Dealing with complaints about NHS services Print E-mail
Written by Michelle Styles   
Despite the best intentions, sometimes things go wrong. Perhaps a patient received the wrong medicine, perhaps a member of staff was rude or a customer overheard details of a patient’s condition being discussed. Whatever the circumstances, things can go wrong, so what should pharmacists do when faced with a complaint?

Fortunately, there are relatively few formal complaints about pharmacy services. In most cases where patients are unhappy with a pharmacy’s services, the pharmacist resolves the matter successfully. While this is good news, the downside is that pharmacists are not experienced in dealing with formal complaints.

In England and Wales, the new pharmacy contract requires pharmacists to have procedures in place for dealing with complaints about NHS services. These procedures must be in writing and should be in line with the NHS (Complaints) Regulations 2004. Patients should be informed about the complaints procedure through the pharmacy’s practice leaflet.

The purpose of a good complaints procedure is to try to resolve complaints without the need to resort to litigation and the NHS complaints procedure puts the emphasis on local resolution where possible. Often the way in which a complaint is first dealt with influences the future course of action. If pharmacy staff appear defensive, try to deny the problem or shift the blame to someone else, patients may be more likely to consider litigation.

Time and again, patients who have been seriously harmed by mistakes made by healthcare professionals state that what they want is, firstly, a sincere apology and, secondly, an assurance that the same mistake cannot happen again. Only rarely is financial compensation a driving factor.

In October 2005 the National Patient Safety Agency launched a national initiative encouraging all NHS Trusts to adopt a policy of “being open” – that is apologising and explaining to patients who have been harmed as a result of an incident that occurred while receiving healthcare. Some primary care trusts have adopted this policy for independent contractors including pharmacists.

What is a complaint?


The Citizen’s Charter Complaints Task Force has defined a complaint as “an expression of dissatisfaction requiring a response”. Often a complaint may begin as a ‘concern’. Careful handling at this stage may lead to immediate resolution and prevent the concern from progressing any further.

Who can complain?


Under the NHS complaints procedure, a complaint can be made by the patient or by a representative if, for example, the patient has died, is a child or is incapable of making the complaint personally.

Who deals with complaints?


The Regulations require the contractor to appoint a complaints manager to oversee and manage the procedure for handling complaints. This could be the pharmacy owner, manager or another experienced member of staff. However, frontline pharmacy staff also need to understand the procedure as they are often the first point of contact for complaints.

When an issue arises, staff should involve the pharmacist as soon as possible. It often helps diffuse a situation if the member of staff states they are sorry that the patient is not happy with the service and offers to involve the pharmacist immediately. This is not the same as admitting that a mistake has been made – it is simply a statement acknowledging that the patient has a concern.

Sometimes using the consultation area can be helpful in such situations, especially if details of potentially embarrassing medical conditions need to be discussed. However, care needs to be taken to ensure patients do not feel they are being ‘silenced’.

The NHS complaints procedure


Complaints may be made orally or in writing. If the complaint is made orally, the complaints manager must make a written record and include the name of the person complaining, the nature of the complaint and the date on which it was made. If the complaint is made in writing, the complaints manager must make a written record of the date it was received. Suitable forms for recording complaints can be downloaded from the Pharmaceutical Services Negotiating Committee’s website (www.psnc.org.uk ). It is best to use forms that can be filed individually in a ring binder as notebooks may lead to inadvertent breaches of patient confidentiality if details of other complaints can be overseen.

Time limits


If a complaint is made more than six months after the date on which the event triggering the complaint occurred, then it does not have to be investigated under the NHS procedure. However, care should be taken when explaining this to the complainant! There may still be a need to resolve the issue outside the NHS procedure in order to prevent a costly claim for compensation or there may be genuine circumstances that prevented the patient from pursuing the claim within the six-month timeframe.

Complaints acknowledgment


When a written complaint is received, the complaints manager must send a written acknowledgement to the complainant within two working days of the date on which it was received. The purpose of the acknowledgment is to reassure the complainant that the complaint is being investigated and to provide information on the action to follow.

If the complaint was made orally, the complaints manager must send a written acknowledgement and accompany it with a copy of the written record made at the time of the oral complaint. The complainant should be invited to sign and return the written record.

As well as acknowledging the complaint, the reply must also inform the complainant of the right to be assisted by the Independent Complaints Advocacy Service (ICAS). This body was set up to support patients or their carers complaining about NHS services. The Department of Health (DH) has awarded contracts to three bodies to run ICAS on a regional basis (contact details for regional providers can be found on the website www.dh.gov.uk ).

In both cases, first class post should be used for correspondence about complaints and proof of postage should be obtained. Letters should be marked “private” to prevent potential breach of patient confidentiality. The Chemists’ Defence Association (CDA) should also be contacted at this stage if the pharmacist believes that the complaint may give rise to litigation.

Investigating the complaint


When a complaint first comes to light the complaints manager should investigate it to find out what happened. Generally this will involve steps such as finding out who was on duty at the time of the incident, interviewing staff, checking patient medication records, prescriptions and so on. If it seems likely that the complainant has legitimate grounds, a root cause analysis should be undertaken to find out what went wrong and why. Details of how to do this can be found in the NPA’s Guide to Pharmacy Risk Management. The incident should be recorded in the pharmacy’s error log and reported if appropriate via any national or local reporting schemes.

During the investigation, the complaints manager should try to ascertain the complainant’s expectations of how the complaint will be resolved, for example, whether an apology will suffice or whether litigation is likely to follow.

The complainant should be kept informed about the complaint’s progress, either in writing or by telephone. In the latter case, records of calls should be kept to demonstrate that the correct procedures have been followed.

Preparing a response


Once the investigation is complete, the complaints manager must prepare a written response summarising the nature of the complaint, the extent and nature of the investigation and any conclusions reached. The investigation may have revealed a need to change procedures to prevent a recurrence and it is worth noting this in the response.

The response should also highlight the right to refer the complaint to the Healthcare Commission and again inform the complainant of the right to be assisted by the Independent Complaints Advocacy Service (ICAS). In some cases, complainants may use the pharmacy’s response to decide whether to pursue litigation so it is worth contacting the Chemists’ Defence Association (CDA) for advice on preparing a response, especially where the pharmacist has little experience of this.

The response should be signed by the contractor where possible or, in the case of multiple pharmacy owners, by a senior manager in the organisation. The response must be sent to the complainant within 20 working days of the date on which the complaint was made.

Next steps


In most cases adherence to the NHS complaints procedure, with its emphasis on timely responses and close involvement of the complainant, will ensure that the majority of complaints are resolved locally. The small number that can’t may be referred to the Healthcare Commission; the patient may decide to contact the primary care organisation or Royal Pharmaceutical Society, or to resort to litigation. However, rest assured that in such situations the Chemists’ Defence Association will be able to help.

 
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