What is a complaint?
An accepted definition of a complaint is 'an expression of dissatisfaction that requires a response'. If a patient makes you or any other member of the team aware they are unhappy with any aspect of your service, you would be wise to treat it as a complaint.
Who can make a complaint?
The patient, the patient's parent or other person with parental responsibility if the patient is a child, or the patient's properly authorised representative can all legitimately make complaints. If a third party is complaining on behalf of the patient it is very important to establish their right to do so before responding, in order to preserve patient confidentiality.
Why might someone complain?
Dissatisfaction with the treatment or service, or a failure to meet patient expectations (which may or may not be reasonable) underlie all complaints. Many complaints arise from misunderstandings due to difficulties with communication, such as not adequately explaining what is involved in carrying out the treatment.
Failure of treatment, complications and mishaps can all lead to complaints, so the explanations and warnings given when seeking consent are important in preventing them. A perception of a lack of courtesy and human empathy, of rudeness, indifference, callousness or aggression often form part of a complaint, or can even be the sole issue.
How might someone complain?
Complaints can be made direct to the practice or via a third party, such as the NHS primary care organisation, the Dental Complaints Service for private treatment, a capitation plan provider or the GDC. The GDC is not a complaints resolution service, and it should only investigate complaints that could give rise to a finding of impaired fitness to practise.
Complaints can be made verbally or in writing, and you should never insist that a patient who wishes to make a verbal complaint puts it in writing. If a complaint is made verbally, a full written record should be made by the person receiving the complaint, and the complaint should then be processed under the practice procedure, in the same way as a written complaint. This means that all patient-facing members of staff should be trained in how to manage verbal complaints.
It cannot be over-emphasised that it is hugely important no obstacles are put in the path of a patient wishing to complain. Full details of the practice complaints procedure should be included on the practice website (a GDC requirement) as well as in the practice information leaflet, and a suitable notice should be displayed prominently at the practice reception and/or in the waiting area.
If patients who wish to complain do not know about your practice procedure or think that you do not take complaints seriously, there is a high risk they will complain elsewhere. Once a complaint involves an outside body, you no longer have any control over how it is managed, and the risks of the complaint escalating increase.
DDU data indicates that around 90% of complaints can be resolved at practice level with our help. While a complaint made at practice level may be somewhat stressful and time consuming, it is time and effort well spent to avoid it escalating outside the practice.
If a complaint can be resolved there and then, or within 24 hours, there is no need to acknowledge its receipt. Otherwise all complaints, whether initially made verbally or in writing, should be acknowledged within three working days of receipt, by confirming receipt of the complaint, explaining that it is being investigated under the practice procedure, and enclosing a copy of the practice procedure.
If there will be a delay in responding to the complaint (for example, because the dental professional concerned is away on holiday), this should be explained in the acknowledgement. There is absolutely no need at this stage to mention other avenues of complaint, and it is highly undesirable to do so unless the patient asks.
Your sole aim at this stage should be to resolve the complaint at practice level speedily and amicably, following a thorough investigation and a carefully considered response. Save for perhaps saying you are sorry the patient has felt the need to complain, or offering an immediate appointment if the patient is in pain or difficulty, no comment should be made at this stage. Remember that an apology is not an admission of liability, and can often smooth the path for a successful resolution.
Where to keep the complaint documents
Complaint documents, including correspondence with the DDU, should be stored in a complaint file, either electronic or paper. Keep this separate from the clinical records.
It cannot be over-emphasised that it is hugely important no obstacles are put in the path of a patient wishing to complain.
All the dental professionals who were directly involved in the treatment or consultations in question, or who are the subject of the complaint, should be asked for their comments and observations on the complaint.
How we can help
As soon as you receive any complaint that is being formally investigated, whether at practice level or beyond, you should seek the DDU's advice by calling our helpline in the first instance (0800 374 626). You will usually be asked to write in to us with the following information.
- A copy of the complaint.
- A copy of the practice's acknowledgement.
- A copy of the practice complaints procedure.
- Copies of the clinical records and any relevant radiographs.
- The identity of any other dental professionals involved and an indication of the nature and extent of their involvement.
- Your comments and observations on the issues complained about.
- Any offer you would wish to make to patient, or any words you would like to include in your response.
All the above information will need to be anonymised, removing the patient's full name and address, but leaving their initials (forenames and surname) and their date of birth, so we can identify the patient without breaching the General Data Protection Regulations. In correspondence with you we will refer to the patient simply by their initials and date of birth.
The DDU dento-legal adviser personally allocated to your case will then draft you a suitable response to the complaint, having asked you for any extra information they need to be able to do so. Time is of the essence. You should be aiming to respond to any complaint within 10 working days of receiving it, and in general a quicker response results in a better prospect of resolving the complaint.
Why respond to complaints?
First and foremost you should respond to all complaints professionally, helpfully and promptly because it is an opportunity to resolve the matter to the satisfaction of all concerned, and possibly to retain the patient as a loyal and satisfied user of the practice.
If you resolve the complaint at practice level you also largely remove the risk of an outside body becoming involved, which is clearly undesirable. Last, and perhaps least important, you should respond to complaints because the GDC and the NHS regulations require you to do so, and a failure to do so can lead to disciplinary action against you.
Responding to complaints
The sole purpose of responding to a complaint is to resolve it as quickly as possible to the satisfaction of all concerned. It is therefore vital to consider why the patient is complaining, what they might be seeking, and what you might reasonably say, do or offer which could satisfy them.
Sometimes it is appropriate to ask the patient this very question, but more often careful analysis of the background to the complaint and its content will indicate possible avenues for resolution.
One or more of the following may help to satisfy a patient and resolve their complaint.
- A sincere apology and expression of sympathy and empathy.
- A purely factual resume of the clinical sequence that references the clinical records, to help remind the patient of events.
- An explanation in plain language, so the patient understands what happened, why it happened and how it can be remedied.
- An offer to meet the patient face-to-face to discuss matters.
- An offer to treat the patient again and resolve the issue(s) they are complaining about.
- An offer to refer the patient to a colleague in the practice for continuation of their treatment, so as to make a fresh start with a new face.
- An offer to refer the patient to an independent consultant or specialist for a second opinion.
- What action you have taken to learn from their complaint and prevent a recurrence.
- An offer to refund the whole or part of the fees, or to provide remedial treatment free-of-charge, as a gesture of goodwill.
With regards to the final point, provided such an offer is made as a gesture of goodwill, it will not in any way prejudice your position if the complaint cannot be resolved at practice level and an outside body becomes involved. Rather, it will show you to be a reasonable practitioner who has done their best to resolve the complaint.
There is no need to couch such an offer in legal terms, although you can make it conditional upon the patient accepting it in conclusion of their complaint.
When initially responding to complaints, the DDU generally advises not to include in the response details of the second stage complaints process (the relevant ombudsman for NHS complaints, Dental Complaints Service for private complaints). There is no requirement to include this information in a letter of response unless and until an impasse is reached and you are making your final response to the complaint.
Unless the patient asks for details of the dental regulator, there is also no requirement to mention the GDC at any stage, as it has no role to play in resolving individual patient complaints. The GDC's Standards for the dental team includes the following:
'If the patient is not satisfied despite your best efforts to resolve their complaint, you should tell them about other avenues that are open to them, such as the relevant Ombudsman for health service complaints or the Dental Complaints Service for complaints about private dental treatment.'
Once a complaint involves an outside body, you no longer have any control over how it is managed.
What might happen if you are unable to resolve a complaint?
- The complainant may remain unhappy but continue as a patient.
- The complainant may seek treatment elsewhere. In this situation and that above, the patient may tell family and friends about their unresolved complaint and dissatisfaction.
- The complaint may move to the second stage procedure; the relevant ombudsman for NHS complaints, Dental Complaints Service for private complaints. NHS patients may initially choose to make their complaint to the practice or to the primary care organisation, but they cannot do both and they cannot move from one to the other. An NHS patient who is dissatisfied with the outcome of local resolution can only approach the relevant ombudsman at the second stage.
- The patient may bring a claim for compensation, alleging negligence or breach of contract, either acting in person or instructing solicitors to act on their behalf.
- The patient may complain to the GDC, which should only investigate the complaint if it evidences impaired fitness to practise.
As with clinical dentistry, prevention is better than cure. Good communication is fundamental to avoiding complaints, and DDU data shows that approximately a third of all complaints have at their heart difficulties with communication, including alleged rudeness by various members of the team and 'customer service' issues, such as running late for appointments.
Communication is an issue in the majority of complaints. Managing patient expectations is also vital to having satisfied patients, and in general it is better to under-promise and over-deliver, rather than vice versa. Also, be prepared to decline to accept a patient for treatment if you think you cannot meet their expectations, when referral to a consultant or specialist may be appropriate.
The consent process is part of the overall communication with the patient. The explanations you give a patient about potential complications, risks and prognosis are invaluable in ensuring they have realistic expectations and are not disappointed if treatment does not go according to plan. Such explanations given only after the event may come across as excuses.
If something goes wrong with a patient's treatment, the patient is entitled to a prompt, full and frank explanation. In these situations, you should also apologise to the patient that the outcome has not been as you would both wish, and explain the options going forward.
Learning from complaints
When responding to complaints it may be important to advise the patient what action you have taken to learn from their complaint and prevent it happening again. This is also important in improving your service generally.
Many successful businesses spend a lot of time and effort analysing their complaints, providing unique feedback on their service. Complaints that have been suitably anonymised to preserve patient confidentiality should be shared amongst the team and can provide the basis for useful discussion and training at staff meetings.
Senior dento-legal adviser
Senior dento-legal adviser
Rupert Hoppenbrouwers (BDS LDSRCS) was head of the DDU until his retirement at the end of 2015. He is a former general dental practitioner and was director of the School of Dental Hygiene at University College Hospital, London, from 1980 to 1986. He has lectured and written widely on risk management and dento-legal matters, has previously chaired the UK Dental Law and Ethics Forum, and has a particular interest in complex ethical and legal issues affecting dental members.
See more by Rupert Hoppenbrouwers