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The Royal College of Psychiatrists Improving the lives of people with mental illness

Psychiatrists' support service
On coping with complaints

To contact the Psychiatrists' Support Service please telephone: 020 7245 0412  or e-mail: pss@rcpsych.ac.uk

Introduction

Psychiatrists receive complaints because they have to articulate opinions that patients and/or their family might disagree about. This leaflet outlines the various mechanisms of complaint, how to respond and what to do if you receive repeated complaints from the same source.

 

Approach complaints with openness, candour and if you think it’s appropriate, apologise. Apologies aren’t an admission of liability and are sometimes the right thing to do. Professional bodies including the General Medical Council support and encourage openness and honesty towards patients.

 

Informal Complaints

If a patient or their family complains, clarifying the issue as a group and apologising is often enough. Record this in your notes and ideally get another team member/secretary to witness it.

 

Formal Complaints to the NHS Trust

  • Trusts have formal complaints procedures in place – you’ll be asked for your response for a ‘local’ resolution.
  • A meeting with the complainant and the complaints manager may resolve the issue.
  • You’ll need to review the case notes and respond to every point in the complaint, giving explanations and acknowledging shortcomings with regret.
  • Appeals are not unusual and might be sent for local independent review. They could also be sent to the Parliamentary and Health Service Ombudsman.
  • Appeal processes might look beyond the complaint and also evaluate clinical practice.
  • Disciplinary procedures may arise from complaints.

Contact your defence organisation at an early stage.

 

Complaints to the General Medical Council (GMC)

The GMC advises people to use the National Health Service (NHS) complaints procedure and complain to the trust or employer concerned. The GMC receives complaints from a wide range of sources but the majority are from the public.

 

About 50% of cases are investigated further by the GMC.  The GMC confirms the doctor’s employer before asking the employer for information about the doctor’s practice and any concerns they may have.

 

  • Don’t be intimidated by the complaint - but don’t ignore it
  • When requested, respond factually to each separate allegation in the complaint, providing reasons for your actions where possible. 
  • Contact your defence organisation for advice and assistance in writing response letters. 
  • The Psychiatrists’ Support Service may be helpful in providing support.
  • Take emotion out of the response and keep it relevant – even if you disagree with what has been asserted. Your defence organisation or the PSS can guide you on overall tone/phrasing
  • The GMC usually asks for responses within a 28-day period. If it’s difficult for you to do this, let the GMC know
  • If you’re aware the letter has come from a ‘serial complainant’ tell the GMC. Give examples of previous complaints and the stage they reached
  • You may have to discuss the complaint further with a GMC case examiner

 

Persistent and Organised Complaints

Some trusts recognise ‘persistent’ or ‘vexatious complainants’ where complaints are unsubstantiated and repeated in their complaints policy. A chief executive or other senior official may decide not to investigate such complaints.

While all psychiatrists are vulnerable to repeated complaints from a single person, those working in child and adolescent, liaison or forensic psychiatry can be targeted by organised pressure groups. The GMC is aware of this and looks out for letters from particular organisations or individuals, instances of repeated language/style of writing, complaints about the same aspects of care or the same groups of doctors.

Nevertheless, there is no policy for dealing with organised groups. Orchestration is a possibility as the GMC is more likely to investigate if there are several complainants.

 

 

Coping with Unfounded Complaints

Unfortunately, in psychiatry, complaints can arise from things beyond your control. Psychiatrists can be an easy target - sometimes as a proxy for other difficulties. However, it’s important for the patient/complainant’s view to be heard.

 

You might be sure you’re in the right or you might be filled with self-doubt. Either way, it’s likely to be stressful and the outcome may be prolonged, so seek support from friends, family, colleagues and professional associations.

 

 

 

FAQs

How can I reduce the likelihood of complaints?

  • Being polite, calm and ensuring the patient and family feel understood and cared about may defuse difficult situations. Be flexible in negotiating solutions.
  • Being open, honest, candid and offering an apology may help deal with a patient’s or family’s concern
  • When writing your notes, be aware that patients and relatives could access them in future
  • Make sure your notes are dated, legible and reasons for your decisions are clear
  • If the decision is likely to be contentious (such as referral to safeguarding children’s services) consult a colleague and make a note of this

What are the characteristics of a persistent complainant?

  • Persistent complainants are distinguished by their pursuit of vindication and retribution
  • They consume time, resources and resort to both direct and veiled threats
  • Communication often misuses legal and medical terminology and rhetorical questions. Intimidating and ingratiating, they often include attached documents, creating  large case files

How do I know and what do I do if a patient already belongs to a pressure group?

  • Know the views of the interest groups in your area of practice
  • The patient is likely to tell you of their links to interest groups - knowing whether or not their beliefs are fixed will be helpful in guiding treatment considerations
  • Many support groups are very valuable for patients
  • A minority attack professionals as groups and individuals. Looking at their websites will give a guide to their approach, methods and language

For further help and support please see our resource booklet

 

References

LESTER, G., WILSON, B., GRIFFIN, L., et al (2004) Unusually persistent complainants. British Journal of Psychiatry, 184, 352–356.

 

This information guide is intended for a psychiatrist against whom a complaint has been made. The information can be used as a guide only and is not a substitute for professional advice. If you need further advice and support, please contact the Psychiatrists’ Support Service.

 

Acknowledgements to the General Medical Council and the Medical Protection Society.

 

© Royal College of Psychiatrists 2016

 

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If you require advice and support about a particular issue then please contact the Psychiatrists' Support Service at the Royal College of Psychiatrists on 0207 245 0412 or email

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