Regulating doctors, ensuring good medical practice

Complaints in context

We received 23% more complaints about doctors in 2011 than in 2010 which led to one in 64 doctors being investigated by the GMC.

Looking at this more closely may help us to understand where patients’ expectations are not being met, where there may be particular challenges and where doctors may need more support.

We received more complaints from the public

Complaints from members of the public rose by 25% in 2011 and accounted for the majority of all the complaints that we received.

The main issues people complained about were also the issues that patients, as opposed to doctors, tended to complain about including clinical care and relationships with patients (which includes issues such as effective communication, respect for patients and consideration of their family and carers).

We needed to take forward more complaints

In 2011, we needed to investigate a complaint about one in 64 doctors. This is compared with one in 68 doctors in 2010.

The nature of the complaints we investigated varied according to different stages of doctors’ careers. For doctors who had been qualified longer, we needed to investigate:

  • a lower proportion of allegations about probity
  • a higher proportion of allegations about clinical care, with an overall increase that appears to coincide with the end of specialist training 
  • a higher proportion of allegations about relationships with patients.

Why have complaints, and those we need to take forward, risen?

We don’t know. It’s likely that there are a number of factors including better clinical governance systems, improved reporting culture and changing patient expectations. It is also possible that standards of practice have declined.

What have others said?

Health minister Dr Dan Poulter said:

‘The GMC is rightly taking steps to better understand and deal with an increase in complaints, but it is important to reassure people that this does not mean that medical standards are falling and complaints to the GMC are not always directly related quality of front line patient care.’

Dr Catherine Wills, medico-legal adviser at the MDU said:

‘There is much food for thought in the report... particularly about the reasons patients complain. In particular, there has been a rise in complaints alleging communication problems and lack of respect. In the MDU's experience, problems with communication are often at the heart of complaints, for example where patients feel they were not clearly warned about complications that arise from their treatment.

‘It is important to listen to patients concerns, share information with them in a way they can understand and give them a chance to ask questions. It is particularly important to be honest and open with patients when things have gone wrong and to apologise.’

Dr Mark Porter, BMA Chair of Council said:

‘It is a good thing that patients feel more empowered to raise their concerns but it is important that there is further research to find out why there has been an increase and the nature of the complaints being made.

'Even though medical standards remain high and the number of complaints is very small, compared to the millions of consultations every year, we should always strive to find ways of improving the quality of care.’

What do you think?

Let us know below.

Comments

42 comments

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LD (2 months ago)

You cannot make a silk purse out of a sow's ear. Doctors are expected to deliver first class care in what amounts to a war zone at times. Perhaps patients using the free NHS could sign a disclaimer accepting they can only expect the level of care from the doctor that it is possible to deliver within a 10 minute GP appointment or in an overbooked hospital clinic or on an understaffed ward. This state of affairs is rarely the frontline doctors or nurses fault yet they are expected to deliver the impossible and bear the brunt of complaints when expectations cannot be met. We are sitting ducks and the management/government get off scott free.

Then there's the complaints process itself - double/triple jeopary, unsubstantiated complaints potentially remaining on the doctors record to be used against them in future, the difficulty in pursuing those who raise vexatious/unfounded complaints ...

R.appadoo (2 months ago)

The solution to the problem(complaint)is very simple.Train more staff,nurses and doctors and aim to have more nurses and doctors than patients.This is simple management.Invest more in training to get more productivity.Secondly let all patients have their own medical records just like we all have passports.Each time they see a doctor wether in private or the NHS they can have it stamped with all clear medical details and documentations.This will give patients more power and respect and solve the problem of poor communication.It will also cut documentation cost for the
NHS.If patients lose their medical passport and confidentiality it will be their own responsibility medico
legally just as losing an ordinary passport.The NHS is still the best service in the world and we all know that all doctors and nurses are dedicated to their patients.

Lee (2 months ago)

Dr Esteki. I,ve shared your very same feelings many times. However.....

All control imposed on us only works because we consent. We consent to artificial demands. They couldn’t be carried otherwise. All we need do is say no. It’s that simple.

Strike turn-out was low because most obeyed the media’s orders. I watched 101 bulletins & they all repeated 3 times, “No public support.” That was code for don’t you dare strike. It's emotional blackmail & it worked. Most Drs internalised that. My colleagues even recited the line “no public support” as if it was their original thought!

On the GMC & BMA, you've assumed they are there to help us. Why? The top of this webpage says "Regulating" Drs i.e. keeping them in line.

What we need is to awaken en masse. May be WE should complain.

A H Esteki (2 months ago)

I have been working hard 8am-8pm my extended hours funding has been cut by one third my staff cost has gone up by 5% and PCT is bullying me with McKenzie rate of consultation. Where is my support gone? Who pays for the time to respond to complaint?
I have strong view if a patient complains is unjustified then the patient should be legally perused to cover the cost for my time and admin to respond to. Any willing provider?
Patient in this country pay one of the rather lower scale for access to health care yet the expectation is very high. There is very limited scope to combine the highest quality and highest quantity! This is the truth and people should wake up and not only understand but also live with it.
The artificial demand created by governments is chocking our clinical care and what we did for? Yes we turned up to strike but only 11%. We should blame ourselves.
Both GMC and BMA have let us down and has lost power and lost their understanding of our priority.

Lee (2 months ago)

LD raises a good point re:how our % increase Vs others – police, teachers etc. I ain’t got figures but complaints are up across the board. Ours are just one example of a general trend. Keep everyone’s cortisol up. You can’t connect the dots when your cortisol’s up but can be controlled.

Rulers have always used fear as a tool of control. There’s nothing new under the sun. Only the object of fear has changed. Once it was witches, then communists (or capitalists), CO2, terrorists & now of course, COMPLAINTS. Different rhetoric, same script – be worried, be very worried.

Reading the script well (any script) takes away fear, lowers cortisol & the dots connect. It’s not about empowering patients (Dr Porter, BMA), nothing to do with medical standards (Dr Poulter, Health Minister). Neither is it about litigious patients (some posts). The “C” in complaints should stand for Control & there’s lot to come, a lot more. Unless...... Well, I’m saying not’ng but I’ll be right behind you.

Antonia Lile (2 months ago)

GPs are expected to be open longer and there is pressure to have 8 til 8 opening in many places. This cannot be met with continuity of care and patients are sometimes disappointed and frustrated that they cant have both. They are also under pressure to work long hours and are sold a dream that you can have access to the NHS 24/7without understanding its limits. Complaints are often related to perceived poor access to appointments and Doctors. Unfortunately it is inevitable that continuity of care if going to be lost as Drs cannot work any more face to face hours as the rise of administration/appraisal/non clinical work that our profession demands increases.
And the wearying think is that each complaint generates more work and despair for the individuals involved.

alan ramsay (2 months ago)

Completely agree with John O'Dwyer's posting; some patients are primed to complain because of their experience BEFORE you set eyes on them. We are sitting ducks - this type of person would complain about any doctor in your position - and 50% of their complaint is not actually about you. When they don't accept the trust's/your explanation, they then waste the Ombudsman's time with a complaint that is thrown out. All quite distressing and a big waste of our time. Adversely affects what you think of patients in general for a few months.

LD (2 months ago)

This % increase in complaints should be compared to any increase seen in other sectors of society e.g. against police, teachers, social workers even private companies. Only then can some perspective be gained. Doctors might actually be faring well. Some of the increase might be simply explained by the fact that people are more willing to complain.

Lee (2 months ago)

Widen a motorway & you get more traffic. Build a new road, more cars use it.

And why now are there more complaints? The answer is simple: Complaints Procedures, of course. Hardly rocket science

John Philip O'Dwyer (2 months ago)

Have you ever had the feeling that the complaints you receive are obvious from the moment you open the door to call the patient into the clinic. More often than not, the patient has arrived late, and before you even get to ask them what they have been referred for, they (for all intents and purposes) attack you with "YOU should have all my records in your notes". One tries to adhere to NICE guidelines, or international ly accepted best practice, and go through this in the few minutes you have. After all that, all you get is a complaint, and the HUGE wasted time devoted to answering it. Why do these patients get away with this? I can understand legitimate professionalism or competence complaints. Where is the line drawn that we are protected from this indignation.

Chan Jeer (2 months ago)

I think we should all take time to simply put ourselves in the shoes of our patients and show them the empathy they deserve as well as doing our best for them at all times. I only wish we had more time to spend with our patients.

Dr Mary Kearney (2 months ago)

I am in Sydney at present and here we changed the tort law making trivial complaints more difficult a few years back. What happened? Disgruntled patient with no legal (tort) grounds for complaint went into overdrive. Complaints ballooned to the Medical Board and Health Care Complaints agencies.The majority were about communication skills. The need for language skills in English seems to be a huge issue in the UK. With doctors coming from all over Europe and being allowed to work in the UK do you have an English competency test? Australian doctors well trained in top 100 universities and fluent in English previously welcomed in the NHS are now having problems with licensing and registration. If the patient can't understand the doctor or the doctor can't communicate in the English to a safe level, then there is definitely an issue and the patient should complain! The complaint should be listened to and be addressed as a matter of priority.

J Glasspool (2 months ago)

My feeling is that the standard of medical training has never been higher- oddly. Undergraduates are given training in communications skills; undreamed of in my time (1975-80)

My feeling is also that there has been a constant campaign of vilification of doctors based on the press and particularly on the prejudices of the last government. All politicians hate doctors as we have a degree of independence and patients, rightly, trust us more than them.

This constant negativity, coupled with a sort of culture where death is prima-facie evidence of medical failure is bound to just stoke the fires of complaint.

I have no confidence in the GMC at all.

Why doesn't the GMC take action against complainants whose allegations are shown to be false? (Answer- they are only there to protect patients. Actually, I hope someone takes the GMC to court soon.)

dr tanya black (2 months ago)

I think that lack of continuity of care is obvious,also not enough staff is on duty after 5p.m.,through the night and at weekends.Patients come in to hospital expecting quite rightly certain standards of care,which they dont get,also they assume that senior consultants are physically present on the wards when they are not,for example on Delivery suite out-of-hours,and when they find out that they can be seen by registrar they are dissapointed,they say they pay their taxes and then they dont get treated in NHS hospitals as they expect to be.I am afraid list is endless and I can fully understand why they complain.I only work as a Locum,however I have noticed that in the last 12 months or so workload in all the various hospitals has increased tremendeously and in my opinion it is becoming more and more impossible to do the job properly and safely for the benefit of general public.It is sad and what is supposed to be caring profession-nursing and treating ill people has become struggle.

Barry Keshavarz (2 months ago)

The Whole idea of NHS is outdated, post war, old, and untenable, when patients and doctors are chained together, and there is no spirit of freedom in both sides, then, no wonder everyone is unhappy, and every so often some paper work policy pops up to bandaid the soreness of this old ailing problem.
Free doctors to be able to compete for their own excellence and potentials by allowing them to pen their own surgeries.
Free patients to choose the ones they think are good.
Remove PCTs and amalgate them as a national board.

Scott Moore (2 months ago)

This is where the Clinical Care/Paper Work ratio has gone grossly wrong. For a moment I wonder why doctors, nurses and health care assistants continue to work in the NHS. The 9 - 5 workers have less responsibilities, less pressure, weekends off, more time with family and friends, annual leave as required and surprisingly they are nice and kind to everyone (because they have a lot of time in their hands). They (not many people know) bring in more paper work and bizarre work practices every minute so that they can rise through the ranks. Rarely do they know what happens from 5 - 9, but not so surprisingly, are the first group of people to jump on the "24/7 worker bashers band wagon".
GMC good medical practices are another set of "tick box" martial arts, where if you know a way to work around it, you can continue to be the best doctor ever.
Unfortunately everything is paper based now and doesn't seem to come from the heart!

Richard Bryce (2 months ago)

I was in primary care for a decade before moving to the US. On several occasions since returning to the UK over the last 10 years I have witnessed first hand the apparent deterioration in standards in general practice. Sadly the problem is not with younger doctors, nor with clinical care and decision making which is generally good, but most definitely with communication and mutual respect. It seems our senior leaders may be the ones failing themselves and their patients. I'm sure there are many reasons for this related to the increasingly difficult conditions and oversight under which GPs work, which is one of the reasons I left to work overseas when the opportunity arose. We must do better and we must re-learn to respect our peers and our patients.

Dr. M. G. MALSTER (2 months ago)

My partner died over twelve months ago in hospital, and I was distressed at the low standards of care I witnessed. This aggrevated a very distressing time for us both, with so much time spent away from rather than with the patient, and such a lack of compassion.
Let us stop making excuses for deteriorating standards, and do something about it. Should a Prime minister have to demand the return of ward rounds . Let us remember, we all have a vested interest, and tomorrow it could be someone we love or perhaps even you!

J A Roberts (3 months ago)

I qualified in 1978 so have seen many changes in the NHS. For the last 10 years I have helped select Medical students. It is apparent to me that the quality of entrant is as good as ever, but the clinical knowledge of the F1 is much less. I suspect this is down to the competancy training, now so popular, replacing the previous striving for excellence training. This continues through doctor training, where endless "competency" boxes are ticked. There is no way to excel. I fear that the next generation, with many exceptions of course, will accept competent (=mediocre) standards in which they have been steeped during training.
The GMC and RCP's should end this drift to competency and rejuvenate excellence as a goal

Monika Schwarz Neurologist (3 months ago)

My experience is that I got 2 complains of patients who were really have a really complicated medical history. They had symptoms such as obesity and alalgesic overuse . When I told them friendly that the should lose weight or cutting painkillers they startet crying are getting angry and they did not accept any medical advise .Then they make a complain that you have been rude . It is frustating that patients are allowed to make complain and the doctor has no protection.Sometimes I would be happy if a doctor would be allowed to complain about the bad behaviour of patients.

kevin crofts (4 months ago)

Dear Sir/Madam,
I read with interest the comment by Edward Compton who was appalled by poor writing and record keeping.I can only agree. In Mr Compton's own letter there are multiple grammatical errors between lines 9 and 11 which which make his meaning difficult to interpret.
'onto' should be on to.
Requirements requires a full stop.
'occupational' requires a capital.
Hopefully these corrections will allow Mr Compton to criticise those involved in busy clinical care more effectively in the future.

Juline Smit (4 months ago)

Patients are not happy. When we take a different perspective we might find that those providing the care are also not happy. Many are struggling to cope with the demands of the modern NHS. The problem is complex and will not be solved by asking doctors to do more. Many are already at breaking point. Doctors need a carrot to raise their morale and reinvigorate them. Give us understanding, support, resources and time. Healthy, happy doctors will lead to less complaints and more satisfied patients. We are all part of one system. Solutions so far reinforce division in an already polarised system: doctors vs patients, doctors vs managers, hospital vs primary care. Most of us, patients and doctors alike, want to work, make a meaningful contribution and live with a sense of peace and happiness. We can learn from Einstein who said: 'The significant problems we face today can not be solved at the same level of thinking we were at when we created them'.

Dr. Mustafa Rahim (4 months ago)

The PCTs have acted very unjustly with their employed salaried doctors and should be brought to task.

They insist as part of their required training package to get their salaried doctors back in the practice to London Deanery.The London Deanery figures themselves give a failure rate of over 80% for all doctors above 50 years.Perhaps Thee London Deanery should review their tests for General practitioners above 50 years.

o The PCT’s process was irregular in that GP had not received
communications about earlier panels

o That the GMC at a recent FtP review had restored GP to the
register without conditions

o That the entrance examination for the London Deanery I&R programme
is recognised as being very difficult for older GPs (even by the
Deanery) with a failure rate of 80%

o That the GP's professional development portfolio was evidence of your
intention and capacity to learn, keep up to date and improve; that you
remained committed to general practice and patie

Dr Richard Hayward (4 months ago)

I agree with Dr Luke Ball that many of the complaints have their basis in the lack of continuity of care. Over the last say 15years I have seen more and more GPs with several jobs or as in my case only working part of he week in practice and part in the University. Also the patient may attend walk-in centres/Out of Hours or even in desperation go to A&E. This has now become a serious problem in general practice and we risk devaluing our service in the eyes of the public.

edward compton (4 months ago)

having been away from NHS practice for fifteen years and now in my last year of medicolegal work, I am appalled by the structure and state of hospital records which come to me to assess.
The tick box forms look as though they have been filled in without thought as to the correctness of the tick, forms that should be ticked are not, the continuity line is tenuous at best. The well typed clincial note of the orthopaedic surgeon is missing and traditional bad doctors' writing abounds.
In reporting for personal injury I regularly find myself explaining what went onto the patient, as well as fulfilling the legal requirements
occupational health records in the private sector are much better.
The loss of continuity in the record needs urgent rectification and perhaps should have a note to say that an entry is agreed by the patient.
Perhaps even better is that the patient holds their record/ dossier and brings it with them to everry encounter. now that would save a bundle!

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