complaints because they have to articulate opinions that patients
and/or their family might disagree about. This leaflet outlines the
various mechanisms of complaint, how to respond and what to do if
you receive repeated complaints from the same source.
Approach complaints with
openness, candour and if you think it’s appropriate, apologise.
Apologies aren’t an admission of liability and are sometimes the
right thing to do. Professional bodies including the General
Medical Council support and encourage openness and honesty towards
If a patient or their
family complains, clarifying the issue as a group and apologising
is often enough. Record this in your notes and ideally get another
team member/secretary to witness it.
Formal Complaints to the NHS Trust
- Trusts have formal complaints procedures in
place – you’ll be asked for your response for a ‘local’
- A meeting with the complainant and the
complaints manager may resolve the issue.
- You’ll need to review the case notes and
respond to every point in the complaint, giving explanations and
acknowledging shortcomings with regret.
- Appeals are not unusual and might be sent for
local independent review. They could also be sent to the
Parliamentary and Health Service Ombudsman.
- Appeal processes might look beyond the
complaint and also evaluate clinical practice.
- Disciplinary procedures may arise from
Contact your defence organisation at an early
Complaints to the General Medical Council
The GMC advises people to
use the National Health Service (NHS) complaints procedure and
complain to the trust or employer concerned. The GMC receives
complaints from a wide range of sources but the majority are from
About 50% of cases are
investigated further by the GMC. The GMC confirms the
doctor’s employer before asking the employer for information about
the doctor’s practice and any concerns they may have.
- Don’t be intimidated by the complaint - but
don’t ignore it
- When requested, respond factually to each
separate allegation in the complaint, providing reasons for your
actions where possible.
- Contact your defence organisation for advice
and assistance in writing response letters.
- The Psychiatrists’ Support Service may be
helpful in providing support.
- Take emotion out of the response and keep it
relevant – even if you disagree with what has been asserted. Your
defence organisation or the PSS can guide you on overall
- The GMC usually asks for responses within a
28-day period. If it’s difficult for you to do this, let the GMC
- If you’re aware the letter has come from a
‘serial complainant’ tell the GMC. Give examples of previous
complaints and the stage they reached
- You may have to discuss the complaint further
with a GMC case examiner
Persistent and Organised Complaints
Some trusts recognise
‘persistent’ or ‘vexatious complainants’ where complaints are
unsubstantiated and repeated in their complaints policy. A chief
executive or other senior official may decide not to investigate
While all psychiatrists are
vulnerable to repeated complaints from a single person, those
working in child and adolescent, liaison or forensic psychiatry can
be targeted by organised pressure groups. The GMC is aware of this
and looks out for letters from particular organisations or
individuals, instances of repeated language/style of writing,
complaints about the same aspects of care or the same groups of
Nevertheless, there is no
policy for dealing with organised groups. Orchestration is a
possibility as the GMC is more likely to investigate if there are
Coping with Unfounded Complaints
Unfortunately, in psychiatry, complaints can
arise from things beyond your control. Psychiatrists can be an easy
target - sometimes as a proxy for other difficulties. However, it’s
important for the patient/complainant’s view to be heard.
You might be sure you’re in the right or you
might be filled with self-doubt. Either way, it’s likely to be
stressful and the outcome may be prolonged, so seek support from
friends, family, colleagues and professional associations.
How can I reduce the likelihood of
- Being polite, calm and ensuring the patient
and family feel understood and cared about may defuse difficult
situations. Be flexible in negotiating solutions.
- Being open, honest, candid and offering an
apology may help deal with a patient’s or family’s concern
- When writing your notes, be aware that
patients and relatives could access them in future
- Make sure your notes are dated, legible and
reasons for your decisions are clear
- If the decision is likely to be contentious
(such as referral to safeguarding children’s services) consult a
colleague and make a note of this
What are the characteristics of a
- Persistent complainants are distinguished by
their pursuit of vindication and retribution
- They consume time, resources and resort to
both direct and veiled threats
- Communication often misuses legal and medical
terminology and rhetorical questions. Intimidating and
ingratiating, they often include attached documents, creating
large case files
How do I know and what do I do if a
patient already belongs to a pressure group?
- Know the views of the interest groups in your
area of practice
- The patient is likely to tell you of their
links to interest groups - knowing whether or not their beliefs are
fixed will be helpful in guiding treatment considerations
- Many support groups are very valuable for
- A minority attack professionals as groups and
individuals. Looking at their websites will give a guide to their
approach, methods and language
For further help and support please
see our resource
LESTER, G., WILSON, B., GRIFFIN, L., et
al (2004) Unusually persistent complainants. British
Journal of Psychiatry, 184, 352–356.
This information guide is intended for a
psychiatrist against whom a complaint has been made. The
information can be used as a guide only and is not a substitute for
professional advice. If you need further advice and support, please
contact the Psychiatrists’ Support Service.
Acknowledgements to the General Medical
Council and the Medical Protection Society.
© Royal College of Psychiatrists 2016
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