint. Your GP surgery should also have someone who oversees complaints. You can also get advice about your complaint from: your local Patient Advisory Liaison Service (PALS), or your local Independent Complaints and Advocacy Service (ICAS).

PALS and ICAS PALS can tell you more about the NHS complaints procedure and may be able to help you resolve your complaint informally. ICAS is a national service that supports people who want to make a complaint about their NHS care or treatment.

Some Figures 2008/09 found that 48,597 formal concerns were recorded against GPs and dentists The MDU logged 517 complaints in 2007/08, up from 337 in 2005/06. Almost a quarter of the complaints here were concerning a delay or failure in diagnosing a condition.

Resolving a Complaint

STAGE 1: Local Resolution You can complain verbally or in writing. A large health centre will normally have a complaints manager. The manager should make a written record of your complaint. A smaller centre, or practice, may not have a complaints manager, but they will still have someone who is responsible for dealing with complaints.

Time Limit The time limit for a complaint is normally: 12 months from the date that the event happened, or 12 months from the date that you first became aware of it.

STAGE 2: Parliamentary and Health Service Ombudsman If your complaint is not resolved successfully after the above attempts, you can complain to the Parliamentary and Health Service Ombudsman (P&HSO). The Ombudsman is independent of the NHS and government.

Your Rights You have the right to: have your complaint dealt with efficiently, and properly investigated know the outcome of any investigation into your complaint take your complaint to the independent Parliamentary and Health Service Ombudsman if you're not satisfied with the way the NHS has dealt with your complaint make a claim for judicial review if you think you've been directly affected by an unlawful act or decision of an NHS body, and receive compensation if you've been harmed.

Medical negligence by a GP Most wrong diagnoses happen when a person is suffering from a serious illness which has similar symptoms to a much more common and trivial complaint and the GP makes the decision that the patient is suffering from the latter.

Most common childhood misdiagnoses Appendicitis Meningitis diabetes mellitus slipped femoral epiphysis.

Top ten Common themes for complaints Clinical care and treatment, including delays in referral or diagnosis – Patients often complained that they should have been referred sooner for specialist treatment or further investigation of their symptoms. Removal of patients from GP lists – – Some GPs did not warn patients that certain behaviour could lead to them being taken off a list or explain to people why they had taken action. Safety - – issues included a mix up over names leading to a child having the wrong injection

Care surrounding a death - – Families may receive confusing information from different staff caring for a relative. In others, relatives felt that they were unprepared for the death or had no time to arrange for family members to be present. Nursing - – Common were complaints about staff attitudes and the dignity of patients and no help with feeding. Discharge from hospital and service coordination – – serious cases involved the discharge of vulnerable patients including children and the elderly without any support or at inappropriate times of the day.

Cleanliness and healthcare associated infection - – E.g Staff not washing hands between patients. Record keeping- – Poor record keeping and misplaced records Out-of-hours GP services – – Concerns were raised about inadequate assessment and treatment and a failure to visit vulnerable patients.

GP surgeries are very busy. GPs will usually see in excess of 100 patients every week and spend an average of 13 minutes with each person. It is unsurprising that some mistakes are made and a small percentage of patients are not happy.

To avoid complaints one of the most important factors for a doctor is to LISTEN

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