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How to raise concerns about your care
Last updated July 2008
The BMA receives many enquiries each year from patients and their families, expressing concerns about their care. However, in our capacity as a trade union and professional association for doctors, we have no statutory authority to investigate patients' concerns.
The information below provides advice on what you can do if you have concerns about the treatment that you or your family have received, whether on the NHS or privately, and at sources of information on good medical practice.
- Concerns about your NHS treatment
- National Patient Safety Agency
- Concerns about private healthcare
- Good medical and surgical practice
- The role of the General Medical Council
- The Council for Healthcare Regulatory Excellence
- The Health Professions Council
If, for whatever reason, you feel you would like to discuss any aspects of the care that you are receiving, or have received, from the NHS, the first step is, generally to contact the local organisation you are unhappy with (for example, the GP surgery or NHS hospital).
Normally, formal NHS complaints need to be made within six months of the incident in question, or within six months of becoming aware of the problem, although patients and their families or carers can make a complaint after six months - in circumstances where a patient could not have reasonably been expected to raise their concerns within six months, for example as a result of illness.
Twelve months is the general extended time limit for making a complaint, although even this can be exceeded in exceptional circumstances.
If anyone other than the patient themselves wishes to make a formal complaint (for example, a relative or carer), the consent of the patient themselves is generally required.
The information below provides general advice and/or helpful websites for patients who have concerns about their NHS healthcare in different parts of the UK. A further useful source of independent advice on NHS complaints procedures throughout the UK is the Citizens Advice Bureau. England
- Local resolution: primary care
If the matter cannot be resolved immediately, then you have the option of taking the matter further by making a formal complaint. This can either be done orally (in which case a written record of the complaint is made) or in writing to the GP surgery. You should receive a written response to your complaint within 10 working days.
If you prefer to talk to someone who is not directly involved in your care, you can talk to the Patient Advice and Liaison Service (PALS) at your local Primary Care Trust (PCT). PCTs are responsible for the delivery of NHS healthcare services in the geographical areas they cover and you can find out more about the role of PCTs in About the NHS on the NHS Choices website.
PALS services were established to provide information and confidential advice to local patients, and although PALS are not part of the formal complaints process, PALS officers can advise patients, their families and carers on how to raise their concerns about NHS services - and provide contact details for local Independent Complaints Advocacy Services (ICAS) where necessary. ICAS services can provide independent advice to patients - see below.
PALS officers can also help to resolve any minor difficulties that patients are having with their NHS primary care services (GP surgery, dental surgery, pharmacy or optician), without them having to go through the formal NHS complaints procedure.
Up-to-date contact details for all PALS are available on the PALS Online website.
Where a complaint relates to treatment or care provided by both the NHS and a local authority (for example by a social services department), these bodies are now under a duty to consult with one another and to produce a joint response to the complaint (provided that the person making the complaint consents to the necessary sharing of information).
Patients can not make use of the NHS complaints procedure, in respect of events which are already the subject of legal action.
- Local resolution: hospital care
For the contact details of a particular NHS Hospital Trust, you can contact the NHS helpline, NHS Direct, Tel 0845 4647, or search the NHS Choices website, which lists NHS Acute Trusts.
If you make a formal complaint (which can be done orally or in writing) you should normally receive a reply within 25 working days (extended from 20 days in September 2006). The 25-day deadline may be extended with the agreement of the complainant.
Like PCTs, NHS Hospital Trusts also have PALS officers who can assist patients, their families and carers by providing advice and information about any immediate concerns they may have.
PALS officers can speak to NHS hospital staff and managers on a patient’s behalf and, where appropriate, help to resolve more minor problems without the need for the patient or others to make a formal complaint.
For further information you can visit the PALS Online website and use the 'Online Search' facility to find the contact details of the NHS Trust PALS you are seeking.
As in primary care, PALS in Hospital Trusts can also direct patients to ICAS services, which will offer independent help with complaints (see below).
NHS Foundation Trusts, although still part of the NHS, have more independence from government, and they have their own systems for the internal handling of complaints. However, the second-stage independent complaints review is still carried out by the Healthcare Commission, and they can also be investigated by the Health Service Ombudsman.
- Local resolution: ambulance trusts, care trusts and mental health trusts
In all cases, it is possible to seek advice from the PALS services within these NHS Trusts. Full contact details for these PALS services are available under the listings for the different kinds of NHS Trusts on the NHS Choices website.
- Independent Complaints Advocacy Services (ICAS)
ICAS services are currently provided by three external organisations, the Carers Federation, South East Advocacy Projects (SEAP) and the POhWER advocacy agency, following the award of new contracts by the DH in April 2006. The current ICAS service providers in the different English regions are listed on the DH website.
Contact telephone numbers for regional ICAS services are also available on the DH website: see 'What can ICAS do').
Following a comprehensive review of ICAS services by the DH, ICAS now assists patients (and/or their families and carers) by either:
- empowering them to raise their own concerns, where patients are able and willing to do this, through providing the necessary information and support (the self-advocacy model); or
- empowering and supporting those with more complex needs through the provision of more specialist advocacy support services (the supported advocacy model)
- Independent reviews
Such reviews are now co-ordinated by the Healthcare Commission, the independent inspection body for NHS, private and voluntary healthcare in England. Once the further investigation has been completed, a report of the investigation is sent to the patient or family member concerned by the Healthcare Commission, a process which should be completed within six months.
You can find out more about the independent review of complaints on the Healthcare Commission's website. You can also ring the Healthcare Commission's helpline on Tel (0845) 601 3012.
- referral to the Health Ombudsman
- it has taken too long to deal with a complaint locally;
- an independent review has been unreasonably refused; or
- patients are not satisfied with the response to their complaint following the independent review process.
More detailed information about the NHS complaints procedure in England is available on the NHS UK website, or patients can ring the NHS helpline, NHS Direct, at any time for advice, Tel (0845) 4647.
Wales
Community Health Councils (CHCs), which were abolished in England in 2003, have been retained in Wales. CHCs offer free help and independent advice to patients and their families who have had a problem with their NHS healthcare in Wales.
In April 2004, CHCs were given additional powers to monitor all primary care services and to visit the premises of GPs, dentists, pharmacists and opticians, as well as private hospitals and care homes.
Patients seeking the contact details of their local CHC can ring the Board of Welsh CHCs on (0845) 644 7814 or visit the Board of Welsh CHCs website.
As in England, independent reviews are carried out regarding unresolved complaints. If patients are unhappy about the way their complaint has been dealt with by their local CHC, they can write to the local Independent Review Secretariat. Further information about the independent NHS review procedure in Wales and the relevant contact details is available from the National Patient Safety Agency website.
Cases can also be referred to the Public Services Ombudsman for Wales.
Finally, patients can contact NHS Direct Wales on Tel (0845) 4647 for further advice about the NHS complaints procedure in Wales - or visit the NHS Direct Wales website.
Scotland
Concerns about NHS services in Scotland, whether at the local GP surgery or hospital, should in the first instance be addressed to the local organisation providing the NHS service.
If you do not feel comfortable approaching the GP surgery or hospital directly, you can call NHS 24, Tel (08454) 24 24 24, for advice on which local health organisation to contact regarding your complaint. Contact details for local NHS health organisations in Scotland can also be found on the NHS Scotland website.
NHS 24 is a nurse-led telephone advice service, equivalent to NHS Direct in England and Wales, now available throughout Scotland.
Comprehensive information on the NHS complaints procedure in Scotland is available in the leaflet 'Making a complaint against the NHS' , which can be accessed via the Health Rights Information Scotland website.
Independent reviews may be carried out by the Scottish Public Services Ombudsman, in cases where local complaints about the NHS have not been adequately resolved
Northern Ireland
Patients with complaints that cannot be resolved immediately should contact the appropriate complaints officer at their local Health Board regarding GP services, or take the matter up directly with the relevant NHS Hospital Trust.
Contact details for the four Health Boards and for all NHS Trusts in Northern Ireland can be found on the Health & Social Care in Northern Ireland website.
Channel Islands (Jersey and Guernsey)
Jersey
If your complaint about treatment involves a local GP practice, it should be addressed in the first instance, preferably in writing, to the practice manager.
If the problem cannot be resolved satisfactorily at the local level, patients can contact the President of the Jersey Division of the BMA, who can act as an independent mediator. The address to write to is:
The President of the Jersey Division of the BMA
Crahamel Medical Practice
Crahamel House
Duhamel Place
St Helier
JE2 4TP
Patients who have concerns about the care that they have received in hospital should, in the first instance, address their concerns to the manager within the particular department, ward or service. If the problem cannot be resolved satisfactorily at the local level, patients can then write to the Health and Social Services Complaints Co-ordinator at the following address:
Chief Executive Office
Health & Social Services
Peter Crill House
General Hospital
Gloucester Street
St Helier JE2 3QS
Tel: (01534) 624196
A patients' guide, 'Comments, Compliments & Complaints', which outlines the complaints procedure in greater detail, can also be obtained from the above address.
Guernsey
If your complaint about treatment involves a local GP practice or the Medical Specialist Group, it should be addressed in the first instance, preferably in writing, to the practice manager.
Where the complaint is related to treatment provided under the States Health Insurance Scheme, it should be forwarded in writing to the Director of Acute Services at the Board of Health:
Director of Acute Services
Board of Health
Department of Health
Corporate Headquarters
Duchess of Kent House
Le Vauquiedor
St Martins
GY4 6UU
If the problem cannot be resolved satisfactorily at the local level, patients can contact the President of the Guernsey and Alderney Division of the BMA, who can act as an independent mediator. The address to write to is:
The President of the Guernsey and Alderney Division of the BMA
Rohais Health Centre
Rohais
St Peter Port
GY1 1FF
Isle of Man
The Isle of Man government has published 'A patient's guide to the complaints procedure for hospital and community health services in the Isle of Man' and the full guide can be downloaded from the Isle of Man government website.
The National Patient Safety Agency (NPSA)
The NPSA is a Special NHS Health Authority which was set up in July 2001 to coordinate the reporting of mistakes and problems affecting patient safety and to learn from these incidents. Although the NPSA cannot investigate individual complaints, patients and carers can make a complaint or report a problem they have experienced via the NPSA Please Ask website (see below).
Through its National Reporting and Learning System (NRLS), NPSA co-ordinates, and publishes, patient safety incident data on a quarterly basis, based on safety reports from NHS health organisation in England and Wales.
Since 2005, the NPSA has taken on responsibility for: the safety aspects of hospital design, cleanliness and food (transferred from NHS Estates); and ensuring that research is carried out safely and ethically through The National Research Ethics Service, NRES, which has a Patients and The Public section on its website.
The NPSA also supports local health organisations in dealing with their concerns about the performance of individual doctors and dentists, through its responsibility for the National Clinical Assessment Service (NCAS), formerly known as the National Clinical Assessment Authority.
NCAS provides confidential advice and support to the NHS in situations where the performance of doctors or dentists is giving cause for concern. Both managers and/or practitioners can contact the NCAS for advice; this may lead to a formal assessment of the clinical performance of a doctor or dentist being carried out.
In 2006, the NPSA started a Please Ask campaign to empower patients to take a more active role in managing their healthcare. On the Please Ask website (under 'Be Informed'), useful safety information and advice is provided for patients, for example:
- top 10 tips for being a safer patient
- inpatients - about staying in hospital
- outpatients - visiting hospital
- emergencies - about emergency admissions
- children in hospital - easing your worries
- relatives - being involved
- medicines - taking them safely
The Healthcare Commission was set up on 1 April 2004 and is now responsible for the inspection and regulation of private healthcare providers in England, including cosmetic surgery and laser clinics.
The Healthcare Commission lists all registered independent healthcare providers on its website.
The Healthcare Commission provides comprehensive advice to patients and their families on complaints about independent healthcare services. You can also ring the Healthcare Commission's helpline on Tel (0845) 601 3012 for further advice.
The equivalent body regulating private healthcare in Wales is the Healthcare Inspectorate Wales while in Scotland, the equivalent body is the Scottish Commission for the Regulation of Care.
In Northern Ireland, the Regulation and Quality Improvement Authority will investigate complaints relating to the private healthcare sector. Complaints can be sent in writing to the following address:
Regulation and Quality Improvement Authority
9th Floor, Riverside Tower
Lanyon Place
Belfast BT1 3BT
Tel: (028) 9051 7500
In addition, the Independent Healthcare Advisory Services (IHAS) - an umbrella group for member organisations providing private heathcare - offers advice to its members on investigating complaints made by patients, including through its Code of Practice for Handling Patients’ Complaints (October 2004).
IHAS has also produced a range of 'codes of practice' and guidance notes for its members and patients, including a guide for patients on making a complaint about private treatment and guidance for people considering cosmetic surgery.
The Citizens Advice Bureau also has an advice guide to private health treatment on its website, which includes a section on complaints.
Good medical and surgical practice
The General Medical Council (GMC) (see below) issues comprehensive guidance on the duties of a doctor and on good medical practice. The GMC's main guidance for doctors 'Good Medical Practice' was revised in October 2006 and is available on the GMC's website.
It includes sections on providing good clinical care to patients and on building good relationships with patients. It applies to all doctors practising in the UK.
The GMC also provides supplementary ethical guidance for doctors on a wide range of other issues such as patient consent, confidentiality and conducting research.
The Royal College of Surgeons recently updated its guidance for surgeons Good Surgical Practice (July 2008), while the Royal College of General Practitioners (RCGP) and the BMA's General Practitioners Committee (GPC) also recently updated their guidance Good Medical Practice for General Practitioners (July 2008).
These updates have been produced in the light of the GMC's amended version of Good Medical Practice in 2006.
The role of the General Medical Council
The General Medical Council is the official body responsible for the registration and regulation of all medical doctors working in the UK. It will investigate where there are serious concerns about a doctor’s fitness to practise or about their professional conduct.
The GMC's website provides information for patients wishing to raise concerns about a doctor - see 'Concerns about doctors'. This section includes guidance for patients on how to refer a doctor to the GMC and/or when using a local NHS complaints procedure would be more appropriate - see 'Making a Complaint'.
The GMC provides comprehensive information on its procedures for investigating concerns about doctors. It may be clear at an early stage that it is not appropriate for the GMC to investigate a particular complaint (for example in the case of a malicious complaint).
Where a case is investigated further, however, the case examiners involved may either: conclude the case with no further action; issue a doctor with a warning; apply conditions to a doctor's work (for example some form of supervision); or refer the case to a Fitness to Practise (FTP) Panel.
At any time a case may be referred to the GMC's Interim Orders Panel (IOP). This can lead to the temporary suspension of a doctor from the Medical Register, or to restrictions being placed on a doctor's right to practise (eg for the protection of the public or in the interests of the doctor). Such restrictions can be placed on a doctor for up to 18 months.
It is a Fitness to Practise Panel which will make the final decision as to whether a particular doctor referred to it is still fit to practise medicine and therefore remain on the Medical Register (Ref 1).
It is now possible to search some previous GMC 'fitness to practise' decisions on their website - see 'Searching Fitness to Practise and Interim Panel Order (IOP) decisions'.
From September 2008, the GMC will pilot plans in the north of England and London for regional officers to deal with minor complaints. Each pilot will pair one medically qualified GMC affiliate with a lay GMC affiliate who will decide whether or not to refer a doctor on to the GMC for further investigation.
These pilot schemes build on proposals in the Department of Health far-reaching White Paper Trust, Assurance and Safety - The Regulation of Health Professionals in the 21st Century (Ref 2).
Minor complaints about the conduct of doctors are increasingly being dealt with locally, via the NHS complaints procedure for example, or through the intervention of the National Clinical Assessment Service (see above). Most complaints about doctors are therefore resolved without the need for referral to Fitness to Practice Panels and only a small number of doctors are removed from the Medical Register each year.
The Council for Healthcare Regulatory Excellence
The Council for Healthcare Regulatory Excellence (CHRE) - formerly known as the Council for the Regulation of Healthcare Professionals - is a statutory UK-wide body, responsible for promoting best practice and consistency in the regulation of a wide range of healthcare professionals, including nurses and doctors.
It was set up in April 2003 to monitor the work and disciplinary decisions of the following nine regulatory bodies:
- General Chiropractic Council
- General Dental Council
- General Medical Council
- General Optical Council
- General Osteopathic Council
- Health Professions Council
- Nursing and Midwifery Council
- Pharmaceutical Society of Northern Ireland
- Royal Pharmaceutical Society of Great Britain
The Health Professions Council
The Health Professions Council (HPC) is an independent, health regulator that sets national standards of professional training, performance and conduct for 13 health professions in the UK.
The HPC keeps a register of properly qualified members of these professions and they will investigate complaints, and take appropriate action, where registered professionals do not meet the required standards. The health professions currently regulated by the HPC are listed below (although they may extend their work to cover other health professionals in the future):
- arts therapists
- biomedical scientists
- chiropodists/podiatrists
- clinical scientists
- dieticians
- occupational therapists
- operating department practitioners
- orthoptists
- paramedics
- physiotherapists
- prosthetists & orthotists
- radiographers
- speech & language therapists
Finally, 12 complementary therapies, including homeopathy and aromatherapy are now to be informally regulated by a body called The Complementary and Natural Healthcare Council, which is due to begin work in summer 2008. It will be an independent, self-regulatory body.
Registration with the Natural Healthcare Council will be voluntary, but those complementary practitioners wishing to register will have to meet certain entry requirements (ie have recognised qualifications) and comply with an agreed set of professional standards.
Some concerns have been expressed that the Council will be regulating complementary therapies for which there is only a limited amount of peer-reviewed evidence.
References
1. General Medical Council; Hearings and Decisions. Available at:http://www.gmc-uk.org/concerns/hearings_and_decisions/index.asp
2. Department of Health; Trust, Assurance and Safety - The Regulation of Health Professionals in the 21st Century. Available at http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_065946