If a complaint isn't resolved at a local level, taking it to the Parliamentary and Health Service Ombudsman (PHSO) is the second stage in the NHS complaints procedure.
Decisions made at this level are generally final. But when the process for handling a complaint directed at an MDU GP practice wasn't properly followed, we stepped in to defend our members' interests and reputation.
The scene
A patient made a complaint to a GP practice about the attitude of a receptionist during a face-to-face interaction. The practice investigated the complaint and responded with the support of the MDU's advisers, setting out the comments provided by the receptionist and noting that when the patient was in the reception area, he was shouting and made threatening gestures towards the staff member.
The staff member involved had been significantly distressed and upset by the patient's behaviour. This was witnessed by several colleagues, and CCTV footage of the reception area at the time was also reviewed. The practice explained that such behaviour was unacceptable and could not be repeated.
The patient wasn't satisfied with the response and requested a copy of the CCTV footage reviewed during the complaint investigation.
The practice contacted the MDU for further advice. We helped the practice draft a letter to the complainant explaining that because the footage contained identifiable images of other patients that could not be blurred or removed, the practice was unable to disclose it.
The complaint is escalated
Some eight months after the incident occurred, the practice was notified of an investigation by a caseworker from the Parliamentary and Health Service Ombudsman (PHSO).
The caseworker enclosed a copy of the patient's complaint and asked that the CCTV footage be disclosed to the PHSO, explaining this was required under the Health Service Commissioners Act (1993). The MDU advised the practice to comply with the request.
The PHSO detailed the scope of the proposed investigation. The practice had no comments on this, but offered to share the complaint response and the patient's clinical records to help with the investigation.
The caseworker asked the practice to explain what threats the complainant made...despite these points having been explained in the practice's complaint response.
Less than an hour after the practice responded, the PHSO caseworker contacted again asking if the practice would consider resolving the complaint by providing, "a detailed apology and explanation for the lack of good service in the complaints process", along with financial compensation to the complainant.
The caseworker asked the practice to explain what threats the complainant made and how they had been aggressive. This was despite these points having been explained in the practice's complaint response.
With the MDU's support, the practice once again replied to the PHSO caseworker, explaining they had already responded appropriately and fully to the complainant and had nothing to add. The practice also offered to share the complaints file again, so the caseworker could understand how the complaint had been dealt with.
The complaint proceeds
Two months after opening the investigation, the practice was informed of a full PHSO investigation into the case, as the caseworker believed there were indications of failings on the practice's part.
We helped the practice to respond, explaining its shock and surprise at this development, given the PHSO caseworker had yet to request or review relevant documentation - including the practice complaint file.
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The practice disclosed all the information on the complaint from the practice file and asked for this to be reviewed. They reiterated they had done all they could to investigate and respond to the complainant's concerns.
The PHSO caseworker rejected the suggestion that the decision to open a full investigation was based on incomplete evidence, and the investigation continued.
The caseworker later set out the provisional view that the complaint should be upheld. They criticised the way the practice handled the complaint and dismissed the accounts from practice staff who witnessed the verbally aggressive incident.
High-level review requested
The MDU instructed a solicitor who responded to the PHSO on behalf of the practice, saying that the practice did not accept the conclusions reached and had concerns about the process followed. They requested a high-level review.
The solicitor commented that the PHSO's conclusions had no concern for the safety and wellbeing of NHS staff and appeared to be oblivious to the concept of a zero-tolerance policy. This was despite having ample evidence about the patient's behaviour, which the PHSO seemed to have ignored.
Ten months after the initial contact from the PHSO, and nearly two years after the incident that resulted in the complaint, the practice received the PHSO's final report.
After this intervention, some ten months after the initial contact from the PHSO, and nearly two years after the incident that resulted in the complaint, the practice received the PHSO's final report. The PHSO decided to reverse the caseworker's provisional decision and did not uphold any part of the patient's complaint.
PHSO apologises
Despite this positive outcome, we strongly felt the practice deserved an explanation and apology for the poor handling of the investigation. With the practice's permission, we instructed the solicitor to complain to the PHSO.
The complaint stated that the way the complaint was conducted:
- was impartial and didn't follow the PHSO's procedures
- unnecessarily prolonged the complaint as a result
- caused unnecessary distress to the practice staff and made them feel ignored.
In response, the PHSO apologised to the practice and paid them £450 in compensation. It acknowledged that how the complaint was handled was, "not in keeping with our service charter, following an open and fair process," and that this led to, "an impartial decision" during the investigation. It recognised this made the investigation unnecessarily long and that the practice may not have felt listened to.
The member's experience
The practice manager explained that dealing with the complaint and PHSO investigation was incredibly time consuming, mentally exhausting and extremely frustrating.
"We were subjected to unnecessary and unjustifiable difficulty by an external review body," they commented, "and the approach felt both hostile and unreasonable. From the outset, we felt the investigation was biased and lacked fairness or impartiality. The recommendations seemed to force the practice into accepting responsibility and apologising for something that was untrue.
"Every defence we presented, whether through statements, evidence, or CCTV footage, appeared to be ignored or deliberately overlooked. The disregard for staff wellbeing, including their health and safety in line with the zero tolerance policy, was disheartening.
"The verdicts were based solely on the complainant's account, dismissing all the evidence and statements we provided, which was deeply concerning."
"If it had not been for the professional assistance and support of the MDU and the legal advisers they instructed, we could have faced serious consequences."
"The entire experience was highly stressful and personally burdensome, both in terms of time and effort.
"If it had not been for the professional assistance and support of the MDU and the legal advisers they instructed, we could have faced serious consequences. We are incredibly grateful for their collective efforts in bringing this matter to a close. It felt like a weight had been lifted off our shoulders.
"We were satisfied with the final outcome, particularly that the PHSO recognised their errors and upheld our complaint. It was a huge relief to see the matter conclude positively, especially with compensation for their failings.
"Hopefully, lessons have been learned, and that others will not face such an ordeal in the future."
In summary
The PHSO was set up by parliament to provide an independent complaint handling service for complaints that have not been resolved by the NHS in England.
The PHSO's website sets out how it will deal with complaints about an organisation. The organisation is the final arbiter of NHS complaints, so it's vital that conclusions are reached after a proper investigation and a fair consideration of the evidence available.
In this case, the complaint investigation was found not to have followed the PHSO's service charter. The practice told us that the whole experience of dealing with the complaint was incredibly stressful and time-consuming.
Need more help and advice?
Each complaint is individual, so get in touch with us for case-specific advice if you're contacted by the PHSO.