Complaints are a common occurrence in clinical practice and sadly the circumstances surrounding the pandemic have increased the likelihood of receiving one.
Research conducted by the Medical Defence Union (MDU) and GP Online into complaints during the pandemic found that the key causes of complaints during this time were:
- waiting times for treatment (58%)
- remote consultations (48%)
- access to routine screening and tests (43%)
- flexibility of appointments (36%)
- technical issues with using and accessing technology (33%)
- communication issues (32%).
Most doctors will be involved in a complaint at some point during their career. In 2020-2021, there were 72,087 new written complaints logged with NHS England for general practice alone, and there are just over 78,000 GPs registered with the GMC.
Patients and their families must be able to complain; the complaints process is a key channel through which services can improve and an important way for patients and their families to get answers when things go wrong. Yet we know that complaints can have a significant impact on the mental health and wellbeing of clinicians.
Where to turn?
Through our work with the HLA, we partnered with the MDU to further investigate the impact of complaints on clinicians and explore gaps in support offered to professionals facing a complaint.
Our survey of 745 MDU members found that 89% of respondents had personally received a complaint, and highlighted that complaints have an impact on both the professional and personal lives of the clinician involved regardless of the complaint nature or escalation level.
Understandably, support preferences vary widely, with many turning to colleagues, family and friends. More formal sources of support were dependent on specialty and training level. While 80% of GPs and 42% of hospital consultants said they had contacted their medical defence organisation after a complaint, this was true for only 27% of trainee doctors.
We further explored this issue through focus groups which highlighted some misconceptions amongst trainees about contacting medical defence organisations, including:
- belief the issue was not serious enough
- reassurance in that they were only minimally involved
- fear it could formalise their involvement
- fear it could be viewed as an admission of guilt
- concern it could increase their subscription fees.
Clinicians liked the idea of having access to an individual from a clinical background who had been through a similar experience.
Other key themes that emerged from the survey were apparent gaps in wellbeing and educational support following complaints. Again, we sought to explore these issues further via focus groups.
Members gave feedback on the type of wellbeing support they would value, comments included:
- "As well as legal advice it would be good to have access to practical support, be that peer support or a counsellor."
- "Dealing with the stress of a big complaint is real and has the potential for a lot of knock-on effects on one's work and family life. I would have valued more mental health support back then."
- "Peer support groups to help deal with the complaint process."
- "More recognition of [the] impact a complaint may have on [your] career and mental wellbeing [and] providing access to support."
Clinicians liked the idea of having access to an individual from a clinical background who had been through a similar experience. They felt this would be a valuable source of support to focus on their wellbeing, separated from the more practical medico-legal advice they may be receiving directly from the medical defence organisation.
Consequently, the MDU has expanded its existing peer support network to include issues with complaints and inquests as well as GMC investigations and claims, because all these experiences can have a potentially significant impact on wellbeing and practice.
Of the 75% of respondents who had contacted their medical defence organisation, 79% felt well supported but many noted they would have liked additional ongoing educational support. As a result, we have developed templates for supervisory and appraisal meetings with the aim of changing the discussion around complaints to a more positive one focussing on the lessons that can be learnt. We have also developed resources to aid significant event analyses and meaningful reflection in relation to complaints.
Advice and tips
The MDU and HLA have developed a series of e-learning resources and templates supporting clinicians in how to approach complaints, to better prepare them for when these do occur.
Here are our top tips for when you're faced with a complaint.
- Remember that every clinician is likely to be involved in complaints processes during their career.
- It is ok to feel a range of emotions about a complaint but, when you are ready, support is always available.
- If you're an MDU member, you can contact a friendly medico-legal adviser via 0800 716 646 or email@example.com at any stage of the complaints process no matter the nature of your involvement. Contacting the MDU advice line does not impact your subscription fees.
- Consider using templates to guide you through each step of the process, from writing a response to reflecting on the experience.
To learn more, visit the MDU's complaints hub for information on the practical, educational and emotional wellbeing support available to members.
Dr Laura Hulmes
Laura is a Newcastle University Medical School graduate and is now working as a GP trainee in the north east of England. She has interests in population health, health inequalities and leadership in healthcare. Outside of work, Laura likes to travel (COVID-permitting) and to spend time with her friends, family and pet cats.
See more by Dr Laura Hulmes
Dr Leila Ellis
Dr Leila Ellis is an academic foundation doctor training in the South West and a cohort director at the Healthcare Leadership Academy.
See more by Dr Leila Ellis