General Medical Practice: Complaint Handling Issues

By John Tingle

There is a new report from Health Service Ombudsman (HSO) on GP (General Medical Practitioner) complaint handling and major failings are revealed. The HSO makes the final decisions on complaints that have not been resolved in England and lies at the apex of the NHS complaints system. The report reveals that some GP practices are failing to handle patient complaints properly. The report is based on evidence from HSO casework files and intelligence gathered by the Care Quality Commission (CQC) , NHS England and Healthwatch England. One hundred and thirty-seven closed complaint cases from November 2014 – November 2015 were analysed. General medical practice forms 90% of all NHS interactions with the general public.The quality of complaint handling by GPs was found to be highly variable:

“…over half of the cases were either good (46%) or outstanding (9%). However, over a third required improvement (36%) and a tenth were inadequate (10%) (p7).”

The report states that there are five areas where general practice has the most scope for improvement:

  • Listening culture: ask for feedback
  • Regulations: make sure practice staff understand what is expected of them
  • Values: be professional
  • Attitude: apologise where appropriate and be open and honest when things go wrong
  • Learning: listen, respond and share

Interestingly GP practices generally do not receive many complaints, annually the average is 8.5. It is unclear why there are not more complaints about general practice. In 2014-15 the report states there were 67,012 complaints about general practice.One key area identified for improvement in the report was GP attitudes to patients and the need to apologise where appropriate and be open and honest when things go wrong

Saying sorry does appear to be one of the hardest things for some GP practices to do according to the report:

“…our review found a third of cases did not provide an apology where it would have been appropriate, and when apologies were given, they were not always sincere. ‘Sorry but’ and ‘sorry if’ were often used.” (p38).

Fear of litigation and increased indemnity fees were reasons that GP’s gave for not apologizing.


Crafting a letter of response to a patient who has complained is an art. If the letter is badly worded, dismissive, defensive in style and lacking empathy that will work to make matters worse. In over a third of the cases the response and the outcome of the complaint or concern was not shared in an empathetic manner:

“Some letters were defensive and dismissive at best and curt at worse” (p.39)”.

Reports recommendations

The report makes a number of recommendations and these include creating programmes of education and training to help practice staff understand how to deal with feedback, concerns and complaints more effectively. More attention should be paid to sharing what has been learnt and strategies for doing this are outlined. Clarification on the complaints regulations, and apologies should be provided to practice staff by the Department of Health, NHS England.

John Tingle

John Tingle is a regular contributor to the Bill of Health blog. I am a Lecturer in Law, Birmingham Law School, University of Birmingham, UK; and a Visiting Professor of Law, Loyola University Chicago, School of Law. I was a Visiting Scholar at Harvard Law School in November 2018 and formerly Associate Professor at Nottingham Law School, Nottingham Trent University in the UK. I have a fortnightly magazine column in the British Journal of Nursing where I focus on patient safety and the legal aspects of nursing and medicine. I have published over 500 articles and a number of leading texts in patient safety and nursing law. My current research interests are in global patient safety, policy and practice, particularly in African health care systems. My most recent publication is: "Global Patient-Safety Law Policy and Practice," edited by John Tingle, Clayton O'Neill, and Morgan Shimwell, Routledge 2018.

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