With NHS England figures from early in 2021 revealing that almost 390,000 people were waiting over a year to start hospital treatment, it's important to recognise the key role doctors play in reassuring and supporting patients whose care has been impacted by pandemic delays and disruption.

A survey of 1,203 MDU members (GPs, consultants, hospital doctors) and GPonline readers in February found that although 87% of respondents said patients have been understanding of changes during the pandemic, 67% of doctors feared facing a complaint related to the pandemic, while 60% feared facing a clinical negligence claim.

Key reasons for complaints

At the MDU, we have supported members with nearly 4,000 complaints and adverse incidents over the last tumultuous year. This has helped us examine some of the key causes of complaints and to advise on how to manage patient expectations at this difficult time. The most common areas for complaints according to our survey were:

• waiting time for treatment (52%)
• access to routine screening and tests (34%)
• remote consultations (34%)
• communication issues (31%)
• technical issues with using and accessing technology (24%)
• flexibility of appointments (26%)
• face covering policy (20%).

Some complaints relate directly to the treatment of COVID-19, such as a failure to diagnose the virus. But in many cases, they are about how care for other conditions was delivered due to the necessary changes during the pandemic - for example, that telephone consultations for COVID symptoms underestimated how ill patients were, or that advice to self-isolate rather than be admitted led to a delay in necessary treatment.

Despite doctors' instrumental role in the success of the vaccine programme, there have nevertheless been complaints about delays in receiving the first or second doses of vaccine or queries about capacity for patients to receive a vaccine.

While most of the dissatisfaction has been expressed via the complaints process, unfortunately the survey found that 34% of doctors had experienced abuse from patients.

Tips on avoiding complaints

We're here to support members with these difficult dilemmas, and throughout the pandemic we've published guidance on our COVID-19 resources page.

Here are some of our top tips for managing medico-legal issues.

• Communication is key to avoid potential misunderstandings. Explaining what you are doing during a consultation and any follow up actions can help to reduce this risk. Make eye contact with patients during remote consultations explaining that you may need to look away to make notes.
• Manage patient expectations if you can. Many complaints arise due to patients not receiving care in a way they expected or within an expected timescale. Ensure patients appreciate the potential timescale for test results or referral appointments.
• Check a patient's understanding. With the time limitations GPs face it can be hard to cover all points however checking with the patient that they understand the outcome of the consultation and the management plan can help to avoid difficulties later on. It gives you an opportunity to identify any misunderstandings or dissatisfaction.
• Provide safety netting advice. Give the patient a clear plan of what to do should their condition not improve or worsen; or if they do not hear from another service within a certain timeframe.
• If a patient or relative has been abusive or threatening to you or other practice staff, the practice can issue a warning letter explaining such behaviour will not be tolerated. Get advice from your medical defence union if this is the case.
• Involve others if patients lack capacity. If there is disagreement about how to proceed when treating a patient who lacks capacity, consider holding a best interests meeting involving those caring for the patient, family members, and those interested in the patient's welfare. If agreement can't be reached, get further advice from your medical defence organisation.
• Clearly document consultations at the time. It will help others involved in the patient's care to easily see what has been done and, in the event of a complaint, good documentation can be invaluable in responding to unfounded allegations or misunderstandings.
• Being involved in complaints is upsetting for patients and colleagues alike. Seek support from your peers or your medical defence union if you are facing a complaint - don't go it alone.