What are the best practices for managing patient complaints?

Why complaints need a system, not goodwill

Most complaints in private general practice are about money, access or communication rather than clinical error. A disputed invoice, a result that nobody phoned back or a prescription that did not arrive. Handled well, they end quickly. Handled badly, they turn into CQC contacts, regulator referrals and online reviews.

In England, Regulation 16 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 says every complaint must be investigated, with proportionate action taken on any failure it reveals. The provider must also run an accessible system for identifying, receiving, recording, handling and responding to complaints. The CQC does not investigate individual complaints, but it can ask you for a summary of the complaints you have received and how you responded, and you must send it within 28 days of the request.

GMC guidance applies to you personally as well. Good medical practice says you must respond promptly, fully and honestly to complaints, and must not let a complaint affect the care you provide or arrange.

Private patients cannot go to the NHS Ombudsman

This is the biggest difference from NHS practice. The Parliamentary and Health Service Ombudsman says that by law it cannot look into complaints about privately funded healthcare. It can only do so where the NHS paid for the care.

So your procedure needs a credible final stage of its own. The main option is the Independent Sector Complaints Adjudication Service (ISCAS), a voluntary subscriber scheme for independent healthcare providers. If you subscribe, patients who have been through your internal stages can ask ISCAS for independent adjudication. If you do not, say clearly in your procedure what the final stage is and who carries it out, and tell patients they can also share concerns with the CQC. The CQC’s guidance on Regulation 16 suggests providers without an independent review stage should check regularly that this is not disadvantaging complainants.

A simple three-stage process

ISCAS’s code sets out three stages, and it is a sensible model even if you are not a subscriber.

Stage	Who handles it	Timescale in the ISCAS code
1. Local resolution	You or the practice manager	Acknowledge within 3 working days. Full written response usually within 20 working days.
2. Internal review	A senior person not involved in stage 1	Full written response within 20 working days of the request
3. Independent adjudication	ISCAS, for subscribers	Request within 6 months of the stage 2 response

A solo GP can struggle to find someone independent for stage 2. Some ask a trusted colleague from another practice or a governance consultant to review the file. Agree this before you need it.

Handling a complaint well

1. Listen first. Many complaints are resolved on the phone within a day. Call back, let the patient finish, and ask what outcome they want.
2. Acknowledge in writing. Confirm what you understand the complaint to be, who is dealing with it, and when they will hear back.
3. Get consent where needed. If someone else complains on the patient’s behalf, check that the patient agrees before you share clinical information.
4. Investigate the facts. Read the record, the booking and payment history, and messages. Speak to staff involved and write down what they say.
5. Reply clearly. Explain what happened, say sorry for what went wrong, set out what you are changing, and name the next stage if they are not satisfied.
6. Close the loop. Record the outcome and any action, and check that the action happened.

Apologising is not an admission of liability. In England and Wales the Compensation Act 2006 says an apology does not of itself amount to an admission of negligence. Your medical defence organisation will usually help you draft a response to any complaint with a clinical element, and some require you to tell them early. Check your policy terms.

Complaints about fees

Many private complaints are really billing disputes. You reduce them by being clear before the consultation. In England, registered providers must give paying patients a written statement of terms and conditions, including the amount and method of payment of fees, before the service starts where practicable. See managing patient expectations for how to set this up.

When a fee is disputed, separate the money from the care. Do not refuse urgent follow-up because an invoice is unpaid, and decide in advance who can agree a refund or goodwill gesture.

When a complaint reveals harm

Sometimes a complaint reveals that something went wrong and the patient was harmed. If it meets the definition of a notifiable safety incident, Regulation 20 (the duty of candour) applies. You must tell the patient in person as soon as reasonably practicable, give a true account of the facts, apologise and follow up in writing. The complaint and the candour process can then run side by side.

Records and learning

• Keep a complaints log with the date, theme, outcome, and time taken at each stage.
• Store complaint correspondence separately from the clinical record. Record in the clinical notes only what is clinically relevant.
• Review the log at least quarterly for patterns, such as the same step in booking causing problems again and again.
• Share anonymised learning with your team and bring it to your appraisal.

A complaints log that shows themes and changes is good evidence for a CQC assessment. Keep it with the rest of your evidence, whether that is a compliance manual, a system such as QCS or Clarity, or a CQC readiness register. A good example of the last is Practice Control Tower, currently taking a waitlist, which links each CQC requirement to an accountable owner and the evidence behind it, and flags evidence that is more than about a year old. Your complaints log also feeds into clinical governance and patient feedback.

Scotland, Wales and Northern Ireland

Independent services outside England are regulated by Healthcare Improvement Scotland, Healthcare Inspectorate Wales and the RQIA in Northern Ireland, each with its own rules on complaints. The principles above still apply, but check your regulator’s requirements for timescales and what patients must be told.