BDA advice

Complaints handling

November 2018
 Contents
3 Handling complaints positively
Learning from complaints
Training
4 Resolving complaints
Responsibility for complaints
Complaints made in person
Information for patients
Information for your team
5 Practice procedure
Acknowledge
Investigate
Respond
Appeals
Records
8 NHS rules
© BDA November 2018
Overview
The Consumer Rights Act 2015 made it easier for patients to understand their rights
as consumers of goods and services and to know what they can reasonably expect
from any service they receive. It allows them to claim a refund, repair or
replacement if the quality of their treatment is not satisfactory or the treatment is
not fit for purpose or as described. So, resolving patient complaints without delay is
vital for good patient relations.
Your practice systems for handling complaints alongside a team that is confident
that it can deal competently with a complaining patient will help you manage
complaints and feedback in a consistent way and effectively.
A lead person to manage complaints will help you ensure that your patients have
the information that they need to provide feedback or complain and that all team
members understand your practice procedures. If you work with an NHS contract,
you must comply with the relevant timescales for acknowledging, investigating and
responding to a complaint.
Key learning points
This advice should help you develop a practice protocol for receiving and managing
complaints within agreed timescales and, where relevant, complying with NHS
requirements. It explains:
• Who should manage complaints within the practice
• The information that you must have available to make it easy for your patients
to give feedback or complain
• What you should include in your practice complaints policy to ensure that you
are patient-focussed when acknowledging, investigating and responding to
complaints, including when a complaint is unfounded
• The appeals process and signposting to appropriate bodies
• The need to keep records of all communications with the patient, your
investigations and your conclusions.
Complaints handling 2
 Handling complaints positively
Most patient complaints result from expectations about the service and not the
technical skill of the clinician or the quality of care. Poor communication, rudeness,
and treatment costs are typical non-clinical causes of complaint that you can keep
to a minimum by ensuring good practice systems, a positive and professional
attitude and keeping the patient informed. Complaints about treatment can be
more difficult to prevent but effective systems, attitude and patient involvement
can aid resolution.
The cost of treatment is a major concern for patients and many complaints are
caused by lack of clarity. Treatment plans and cost estimates will help ensure that
you provide sufficient information to allow patients to make choices with
confidence, but you need to keep them updated if there are changes to the
proposed treatment. An indicative price list displayed prominently in the practice
can be a useful addition to a treatment plan and cost estimate.
Complaints are usually made by the patient (or a legal guardian or representative)
directly to the practice or, less commonly and for NHS treatment only, to the
appropriate NHS body (NHS England or the local health board, for example).
Resolving a complaint at practice level is in everyone’s interest.
Skilful handling of complaints is essential. How you respond to and deal with
complaints allows you to demonstrate a professional approach and reinforce your
desire to provide a high standard of care and service. Responding defensively to a
complaint is unlikely to satisfy the patient and could make matters worse. If
handled properly, a complaint can enhance relations and turn a potentially lost
patient into a satisfied one, provide opportunities to make improvements to your
service and identify training needs.
The NHS provides some useful time-limits for patients to complain:
• Within 12 months of the cause or when it was first noticed (England and Wales)
• Within six months of the cause or when the cause was first noticed (but within
12 months of the date of the cause) (Northern Ireland and Scotland).
© BDA November 2018
Learning from complaints
You will always learn something from a complaint, so encourage feedback and
make it easy for your patients to raise concerns. It is always better to hear of
concerns from the patient than to discover that they have reported their concerns
to others either directly or via social media. It gives you the opportunity to
• Discuss their concerns and identify the real issues
• Offer an apology
• Explain what you will to
• Tell the patient when they can expect to hear from you about the matter.
Discussing complaints and feedback at practice meetings keeps everyone involved
with what is happening at the practice, whether the systems in place are working,
and how they can be improved. Complaints directed at individuals should be dealt
with sensitively and raised in private with the individual concerned. And remember
to share good feedback; people should feel positive about their role at the practice.
Keep a log of the complaints and comments (good and not so good) that you
receive about the practice to help you identify trends and recurring issues. Only
when you know what your patients think of your service can you decide whether you
need to make any changes to improve it.
Training
All team members should understand the practice procedure for handing
complaints and receive training in customer care and communication skills,
particularly in relation to angry, aggressive or upset patients. Your complaints
manager might also benefit from training in negotiation, conflict resolution and
assertiveness.
Complaints handling 3
 Resolving complaints
No matter how careful and conscientious you are, you still face the possibility of
receiving a complaint from a patient. You need to consider
• Who will be responsible for dealing with complaints
• How you manage complaints made in person
• Information for patients
• Information for your team.
Responsibility for complaints
The NHS requires that you appoint a responsible person to ensure compliance with
the complaints procedure and a complaints manager who deals with all complaints.
The responsible person and the complaints manager can be the same person.
The NHS contracts for England and Scotland stipulate that the responsible person
must be the contract holder. In England the contract holder will be an individual, a
partnership or a director of a company. In Scotland, this responsibility can be
delegated by the contractor to another suitable person within the practice.
In private practice, the practice owner or the practice manager should manage any
complaints received and ensure that the agreed procedure is followed.
Complaints made in person
Plan where you will receive complaints made in person. A busy reception area is not
ideal; other patients will witness the interchange, which may not be straightforward,
especially if the patient has experienced pain, distress or inconvenience and wants
compensation (loudly). If flustered or embarrassed, your reception staff may not
follow your procedure exactly. The encounter is unlikely to be positive nor regarded
by the patient or the reception team as providing an opportunity to improve.
Identify an area where a complaining patient can explain their concerns in private
– for example, the practice manager’s office, a general office, a staff room or a
vacant surgery. All team members must appreciate the need for these discussions
to take place in private and to do all that they can to help (by vacating a staff room,
for example, or offering refreshments).
© BDA November 2018
Information for patients
You must have information for patients that is readily available (patients shouldn’t
need to ask for it) and explains how to make a complaint; you must make it easy for
patients to raise concerns, complain or provide feedback.
Your patient information should follow GDC’s guidance and explain that:
• All feedback is important, and you want to know what went well and what could
be done better to help you improve and learn
• You want to make it easy for patients to raise a concern or complain and that
you will take feedback and complaints seriously
• You follow a complaints procedure and will let them know who is dealing with
their complaint and when to expect a response
• You will try to answer their questions sympathetically and deal with any
concerns
• You want the patient to have a positive experience if they make a complaint
and to know that they will not be treated differently because they have
complained
• Feedback gives you the opportunity to learn from the incident and improve your
service.
A patient leaflet and poster are available from the GDC. An Expert template code
of practice for patients that incorporates these requirements is also available.
Information for your team
You must be confident that your team understands how to receive and deal with
complaints and feedback. Your complaints handling policy should describe the
practice procedure for:
• Receiving complaints
• Acknowledging the complaint
• Investigating the complaint and responding to the patient
• Keeping records.
The procedure should be followed routinely for all complaints, unless, for example,
the complaint is raised verbally and resolved quickly (within 24 hours). However, you
must keep a record of all complaints, even if a formal procedure is not followed.
Complaints handling 4
 Practice procedure
A practice procedure will help you deal with complaints properly and consistently
and ensure that patients are treated with respect and courtesy and those involved
understand the process and what to expect. A patient will usually want an apology
and to know: what happened and why; what can be done to put it right; and what
action will be taken to ensure that it will not happen again.
As a minimum, the procedure should identify the complaints manager and how the
complaint is managed: acknowledgment, timescales, investigation, response to the
patient, further action and record keeping.
Confidentiality is essential. Communications should be marked ‘private and
confidential’ or ‘personal’ and, ideally, sent by first class post. If you respond by
email, check that the patient is happy to receive email responses.
Acknowledge
If you are working under an NHS contract, you must comply with the NHS timescales
for acknowledging a complaint: within three working days in England, Northern
Ireland and Scotland; and within two working days in Wales. These timescales
provide a useful guide for private dentistry.
Your acknowledgement must offer the patient the opportunity to discuss the cause
of the complaint, which will allow you to gather more information and decide how
you will deal with it and the timeframe for resolution. It should also indicate the
independent bodies that can provide advice – for example:
• England – Citizens Advice Bureau or local patient groups and the contact details
of NHS England and the Health Service Ombudsman
• Northern Ireland – the Patient and Client Council
• Wales – local health boards do not investigate complaints directly but will deal
with the practice on the patient’s behalf.
A written response will ensure that the relevant information is given to the patient
and provides you with a useful record.
You must let the patient know who will be dealing with their complaint and keep
them informed of your progress (including delays) by their preferred method (by
telephone, face-to-face meetings, email or letter for example).
© BDA November 2018
Investigate
You need to understand what the complaint is about, the patient’s view of the
events and any concerns they might have. Although the patient may, reasonably,
want to recoup the cost of failed treatment or its rectification, their motivation for
complaining may be because they want an explanation rather than financial gain.
Investigate the substance of the complaint as thoroughly and speedily as possible.
Look at practice records and talk to those involved; the views of team members may
be helpful, and they may have suggestions for resolving the matter. Keep written
records of your investigation. Any meetings or telephone conversations with the
patient should also be confirmed in writing.
If the investigation requires the patient’s records to be disclosed to a person other
than a member of the practice team or their legal representatives, the patient must
be informed and give their written consent.
For a complaint relating to the provision of treatment under the NHS, you should
provide the patient with a response within the required timescale:
• England and Northern Ireland: within 10 working days from receipt of the
complaint. In England, there is an outer limit of six months, if the delay can be
justified
• Scotland: within 20 working days of receiving the complaint
• Wales: within 30 working days of receiving the complaint. Where this is an
interim response, the patient must be kept updated. Investigations should be
concluded within six months, or one year if liability issues are identified.
If the investigation is to take longer, you should inform the patient, offer an
explanation and keep them informed of progress. In Scotland, you should also let
the patient know that they can take their complaint to the Scottish Public Services
Ombudsman if they do not agree with your reasons for the delay.
Complaints handling 5
 Respond Appeals
When you have completed your investigation, you should provide the patient with If the patient doesn’t agree with your decision or wants to take the matter further,
a full written response, signed by the complaints manager, which explains you should provide details of the relevant bodies:

• How you considered each concern that was raised and your conclusions • For complaints relating to NHS treatment –
• The action that has been, or will be, taken to prevent the issue reoccurring England Parliamentary and Health Service Ombudsman
Northern Ireland Public Services Ombudsman
Where appropriate, you should include an apology. Scottish Public Services Ombudsman
Wales Public Services Ombudsman
Model response letters are available in Expert Templates. • For complaints relating to private treatment – the Dental Complaints Service.

If you are offering to redo work free of charge or at a reduced cost or give a full or
partial refund of fees, you should make it clear that this is a gesture of goodwill and
does not imply an admission of liability.
The response should be sent to the patient by first class post and marked ‘private
and confidential’. The complaints manager should telephone the patient to ensure
that they have received the letter.
Public/Health Services Ombudsman
The Ombudsman will undertake an independent investigation to assess whether
you acted properly and fairly or provided a proper service; it is the final point of
contact for complaints. However, if the patient has taken or intends to take legal
action, the Ombudsman may not be able to consider the complaint. The view of the
Ombudsman is final, but if the correct procedures have not been followed the
patient could seek judicial review in the courts.

If you find that the practice and your staff are not at fault or there was no basis for The Ombudsman will consider your procedure (as described in your complaints
the complaint, your written response should: policy) and the extent to which you have satisfied the six key principles of good
administration:
• Explain what happened and why it happened, including factors beyond the
control of the practice (NHS regulations or other legislation, for example) 1. Getting it right
• Acknowledge how the patient feels 2. Being customer focused.
3. Being open and accountable
• Emphasise that the dentist or staff acted properly
4. Acting fairly and proportionately
• Avoid saying or implying that the practice is right, that the patient made a 5. Putting things right
mistake, or that the patient cannot be expected to understand clinical dentistry 6. Seeking continuous improvement.
or how the NHS works
• Include the patient’s right to appeal your decision. You should be aware of these principles whenever you communicate with the
patient, as you undertake your investigation and when you provide the post-
investigation written report to the patient.

© BDA November 2018 Complaints handling 6

 The Ombudsman may regard as maladministration:
• Avoidable delay
• Faulty procedures or failing to follow correct procedures
• Failing to tell the complainant about any rights of appeal
• Unfairness, bias or prejudice
• Giving advice that is misleading or inadequate
• Refusing to answer reasonable questions
• Discourtesy and failure to apologise properly for errors
• Alleged mistakes made in handling a complainant’s claims.
You must cooperate with an Ombudsman investigation and provide information,
answer questions and attend meetings, as requested.
If the Ombudsman decides that a complaint is justified, it can recommend that you
provide a remedy or put the patient in the position that they would have been if
they had been treated fairly in the first place. This may require you to provide an
apology and improve your procedures to prevent others suffering in the same way.
It need not involve payment; the Ombudsman does not obtain compensation for
the patient. The Ombudsman can also refer the matter back to the practice if it feels
that you have not exhausted all avenues to resolve the complaint.
The Dental Complaints Service
The Dental Complaints Service (DCS) was established by the GDC to resolve
complaints about private dental care. It will help patients seek an explanation
and/or an apology, a full or partial refund of fees, remedial treatment by the original
dentist or a contribution towards remedial treatment by another dentist. It cannot
help with complaints that are more than 12 months’ old, professional behaviour
issues and compensation claims.
The DCS will discuss the complaint with the patient to establish how they want the
complaint to be resolved. If the issue cannot be resolved between you and the
patient, it will arrange a panel meeting to facilitate an amicable resolution. If
agreement can’t be reached, the panel will make a recommendation to resolve the
complaint. It cannot enforce its recommendations but expects them to be followed.
There is no appeals process.
A template complaint letter is available from the DCS to help patients ensure that
they include all the relevant information when sending a complaint to their dentist.
© BDA November 2018
Records
You must keep full records of all complaints, investigations and responses and
ensure they are secure and separate to the patient’s clinical records. If the patient
requests access to their health records, you should include records of any
complaints.
Your complaints records should include:
• The original complaint and the date it was received
• Who received the complaint and how (verbally or by telephone, letter or e-mail).
Attach copies of any communications or records of conversations
• Details of the complaint and the results of the subsequent investigation
• Contemporaneous notes of telephone conversations and meetings
• The outcome of the complaint and action taken by the practice
• Correspondence between the patient and the practice.
Reports to the NHS
If you hold an NHS contract, you will need to prepare regular reports for your
primary care organisation (PCO) on the number of complaints received, the issues
raised, and the remedial action taken, the number referred to the Ombudsman, and
(in Scotland) the number of complaints where alternative dispute resolution services
were used. These reports should be prepared at the following intervals:
• Annually, at the end of each contract year (1 April to 31 March) in England and
Wales
• Quarterly in Northern Ireland and Scotland.
Alternative dispute resolution (Scotland)
If requested, the NHS Board must provide alternative dispute resolution (ADR)
services where a patient wishes to raise a complaint about a dentist, or about the
investigation process, or if they are dissatisfied with the outcome.
Complaints handling 7
 NHS rules
The Local Authority Social Services and National Health Service Complaints
(England) Regulations 2009.

The National Health Services (General Dental Services) (Scotland) Regulations

2010, as amended by the Patient Rights (Scotland) Act 2011. Official good practice
guidance, Can I Help You?, encourages learning from comments or complaints
about your services.

The National Health Service (Concerns, Complaints and Redress Arrangements)

(Wales) Regulations 2011.

The Health and Social Care Service (HSCNI) complaints directions.

© BDA November 2018 Complaints handling 8