Complaints Policy and Procedure for GPs and GP Practices

​​​​​​​Introduction

Rationale

If anyone has concerns about the care or treatment they or their relative have received from a GP or GP practice, they have the right to complain and have their complaint investigated by a suitably qualified person in a timely and efficient manner.

This policy has been developed to define the role of the Primary Care Governance Team (PCGT) in the handling of primary care complaints and concerns.

It specifies the procedures for the handling of such complaints. It also provides signposts to further information and gives guidance on how complaints are to be managed in Jersey.

Role of the Primary Care Governance Team

The Primary Care Governance Team (PCGT) provide a governance and quality assurance role for Primary Care in Jersey, ensuring local systems operate effectively and deliver sustainable primary care.

PCGT will acknowledge receipt of all complaints within 3 working days. They will undertake investigations and aim to respond within 20 working days following receipt of the patient’s written consent.

There may, on occasion, be a requirement to refer a complaint to an external agency for investigation. Such referrals would usually be made to a specialist investigation team co-ordinated and led by NHS England but may also be referred to NHS Resolution or, in more serious cases, to the appropriate regulator, usually the General Medical Council (GMC).

Scope of the policy

This policy is applicable to the handling of any concern or complaint received by PCGT relating to a GP Practice or an individual Doctor on the Performers List, including those who are temporarily included such as locum GPs and trainees.

The introduction of the Health Insurance (Performers List for General Medical Practitioners) (Jersey) Regulations 2014 has established a formal process by which concerns about a GP can be addressed. This policy should be read in conjunction with those regulations and the accompanying Performers List Policy.

Wherever possible, complainants will be advised to first use the complaints procedure in place at their GP practice before progressing to investigation with PCGT.​

All GP practices have an internal complaints procedure and the complainant should be encouraged to follow the practice process. All GP practices must make this information readily available and accessible to patients.

This policy describes a process for complainants who not satisfied with the response they receive from their GP Practice.​

Key responsibilities within PCGT

The Medical Director for Primary Care has overall responsibility for the management of complaints and will make decisions on the outcome and actions resulting from an investigation. The Primary Care Governance Lead and Primary Care Governance Officers have the delegated authority for the first level management and monitoring of the complaints policy and procedures and should be made aware as soon as possible of any complaint or concern received.

Information obtained with regard to complaints will be stored in a protected area of the computer system and access rights limited to PCGT. Paper correspondence will be filed in a secure filing system.

Records on complaints will be kept in line with the time periods as stated in the NHS’s Records Retention and Disposal Policy, currently this is 10 years at the date the file is closed.

PCGT will report as required on complaints. This will be a high-level report with no patient or doctor/practice identifiers shared and will report on the number of complaints received, the number of complaints ongoing and the nature of those complaints.

How to make a complaint

Making a complaint​

If you are unhappy with the treatment or service you have received from a GP in Jersey, or you have a concern about a GP in Jersey, you are entitled to:

• register a complaint
• have the complaint investigated 
• receive a response from PCGT about the complaint

However, it is recommended that you contact the GP Practice directly in the first instance and exhaust their internal complaints process prior to escalating your complaint to the Primary Care Governance Team. 

If you are not satisfied with how your complaint was handled by the Practice or are unsatisfied with the outcome of their internal investigation, you can email PCGT@health.gov.je or write to:

Primary Care Governance Team
Maison le Pape
The Parade
St Helier
Jersey
JE2 3PU

Complaints can also be made face-to-face or over the telephone.

Individuals wishing to discuss their concerns prior to formalising a complaint should contact the Primary Care Governance Team on +44(0) 1534 443510 or +44 (0) 1534 443530 or email pcgt@health.gov.je.

If having discussed the complaint, the complainant wishes PCGT to investigate, a complaint will be opened but no investigation will be commenced until either:

• the complaint has been confirmed in writing
• a written summary of the complaint has been agreed
  

If after 20 working days of the complaint being opened, the details of the complaint have not been confirmed in writing, the complaint will be closed.

It is important that a complaint is made as soon as possible but generally a complaint should be made either:

• within 12 months of the date when the service was provided or the event being complained about occurred
• within 12 months of becoming aware of the event or subject matter

This time limit may be extended should the complainant have good reasons for not providing feedback sooner. In cases of historical complaints, we will assess if it is possible to complete a fair investigation and be robust and transparent in this.

Who can complain

A complaint or concern can be made by anyone. This includes a patient or person affected, or likely to be affected, by the actions or decisions of a GP or GP Practice.

Complaints can also be made by someone acting on behalf of the patient. However, in order for the outcome of the investigation to be shared, the patient’s explicit consent is required.

Consent is not required if a complaint is being made in the name of: 

• a deceased person (although proof of relationship will be required)
• someone who lacks the capacity to make their own decisions 
• a non-Gillick competent child

PCGT can also raise a complaint or concern if they receive information about a GP from several sources that taken as a whole cause concern but when viewed separately would not raise a concern.

Financial compensation

It is not possible to obtain financial compensation through the Primary Care Governance Team complaints procedure. 

Taking legal action about a complaint

If you are considering taking legal action about your complaint, you will need to consult a solicitor.

All practitioners are insured and the legal action will be contested by an insurance company.

Withdrawal of complaint

A complaint can be withdrawn at any time during the complaints process and this can be done verbally or in writing.

The withdrawal of a complaint will be acknowledged in writing. Issues may still be investigated according to the nature of the issues raised.

Handling complaints

Any complaint received will be reviewed by the Medical Director, with consent obtained from the complainant to contact the GP or GP practice concerned as part of the investigation and, if necessary, consent obtained for PCGT to review medical records held at the GP practice.

The Medical Director will determine the action required to achieve resolution, which may involve speaking to the complainant, the GP andor GP Practice, and colleagues to obtain relevant details and to ascertain whether any action has been taken previously or already agreed. A written response from the GP will be requested. 

There may be a requirement for the Medical Director to also view hospital records. Separate written authorisation from the complainant will be required for this. A formal request must be submitted to the Information Governance Office detailing whose records are to be reviewed, the purpose of the request and what type of records are required. Any further detail regarding speciality, specific times, etc should also be included if available.

If the Medical Director decides that the matter is not a substantive issue, it will be resolved locally. 

Where a complaint or concern raises, or may raise a substantive issue, the Medical Director will refer the matter to an investigator who has appropriate experience and expertise. The cost for such investigations will be funded by PCGT. The Medical Director on receipt of the investigator’s report will decide if the complaint or concern raised can be resolved locally or if a formal resolution is needed.

Where a complaint is made that raises or may raise an issue that should be referred to the Minister for Social Security, for example, unreasonable charges being made on the Health Insurance Fund, the Medical Director will make such a referral.

If the complaint is deemed to reach the threshold for referral to the GMC on the grounds of Fitness to Practise, this will be escalated immediately to the GMC for investigation. For any complaint or concern that is deemed a substantive issue, the Medical Director must inform the GP of this decision and of any referrals that are being made as a result of this, within 7 days.

Where a complaint is raised anonymously and there is a potential risk to patient safety, PCGT may take a decision to look into the issues raised to satisfy itself that correct protocols and procedures have been followed. Anonymous complaints are not however encouraged, and we would recommend a discussion with PCGT if a complainant has concerns about their anonymity.

Find the steps taken and required timeframes in the process of managing a complaint in Appendix 1: complaints flow chart.

Anonymous feedback

We accept anonymous feedback.

We will carry out an investigation of the issues raised where there is enough information provided to inform organisational learning and continuous improvement.

Accessibility

We will ensure that:

• information about how and where feedback can be given to or about us is well publicised
• our systems to manage complaints are easily understood and accessible to everyone, particularly people who may require assistance, including children and young people and those with disabilities

If a person prefers or needs another person or organisation to assist or represent them in the giving or resolution of their feedback, we will communicate with them through their representative if this is their wish.

Anyone may represent a person wishing to give feedback with their consent such as:

• an advocate
• a family member
• a legal or community representative
• a States member
• another organisation

Safeguarding

If at any point there is a safeguarding concern it must be investigated as per the Safeguarding Partnership Board Managing Allegations Framework.

A safeguarding alert must be raised without delay.

Where there is a complaint involving a vulnerable adult or child, the most appropriate route of investigation will be agreed. This may not be under the PCGT complaints policy.

Learning and improving

All complaints offer the opportunity for colleagues to learn and improve. It is important that all complaints are reviewed, and lessons are learned.

As a learning organisation, we are committed to improving effectiveness and efficiency. We want to get it right first time. To this end, we will:

• ensure that any actual or proposed improvements to services and programs will be followed up and acted upon
• implement appropriate system changes that have been identified by analysis of complaints data and continual monitoring of the system
• implement best practices in handling customer feedback
• recognise and reward exemplary handling of customer feedback by staff
• regularly review the complaints management policy of each practice and of PCGT and complaint data
• listen to people going through the feedback process in order to learn how the customer feedback procedures can be improved
• learn from customer feedback so that improvements can be made across Primary Care

Persistent and habitual complainants

PCGT will make every effort to follow this procedure and will do everything it reasonably can to resolve issues of complaint. Occasionally, complainants may focus solely on their concerns to the extent of causing disruption to the proper conduct of business and potentially causing undue stress or harassment to staff.

PCGT is committed to dealing with complaints fairly and impartially. Staff are expected to deal with individuals in a respectful and professional manner and to follow all appropriate procedures.

However, there can be instances when nothing more can reasonably be done to rectify a real or perceived problem. At this stage it is important to ensure that complaints procedures have been followed correctly and that all elements of the complaint have been adequately addressed.

Should such situations occur, PCGT will consider whether it is appropriate to flag the complainant as vexatious. It is envisaged that this action would only be invoked in exceptional circumstances.

Process for managing vexatious complaints

Where a person’s contact has been identified as unreasonable or persistent, the decision to flag the complaint as vexatious is made by the Medical Director.

The Primary Care Governance Lead will write to the complainant informing them that either:

• their complaint is being investigated and a response will be prepared and issued as soon as possible within the timescales agreed
• that repeated calls regarding the complaint are not acceptable and calls will be terminated
  
• their complaint has been responded to as fully as possible and the matter in now closed
• that any further correspondence will not be acknowledged

If the complainant raises a new issue, then they should be dealt with in the usual way.

Appendix 1: complaints flow chart​​

​​​