CCGs and GP Complaints

NHS England did not have the information requested.

Dear FOI, NHS England,

In a previous FOI question directed to a local CCG (Solihull) the response was that they had no responsibilities re GP Complaints, and that I should enquire of NHS England.

Hence: please could you tell me as an FOI request, what procedures are specified, and what responsibilities –if any– are placed on CCGs, with relation to GP Complaints.

(1) What record should be (or is) kept by Commissioners with relation to GP complaint monitoring and assessment?

(2) Is the CCG required to respond or react to complaints made against ‘their’ GP practices, where a complainant is not satisfied with the Practice response, or suspects that a GP self-investigation was not conducted with accuracy or candour.

(3) I was told by the previous local commissioners (Solihull PCT Contracting) that they had no responsibility to investigate; but I am now informed by the GMC (through FOI request) that GP Commissioners DO have responsibilities (relating to Complaints/Practices/GPs): please clarify this apparent anomaly.

(4) Can you tell me if NHS England has prepared and/or issued any Standard Procedures for use by GP Practices for executing AND documenting complaint investigations; or if there is any intention so to do for the purposes of conformity and clarity of actions? Would those procedures be obligatory?

(5) As an illustration please: a request to a local Practice –after an unsatisfactory complaint response– could not provide (a) investigation procedures, or (b) any account or proof (e.g. steps taken; records examined) of an internal investigation. I requested this because the Response or ‘explanation’ I had received patently did not align with recorded facts. What should the Practice have provided? (Terms of reference: provided now in 2013; and in 2009.)

(6) If there are any policies, procedures or instructions on the above matters (re GP Complaint Investigations), could I have a copy of that information, or a link if available in the public domain please? (I am not referring here to Ombudsman –PHSO– appeal/complaint procedures). Thank you.

Yours faithfully,

C Rock

Contactus England (HEALTH AND SOCIAL CARE INFORMATION CENTRE), NHS England

Thank you for contacting NHS England.

 

Your Freedom of Information (FOI) request, which we received on 04 october
2013 has been allocated a reference number of SDR 148085.  Please quote
this reference in any further communication regarding this matter.

 

Your FOI request has been passed to the Case Management Team and a Case
Officer will acknowledge your request within two working days.  We will
respond to your FOI request within 20 working days in line with the FOI
Act 2000.

 

If you require any further information or wish to speak to someone about
your request, please contact NHS England at the email address and
telephone number shown below.

 

Yours faithfully

 

 

 

NHS England

PO Box 16738 | Redditch | B97 9PT

0300 3 11 22 33

[email address]

www.england.nhs.uk

 

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FOI England (NHS ENGLAND), NHS England

Our reference: SDR-148085: Acknowledgement

 

Dear Mr Rock,

 

Thank you for your Freedom of Information (FOI) request, dated 3 October
2013. Please be assured that your request is being dealt with under the
terms of the Freedom of Information Act 2000 and will be answered within
twenty working days.

 

If you have any queries about this request or wish to contact us again,
email [1][email address] and the message will be forwarded
appropriately. Remember to quote the above reference number in any future
communications.

 

Please do not reply directly to this email. This message has been sent
from a central mailbox and incoming messages will not be received.

 

Yours sincerely,

 

Natasha Mahoya

Customer Contact Centre Case Officer

 

NHS England

 

PO Box 16738 | Redditch | B97 9PT

0300 3 11 22 33

[2][email address]

[3]www.england.nhs.uk

 

 

 

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References

Visible links
1. mailto:[email address]
2. mailto:[email address]
3. http://www.england.nhs.uk/

FOI England (NHS ENGLAND), NHS England

Dear Mr Rock,

 

Re:      Freedom of Information request (Our Ref: SDR - 148085)

 

Thank you for your Freedom of Information (FOI) request dated 3 October
2013.

 

Your exact request was,

 

“Hence: please could you tell me as an FOI request, what procedures are
specified, and what responsibilities –if any– are placed on CCGs, with
relation to GP Complaints.

 

(1) What record should be (or is) kept by Commissioners with relation to
GP complaint monitoring and assessment?

 

(2) Is the CCG required to respond or react to complaints made against
‘their’ GP practices, where a complainant is not satisfied with the
Practice response, or suspects that a GP self-investigation was not
conducted with accuracy or candour.

 

(3) I was told by the previous local commissioners (Solihull PCT
Contracting) that they had no responsibility to investigate; but I am now
informed by the GMC (through FOI request) that GP Commissioners DO have
responsibilities (relating to Complaints/Practices/GPs): please clarify
this apparent anomaly.

 

(4) Can you tell me if NHS England has prepared and/or issued any Standard
Procedures for use by GP Practices for executing AND documenting complaint
investigations; or if there is any intention so to do for the purposes of
conformity and clarity of actions? Would those procedures be obligatory?

 

(5) As an illustration please: a request to a local Practice –after an
unsatisfactory complaint response– could not provide (a) investigation
procedures, or (b) any account or proof (e.g. steps taken; records
examined) of an internal investigation. I requested this because the
Response or ‘explanation’ I had received patently did not align with
recorded facts. What should the Practice have provided? (Terms of
reference: provided now in 2013; and in 2009.)

 

(6) If there are any policies, procedures or instructions on the above
matters (re GP Complaint Investigations), could I have a copy of that
information, or a link if available in the public domain please? (I am not
referring here to Ombudsman –PHSO– appeal/complaint procedures). Thank
you.

 

NHS England holds this information. For clarity we have responded to your
request in a sequential manner.

 

1. NHS England as commissioners of primary care services record and
monitor only those complaints directed to them by complainants for
investigation and management. Complaints directed to the GP practice are
managed entirely by the Practice themselves.

 

2. There is no requirement for a Clinical Commissioning Group (CCG) to act
in these circumstances. If a complainant is unhappy with the response
received from the practice the next action would be to contact the
Ombudsman.

 

3. The CCG has no responsibility to investigate complaints made about GP
practices. CCGs do however have some responsibility for the continual
improvement of primary care. Complaints may inform this improvement.

 

4. NHS England has produced an Interim Complaints Policy.

 

5. Reference to the NHS England Interim Complaints Policy and the Care
Quality Commission guidance about compliance for Outcome 17: Complaints
may provide helpful clarification. Please find the Interim Complaints
policy attached to this response.

 

6. I can confirm that NHS England holds information relevant to your
request. However, as the information held by NHS England is in the public
domain, we will under Section 21 of the FOI Act (information accessible to
the applicant by other means) refer you to the published source. 

 

[1]http://www.cqc.org.uk/content/essential-...

 

I hope this information is helpful. However, if you are dissatisfied, you
have the right to ask for an internal review by writing to us, within two
months of the date of this letter, to:

 

NHS England

PO Box 16738

REDDITCH

B97 9PT

 

Email: [2][email address]

 

Please quote the reference number SDR-148085 in any future communications.

 

If you are not content with the outcome of the internal review, you have
the right to apply directly to the Information Commissioner for a
decision. The Information Commissioner’s Office (ICO) can be contacted at:

 

The Information Commissioner’s Office

Wycliffe House

Water Lane

Wilmslow

Cheshire

K9 5AF

 

Telephone: 0303 123 1113

Email: [3][email address].uk  

Website: www.ico.gov.uk

 

Please note there is no charge for making an appeal.

 

Please do not reply directly to this email. This message has been sent
from a central mailbox. To communicate with NHS England regarding FOI,
enquiries or complaints we ask that these are sent directly to the
customer contact details provided above. This is to ensure all
communications are progressed correctly.

   

Yours sincerely,

 

 

Natasha Mahoya

Freedom of Information

 

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References

Visible links
1. http://www.cqc.org.uk/content/essential-...
2. mailto:[email address]
3. mailto:[email address]

Dear FOI England (NHS ENGLAND),

Thank you for your response. In clarifying responses to questions (quoted for ease of reference):

(1) What record should be (or is) kept by Commissioners with relation to GP complaint monitoring and assessment?

Answer: CCG monitor only those complaints directed to them in first instance. There is no duty to record and monitor Practice complaints in general.

(2) Is the CCG required to respond or react to complaints made against ‘their’ GP practices, where a complainant is not satisfied with the Practice response, or suspects that a GP self-investigation was not conducted with accuracy or candour.

Answer: There is no CCG requirement to investigate [As I understand you there is no duty to become involved if for instance GP response is deceitful or negative; where the Ombudsman is the only recourse] I.E. complaints may be addressed to the Practice or, if to the CCG, the CCG will actively investigate them.

(3) I was told by the previous local commissioners (Solihull PCT Contracting) that they had no responsibility to investigate; but I am now informed by the GMC (through FOI request) that GP Commissioners DO have responsibilities (relating to Complaints/Practices/GPs): please clarify this apparent anomaly.

Answer: The CCG has no responsibility to investigate complaints made about GP. The CCG may use complaints to improve service [although it leads to the question of how the CCG become aware of complaints other than those in (1)]. The GMC must therefore be wrong in their assumption that there is a responsibility or system in CCGs for [all] GP complaints.

(4) Can you tell me if NHS England has prepared and/or issued any Standard Procedures for use by GP Practices for executing AND documenting complaint investigations; or if there is any intention so to do for the purposes of conformity and clarity of actions? Would those procedures be obligatory?

Your answer: (a) NHS England has produced an Interim Complaints Policy [Sorry - Not attached] (b) An obligation has not specified [please include or attach].

FURTHER QUESTION: I did not find the referenced attachment to this response – can you email it to me please (or attach it to a new response)?

(5) As an illustration please: a request to a local Practice –after an unsatisfactory complaint response– could not provide (a) investigation procedures, or (b) any account or proof (e.g. steps taken; records examined) of an internal investigation. I requested this because the Response or ‘explanation’ I had received patently did not align with recorded facts. What should the Practice have provided? (Terms of reference: provided now in 2013; and in 2009.)

Your response: You have given a link to the CCQ web site and I found a reference to Outcome 17 and the Provider Compliance Assessment, thank you, although it does not directly answer my enquiry for more specifics. [The 'PCA' may however be useful if for instance complainants wish to feed back their own impressions of Practice compliance to the CQC].

(6) If there are any policies, procedures or instructions on the above matters (re GP Complaint Investigations), could I have a copy of that information, or a link if available in the public domain please? (I am not referring here to Ombudsman –PHSO– appeal/complaint procedures). Thank you.

Your response was understood but not entirely complete.

FURTHER QUESTION: Can you be more explicit on where I will find this information in the public domain (re conducting GP Complaint Investigations)? I have not been able to find any useful information or guidance on how GPs should investigate complaints directed to themselves and what record (i.e. evidence/justifications/etc) should be made available to the complainant.

Thank you for your replies and could I ask you to confirm my understanding (with corrections if necessary), and answer the two queries.

Yours sincerely,

C Rock

FOI England (NHS ENGLAND), NHS England

1 Attachment

Dear Mr Rock,

 

Thank you for your clarification email below, please accept our apologies
for omitting to attach the relevant documentation.

 

(4) Can you tell me if NHS England has prepared and/or issued any Standard
Procedures for use by GP Practices for executing AND documenting complaint
investigations; or if there is any intention so to do for the purposes of
conformity and clarity of actions? Would those procedures be obligatory?

 

Our response: (a) NHS England has produced an Interim Complaints Policy
please find this attached as a PDF document. Please be advised that the
policy and responses provided are for when a complaint has been made
against a GP directly to NHS England. General Practitioners (GPs) have
their own complaints procedures with some guidance that can be found on
the NHS choices website.
   [1]http://www.nhs.uk/choiceintheNHS/rightsa...

 

(6) If there are any policies, procedures or instructions on the above
matters (re GP Complaint Investigations), could I have a copy of that
information, or a link if available in the public domain please? (I am not
referring here to Ombudsman –PHSO– appeal/complaint procedures). Thank
you.

 

Our response: The information held by NHS England is in the public domain
to which we provided the link to you. However, to reiterate GPs have their
own policies and procedures when it comes to complaints, so it may be
useful to you to contact them directly. The complaints policy provided to
you by NHS England relates to complaints made directly to us against GPs,
dentists, pharmacists, opticians, offender and mental health.

 

FURTHER QUESTION: Can you be more explicit on where I will find this
information in the public domain (re conducting GP Complaint
Investigations)? I have not been able to find any useful information or
guidance on how GPs should investigate complaints directed to themselves
and what record (i.e. evidence/justifications/etc) should be made
available to the complainant.

 

Our Response: GPs have their own complaints procedure which follows the
NHS guidance which can be found on the NHS Choices website :
[2]http://www.nhs.uk/choiceintheNHS/rightsa...

You may find it useful to contact your GP directly for a copy of their
complaints policy and procedures. If after complaining you are still
dissatisfied with your response you have the right to take this to the
ombudsman through the following link: [3]http://www.ombudsman.org.uk/

 

I hope the information below fully answers your request, however if you
are dissatisfied with the response you have the right to request an
internal review by writing to us, within two  months of the date of this
letter, to:

 

Address:        NHS England

PO Box 16738

           REDDITCH

B97 9PT

 

Email:             [4][email address]

 

Please do not reply directly to this email. This message has been sent 
from a central mailbox. To communicate with NHS England regarding FOI, 
enquiries or complaints we ask that these are sent directly to the 
customer contact details provided above. This is to ensure all 
communications are progressed correctly.

 

Yours sincerely,

 

Natasha Mahoya

Customer Contact Centre Case Officer

 

NHS England

 

PO Box 16738 | Redditch | B97 9PT

0300 3 11 22 33

[5][email address]

[6]www.england.nhs.uk

 

 

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Dear FOI England (NHS ENGLAND),

I found your own procedures and policies which you supplied, very helpful and revealing, if they are intended to represent best practice and typical requirement – practically a model document.

You have told me however that they only relate to complaints directed to NHS England and not to complaints directed to the GP, which is where most persons would turn in the first instance.

It is apparently up to the GP Practice to develop and publish its own terms and policies, but I could still find no help with details or statutory requirements through the link you gave.

Neither did you comment on the matter of obligation on a Practice to produce and make available their complaints handling terms and policies.

My request was essentially to establish if GP Practices employed by NHS England were under obligation to adopt and follow standard policies and procedures on complaint handling –perhaps developed and controlled from one place (NHS England) - but essentially you have told me that GP Practices are free to write their own –or not, as the case may be.

In implication if I understand you correctly you have also said that there is no obligation on CCGs or NHS England to monitor GP complaints or the success or failure of them. Also, GP Practices will be inspected by CQC but not against standard procedures and not against any specified requirement for conducting or recording complaints details, apparently.

Please correct me if I am wrong but I have seen the policy failing – hence my questions. Please add any comment if you wish but otherwise I will close the request shortly.

Thank you again for your replies.

Yours sincerely,

C Rock

C Rock left an annotation ()

How GP Practices investigate, record and follow-up complaints, then, is entirely up to the Practice: the documentation skills they have, the willingness to cooperate, the time available to devote to these matters; all of which can vary between Practices who, essentially, are under pressure just to deal with the daily servicing of patient appointments.

It is easy for a GP Practice to close a complaint for whatever reason. The Ombudsman does not automatically investigate and does not first establish facts easily obscured in a short or negligent GP response.

The next stage: You will be referred to the 'Ombudsman' (the PHSO) but they do not check to see if the GP Practice (or an NHS group or department) has any complaints procedures or policy statements against which the quality or reliability of the responses can be measured.

It is unwise to rely on any further expectation for redress from the Ombudsman. It is unlikely that their advisers/ respondents/ assessors would be aware of complaint procedures or policies, or the importance of referring back to them, since their own policies are ignored or waved aside using their discretionary powers https://www.whatdotheyknow.com/request/p....

It is fairly obvious that there is currently no clear and open complaints system as it is too easy for negligence to be covered up with the prevailing assumption that doctors can be trusted to do their best for a patient. If there are slip-ups, practitioners will naturally do their utmost to play them down - or conveniently forget facts.

Opportunities for learning and redress are arrogantly denied, and missed, and we see that every day in the media.

FOI England (NHS ENGLAND), NHS England

Dear Mr Rock,

 

Thank you for getting in touch with in regards to the response that we
provided to you. I apologise if the links we provided to you do not
respond to your enquiry as comprehensively as you were looking for. It
might be beneficial to you if I explained the NHS complaints procedure.
All NHS bodies are required to have a complaints procedure that meets the
regulations as set out by the Department of Health. These regulations can
be found by following the link below.
[1]http://www.legislation.gov.uk/uksi/2009/...

 

GP practices are not employed by NHS England but are however commissioned
by us. They are required by law to have a complaints policy and have this
freely available to their patients. If a complainant is still unhappy
about the way their complaint has been dealt with they can then take this
further with the Parliamentary Health Service Ombudsman. It may be helpful
for you to contact your GP to get further information on their complaint
procedure.

 

You may also find it beneficial speaking to one of our complaints
managers, if you are happy to do this please provide us with your contact
number or call our Customer Contact Centre using the details below and
they will transfer you to a complaints manager who will be more than happy
to take you through the processes and procedures.

 

Please do not reply directly to this email. This message has been sent 
from a central mailbox. To communicate with NHS England regarding FOI, 
enquiries or complaints we ask that these are sent directly to the 
customer contact details provided above. This is to ensure all 
communications are progressed correctly.

 

Yours sincerely,

 

Natasha Mahoya

Customer Contact Centre Case Officer

 

NHS England

 

PO Box 16738 | Redditch | B97 9PT

0300 3 11 22 33

[2][email address]

[3]www.england.nhs.uk

 

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Dear FOI England (NHS ENGLAND),

You said:

"All NHS bodies are required to have a complaints procedure that meets the regulations as set out by the Department of Health. These regulations can be found by following the link"

This was not the case in my original complaint to the GP Practice. It is obviously not a requirement that is policed. That is why I am trying to find out what should happen.

"GP practices are not employed by NHS England but are however commissioned by us. They are required by law to have a complaints policy and have this freely available to their patients"

This was not the case when I made a complaint of a very serious matter to Bernays and Whitehouse medical practice. It appears open to the Practice what to publish and how to respond to a complaint.

"If a complainant is still unhappy about the way their complaint has been dealt with they can then take this further with the Parliamentary Health Service Ombudsman"

This action has already been taken. However, the Ombudsman (PHSO) did not enquire or check on the Practice's interpretation of NHS requirements, or manner of internal investigation. There was no policy, investigation procedure or record available, and NHS requirements were not followed in response or time-scales. The PHSO did not check this and as a result were misinformed. That is why I am asking if there is a standard procedure. Evidently not.

"It may be helpful for you to contact your GP to get further information on their complaint procedure"

Contacting the Practice was not helpful and, in short response, nothing could be provided. The complaint response was not only not helpful, but was incomplete, inaccurate and dishonest. That is why I am trying to clarify the exact requirements. Following on from that, the PHSO was evasive, incorrect in its assumptions, and rude - against all their 'principles'- and did not investigate. The matter remains unresolved.

I have recently asked the Practice in question to provide under FOI request their exact procedures and policies, before taking the matter up with the CQC who should be ensuring compliance with so-called legal requirements.

Your responses appear to rely on an uncontrolled chain of events left open to trust in your contractors, yet open to interpretation. Patients and their family are the ultimate victims as can also be evidenced. Thank you for your responses to-date.

Yours sincerely,

C Rock

C Rock left an annotation ()

Although some of the questions were answered in a roundabout way I do not consider that satisfactory answers were given in the resolution of the matter in question.

With regard to GP Practice procedures NHS England do not hold or stipulate these procedures which can vary between practices according to competence and ability of staff.

Persons wanting a better understanding of how complaints might be handled at their family's GP Practice might do well to enquire directly before there is a problem, or join a patient participation group to urge compliance or make changes.