NHS patients in England and Wales have 12 months from the date of an incident, or the date they first became aware of a problem, to make a complaint. In Scotland and Northern Ireland, the limit is six months. When dealing with complaints, practices need to be aware of the limits set out by the NHS complaints procedure for acknowledging, investigating, and responding to complaints.
However, these time limits may occasionally be difficult to achieve, perhaps because a member of staff goes on leave just as the complaint is received or has already left the practice. Inevitably some complaints are more complex than others, and this may lead to a more protracted investigation. In these circumstances, it is important that the quality of the response does not suffer, as in the example below, which is based on cases from the MDU's files:
Case study: failure to diagnose appendicitis
A patient made a complaint to the practice about a delay in diagnosing appendicitis. Over a five-day period, he attended the practice three times with generalised abdominal pain and vomiting.
Based on the patient’s signs and symptoms, the first two GPs he saw believed this was likely to be gastroenteritis and gave supportive advice.They ensured the patient knew what symptoms would need further assessment or urgent care.
At a third consultation the pain had become more localised and a clinician arranged for an emergency department assessment for possible appendicitis. The patient had surgery and appendicitis was confirmed.
The practice manager acknowledged the complaint within the necessary timeframe and contacted the MDU for advice because the first GP referred to in the complaint was on long term sick leave.
The practice manager was advised that, despite this, the practice could still initiate a complaint investigation. The patient’s concerns and the care provided, could be reviewed and any lessons learned. The practice should ask the other GPs involved for their comments.
When appropriate, the doctor who was off work could be informed of the complaint and provided with an opportunity to comment. If this wasn’t possible, because of the length of sick leave, for example, the practice could still respond to the complaint.
The response should explain that although one of the doctors was unable to comment personally, they had reviewed the records. Once the doctor was back at work, a further response could be sent if necessary. If there was going to be a significant delay, the practice manager was advised to keep the patient updated.
Time limits in the four UK countries
The time limits for acknowledging and responding to complaints vary within the four countries of the UK. In England, Scotland and Northern Ireland, practices have three working days to acknowledge a complaint, whereas in Wales it is two working days.
In England, there are no time limits set for responding to a complaint, but if a response is not provided within six months from the date of the complaint, the practice must write to the complainant to explain the delay.
In Wales, a full response should be sent to the complainant within 30 working days of receipt of the complaint. If this is not possible, the complainant should be informed of the reason for the delay and when they can expect a reply.
In Scotland, complaints are divided into two broad categories. Simple complaints which can be resolved without the need for investigation should be addressed within five working days, although this period can be extended to 10 working days if necessary.
Most clinical complaints are however more likely to fall into the category which require investigation. A response to these complaints should usually be provided within 20 working days. If there is going to be a delay, explain and tell the complainant when they may expect a response.
In Northern Ireland, the investigation should normally be completed within 10 working days but, again, if this is not possible, you will need to explain why to the complainant and tell them when they will receive a response.
Many organisations, such as local NHS England Teams, NHS trusts and out-of-hours organisations, have their own internal policies and deadlines. These deadlines do not always align with those set by the NHS complaints regulations.
It is advisable to co-operate with these, if possible, but, if facing an unworkable deadline approach the organisation, explain the difficulty you face and request an extension. It is important not to let these deadlines affect the quality and accuracy of your response.
Responses outside time limits
Usually, the complainant is anxious to receive a prompt response and practices are anxious to resolve complaints at the earliest opportunity. However, your ability to resolve a complaint successfully will be helped by a thorough investigation and detailed response and sometimes this takes more time than expected.
When a delay occurs, it is important that you inform the complainant of the reasons for the delay and when you expect to get in touch with them, reassuring them that their concerns are being taken seriously.
When a patient complains after 12 months
Sometimes, a patient will complain about an incident that happened, or which they became aware of, more than 12 months before the date of their complaint. The complaints regulations state that you should consider a complaint made outside the time limit if the complainant has good reason for complaining and if, despite the delay, it is still possible to investigate the complaint fairly and effectively.
Bear in mind that responding to a complaint outside the 12-month time limit may avoid the patient pursuing other avenues for raising a problem, such as through the GMC or a clinical negligence claim.
The difficulties faced by out-of-time complaints is that it will probably be difficult to recall the events being complained about, or the staff involved may have left the practice. In this scenario, you are expected to make reasonable attempts to contact former staff members. If you are unable to do so, you can only respond based on the entries in the medical records and standard practice at the time.
The MDU has advice on responding to complaints on our website including an elearning module on writing a response to a complaint.
- Dr Leask is a medico-legal adviser at the MDU