Making a complaint against the NHS and other medical practitioners – what you need to know
Please note: this guide concerns making a complaint to the NHS in England, there are slightly different procedures for making a complaint in Wales, Scotland and Northern Ireland.
Not many people are familiar with it, but the NHS constitution promises you:
- the right to have any complaint you make about the NHS properly investigated
- the right to receive an appropriate explanation
- the right to compensation where you have been harmed by negligent treatment
- they will ensure that lessons are learned to avoid similar incidents in the future
How to complain to the NHS
You can make a complaint on behalf of a family member or friend, but you will usually need their permission to do so. It is also possible to complain on behalf of a child or someone who does not have mental capacity.
If you are being assisted by a patient advocacy service, such as: Patient Advice and Liaison Service (PALS), the Citizens Advice Bureau (CAB) or SEAP (Support, Empower, Advocate, Promote) you can request that they deal with all matters related to the complaint on your behalf.
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Informal Complaint
You could make an informal complaint if the matter is not serious or complicated or you would like something done right away. For example, if you notice the meals are not being taken away very quickly once they are finished, or your relative is having trouble reaching the call bell, this would be an informal complaint.
To make an informal complaint you should speak with a member of staff or a manager. As an informal complaint, it is unlikely that any record will be kept.
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Formal Complaint
The formal complaints process is for more serious or complicated concerns.
For example, if you think that you or a loved one may not have received the correct treatment, this treatment has made you worse not better, or perhaps you were ‘lost to follow up’ and as a result your condition has progressed to a point where it is now worse than it otherwise would have been.
Yes, you must make your complaint within 12 months of the incident in question, or within 12 months of the knowledge of that incident.
A formal complaint can be made verbally (if you formally complain verbally the NHS must keep a record and send it to you), electronically or in writing.
You must first decide to whom to complain, you may complain directly to the institution that treated you who will have their own complaints procedure, or you may complain to:
- The Commissioner (for primary care services such as GPs or Dentists): NHS England Complaints Manager, PO Box 16738, Redditch B97 9PT, Email: [email protected], Tel: 0300 311 22 33 (Mon-Fri 8am to 6pm)
- Clinical Commissioning Group (for hospital services and some community services): Clinical Commissioning Groups, Find the appropriate clinical commissioning group at www.nhs.uk/service-search
- Care Quality Commission (CQC) for mental health services. Care Quality Commission, CQC Mental Health Act, Citygate, Gallowgate, Newcastle upon Tyne NE1 4PA, Tel: 03000 616161
To ensure that you get a full and frank response, you need to try to be as specific as possible. You will need to say who or what you are complaining about, as well as where and when things took place; names and dates are really useful.
It may be helpful to say whether you have complained about this previously, perhaps informally, and mention what was done. It is also useful to set out how you want your complaint resolved, perhaps with a meeting, or perhaps you would just like some answers. Maybe you are even looking for further action to be taken.
For further information see our sample complaint letter below.
Under the NHS complaints procedure, you can expect to receive an explanation or an apology and/or a statement detailing how such incidents will be avoided in future. You are very unlikely to receive any financial compensation as a result or achieve any form of formal disciplinary action against a member of staff.
You may receive a written response to your complaint in the first instance, or you may be asked to attend a meeting before a written response is made. Meetings can be a really useful part of the process.
In order to ensure that you get the most out of a meeting it is a good idea to take a list of questions with you or send them to the complaints manager in advance. It may also be advantageous to ask for the minutes of the meeting one it has concluded. You may wish to take someone with you to help you explain your concerns, this may not be a legal representative but it could be a friend, family member or patient advocate.
Whether you have attended a meeting or not, you should always receive a formal written response which should address all of the issues which you have raised. You should ensure that you fully understand what is being said within the response and that any medical terms used have been fully explained.
If there is anything you don’t understand you can ask them to explain or expand upon certain points. However, if you are still not satisfied with the response you may take further action by asking the Parliamentary Ombudsman for Health to review your complaint.
There is no formal time limit; the time limits should be agreed with you as part of the process.
If you feel that your complaint is not being dealt with quickly enough, patient advice charities such as AvMA would suggest that six months is too long to wait, you may wish to take things further by contacting the Parliamentary Ombudsman for Health. https://www.ombudsman.org.uk/ .
A. Once your compensation has been agreed, we can give you advice on how best to fund your care. The court will decide whether the compensation should be paid in a lump sum or instalments, which are normally used if you need extensive long-term care.
Any compensation you receive after a successful medical negligence claim is designed to fund the extra levels of care and support you’ll need for your injuries. We can help you protect the real value of your compensation by placing it in a compensation protection trust [LINK]. This means that you and/or your partner can continue to claim any means-tested benefits.
A. In theory, you can choose any practising solicitor to handle a claim. However, in practice it is essential to make sure that they have expertise and experience in clinical negligence claims.
Ask your solicitor if they’re a member of a specialist panel, either the Law Society Clinical Negligence Accreditation Scheme or the Action against Medical Accidents (AvMA) Specialist Clinical Negligence Panel. If they’re not members themselves, they must be supervised by a panel member.
It may also be worth seeking out specialists in your particular area of claim, such as cerebral palsy claims or cauda equina claims [LINK].
Accessing medical records: knowing your rights
Obtaining your own medical records, or the records of someone you care for, can often be an essential element in making a successful clinical negligence claim. However, people are often confused about whether or not they have the right to obtain records, or how they can do this.
The term medical record is inclusive of any record held or created by a healthcare professional (GP, hospital trust, dentist or other healthcare provider) which relates to a person’s mental or physical health condition. The records can be either electronic or paper, and can include correspondence such as referral or discharge letters, test records, and x-rays and film.
According to the General Data Protection Regulation (GDPR) every living person has the right to apply for their own records, whether held as paper versions or on a computer. This right is inclusive of both NHS and privately held records.
You can request your medical records verbally, by letter, by form or through email according to the GDPR. What is more, under the GDPR your medical records must be provided free of charge. A charge should only be expected in situations where you make an unfounded or excessive request; for example if you request three separate copies of the same records.
Once a request for medical records has been made, the records ought to be provided within one month from the date of the request. If the request is complex – for example if the records are in many different hospital sites or are a very large set of records – and will take longer to fulfil, then the record holder can take up to two months to provide the records, but they must inform you that this is the case within the first month of your request.
As a patient you always have a right to request your own medical records.
If you have Parental Responsibility for a child under 16 years of age then you also have the right to request their records. However, if the child is 16-17 then they may be required to give their consent to your request as well. If you have legal authority to act on someone’s behalf, such as through a Power of Attorney, then you also have the right to request their medical records for them.
If you lack the legal authority to obtain someone else’s medical records on their behalf then you may still request their records, provided that you have their written consent to do so.
Rights to medical records under the GDPR only apply to people who are alive. Rights in relation to accessing records for someone who has died derive from the Access to Health Records Act (AHRA) 1990. According to the AHRA, either Personal Representatives or those who hold Letters of Administration have the right to request medical records on the deceased’s behalf. Lastly, you may also be granted to the records if you can demonstrate that there is a potential claim arising from the death.
If you have requested records and are disappointed in how this request has been dealt with by the healthcare provider, then you can make a complaint to the Information Commissioner’s Office (ICO). Any complaint made to the ICO should be made within three months of your final correspondence with the medical organisation in question.
Medical records should be be retained by a service provider for a minimum period, depending on the type of record, and who is holding them.
Important examples include the following:
- dental records are kept for 10 years after you are last seen;
- GP records are kept for 10 years after a person has died. Electronic Patient Record should never be destroyed;
- care records generally are kept for 8 years after you are discharged from care or from when you were last seen;
- children’s services records are kept up until the individual’s 25th birthday
- general hospital records should be kept for 8 years after the conclusion of treatment or death.
Making a complaint about a doctor
As a patient, raising a concern regarding the care afforded to you can seem like a daunting process. This guide explains how a complaint can be made and what the outcome of a complaint might be.
The regulatory body that governs doctors is the General Medical Council (GMC). This is where you should make a complaint if you have a concern about an individual doctor’s professionalism or ability to practice medicine.
If you have a complaint about the treatment you have received from either a nurse or a midwife, then the regulatory body that you should consider contacting is the Nursing and Midwifery Council (NMC). Please see our guide on making a complaint to the NMC here [LINK].
Before you contact either regulatory body, you should make a complaint to the hospital Trust that employs the health professional. All NHS organisations have to follow the NHS complaints procedure which you can find out more about here.
As a regulatory body, part of the GMC’s role is to investigate complaints about individual professionals in order to consider whether or not they are fit to practice. When considering whether or not a doctor is fit to practice, the GMC will consider a doctor’s behaviour including:
- serious or repeated mistakes;
- violence or criminal offences;
- dishonesty;
- abuse of a professional position;
- discrimination; and
- serious breaches of patient confidentiality.
The GMC will only consider complaints arising within five years of an incident, but we advise that any concerns should be raised as soon as possible. If the incident you wish to complain about took place more than five years ago or your complaint has been rejected on this basis then you can write to the GMC Chief Executive to appeal this decision.
If you are not satisfied with the response of a hospital Trust to your complaint through the NHS process, you can complain about an individual doctor’s skills or behaviour to the GMC through an online form.
You should also send the GMC copies of the complaint you made to the Trust and the response you received.
Most complaints that the GMC receives are not investigated further. This may be because the complaint does not reach the GMC threshold or because they are matters that the GMC cannot investigate. Even if the allegation is not investigated further by the GMC then your concern will still be shared with the doctor involved and be considered as part of their ongoing professional appraisal.
If the GMC is concerned that the doctor in question may not be fit to practice then they will open an investigation. Once this happens, as the complainant you may become a witness in the fitness to practice procedure.
If the GMC do decide to carry out an investigation then this can take as long as a year, and in complicated matters could take even longer. As the complainant you will be updated by the GMC every eight weeks about how the investigation is progressing.
Any investigation may also include a review of your medical notes, which you would be asked to consent to if required.
Once an investigation by the GMC has concluded the examiners will review the evidence and consider whether any action should be taken.
The possible outcomes of a GMC investigation can range from:
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No further action
This could be because the doctor has made every effort not to repeat their mistakes or because there is not enough evidence against the doctor.
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Limit the doctor’s ability to practice
If the GMC believes that immediate action is necessary, then it may apply for the Medical Practitioners Tribunal Service to make an immediate order to suspend the doctor or restrict the ways they can work, such as not performing operations without senior supervision.
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Warning
The GMC may give the doctor a warning, which states that their behaviour was below the standard acceptable for a professional. Warnings are published on the GMC website for two years.
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Undertakings
These are formal agreements between the doctor and the GMC and they will set out specific conditions which the doctor will have to abide by. These conditions may include supervision of their work, limiting what work they can carry out or where they are able to work. These are published on the GMC website for 10 years.
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Referral to the Medical Practitioners Tribunal Service (MPTS)
The doctor would have to attend a hearing at which s/he may be struck off from the GMC register (and so unable to practice as a physician).
Making a complaint about nurses or midwives
If you receive poor care from a nurse, midwife, or nursing associate then you may wish to raise a complaint. This guide provides information about how you can do this.
The Nursing and Midwifery Council (NMC) is the regulatory body for nurses, midwives and nursing associates and investigates complaints made about individual professionals.
The NMC will investigate incidents that involve:
- serious professional misconduct;
- criminal offences;
- concerns about a professional’s competence; and
- addictions or mental illnesses that may affect a professional’s ability to practice.
The NMC will only consider complaints calling into question the individual’s current fitness to practice. The term “fitness to practice” concerns the professional’s skill, knowledge and character, and whether these attributes (or a lack of them) negatively impact their ability to carry out their job safely.
In almost all cases you should raise your complaint first with the Trust or private organisation that employs the nurse or midwife you are concerned about. An internet search can help you identify the Trust that runs the hospital or medical centre where you received poor care.
If you are concerned that a professional poses a continued threat to patient safety, or where you are not satisfied about the outcome of your complaint to the hospital Trust, then you can write to the NMC.
Any concerns or complaints made to the NMC should be submitted in an online form which can be found here, or you can make your complaint in a letter or email. In your complaint, you should set out the events that took place and your concerns about the health professional involved. The NMC will also have to identify the nurse or midwife involved so, if you are able, include the name of the professional, the date and time that you saw them, and the address of where the treatment took place. If you have made a complaint to the Trust, then you should include copies of your complaint and the response you received.
You will also need to agree to your complaint being disclosed to the nurse or midwife involved in order for them to provide a response.
When the NMC receives a new complaint it will begin by screening it to make sure that they are able to make an effective investigation. This includes checking that you have provided enough information about what happened and about the identity of the health professional involved. The NMC will also consider whether or not the allegations are serious enough that the nurse or midwife may pose a risk to members of the public and whether or not there is evidence that your concerns or complaints have already been addressed by the individual.
The NMC may not take your complaint any further at the screening stage if they do not feel that the matter relates to a nurse or midwife’s ability to practice safely, if they do not have enough information to identify the healthcare professional, or if they cannot obtain evidence in support of your complaint.
If it is decided that further investigation is necessary, then an investigator will be assigned to your complaint and should contact you within three weeks. The investigation can take up to one year. An investigator is likely to require access to your medical records which you will be asked to agree to.
The NMC will then consider whether the actions of the individual mean that they may not be competent to practice as a nurse or midwife. They will look at the incident that took place as well as the professional’s knowledge, skill and judgment to decide whether the nurse or midwife is not fit to practice due to:
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Misconduct
Professional conduct falling short of what is expected of an individual.
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Lack of competence
This is most likely in continued incidence of poor performance which could put patients at risk.
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Cases investigated by the police which have not led to a conviction
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Poor knowledge of English
This is where a poor standard of English could result in wrong prescriptions, poor record keeping or a failure to handover information about a patient’s treatment due to a language barrier.
After the investigation, a report will be produced and the individual being investigated will have 28 days to comment on the findings. After this 28 day period, the NMC will decide on the next necessary steps. They may:
- give a warning to the healthcare professional or agree a plan to ensure that they are safe to continue working with patients;
- close the case with no further action;
- decide to refer the case to a fitness to practice committee.
If your case goes to a fitness to practice committee then it will likely be dealt with by a FtPC meeting.
During a fitness to practice meeting the committee will meet with legal assessors and consider the paperwork produced up until this point. The meeting is private and so neither you nor the healthcare professional will be present during the meeting. The results of the meeting, the committee’s decision and reasons for their decision will be made public.
In some cases, the FtPC may conduct a live hearing and you may be called as a witness. It is normal for the nurse, midwife or nurse associate to have legal representation at a hearing, and you can as well, although this is less common. The decision of the FtPC hearing will be sent to you in writing.
After the meeting or hearing, the FtPC can impose the following sanctions on a nurse or midwife:
- a caution of 1-5 years;
- conditions of practice for a period of up to 3 years;
- suspend the healthcare professional for up to 1 year;
- strike off the individual from the register.
Private healthcare: how to make a complaint
Whenever you receive substandard medical treatment you are entitled to make a complaint. This document provides information about making a complaint about private healthcare.
If you are concerned about the treatment that you have received then you should always discuss this with the clinician or nurse who treated you. They may offer a useful explanation and advice on how to overcome any immediate concerns. If you do not find the response useful, then you should next discuss any other potential treatment options with your GP, especially as you may require a referral for a second opinion.
Whether you received care from a hospital or a clinic, by law it is required that they must operate a complaints procedure. Therefore if you intend to make a complaint about private healthcare then you should enquire about the organisation’s complaints policy. Usually this is clearly available on their website but if not then you can request it from them directly.
If you cannot access their complaint’s policy, or if you cannot get a response to your complaint then you should make a complaint to their regulatory body as appropriate, depending on their role, e.g. the General Medical Council, The Nursing & Midwifery Council or the Care Quality Commission.
A complaint should be made within six months of the incident occurring, or within 6 months of you learning of its consequences. If this time period has lapsed then you should write at the earliest opportunity and request that they extend their deadline to explore your complaint.
If you need to make a complaint on behalf of a family member then you will require their written consent.
The process of making a complaint can be a lot easier if the complainant has gathered sufficient information to prove the major elements of their complaint. This may include keeping a record of any telephone calls, copies of any correspondence from the organisation and any meetings that you attend.
The ISCAS provides a framework that sets out how private care providers may deal with complaints made either by patients or someone else, on the patient’s behalf.
This framework sets out three progressive steps that can be used in order to deal with a complaint:
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Local resolution
At this stage it is the responsibility of the treatment provider to look into and respond to the complaint. A simple conversation between the professional and the patient may be all that is required. If this does take place then it will be beneficial to request a full written response that reflects what was discussed and agreed during the meeting. If the complaint is about an individual practitioner, then any complaint should be addressed to them. Although you can make a verbal complaint, it is easier to evidence a written complaint. It is reasonable to expect a response within 20 days.
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Internal appeal
If you are not happy with the outcome of the local resolution then you can apply for an internal review which should be made in writing within 6 months of your final written response from the treatment provider. The complaint will then be considered by the investigating director and they will review the actions that were taken at the local resolution stage.
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Independent external adjudication
If you are still dissatisfied with how your complaint has been managed at this stage, then you can request an independent external adjudication. This should be requested for in writing. Once a decision has been made by the adjudicator then this can be sent to the Care Quality Commission.
