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- To provide an update on the requirements for a good complaints procedure.
- To give dental professionals an understanding of how and why complaints should be handled.
- To offer a comprehensive guide to the process and procedures dental professionals should follow when a complaint is made.
Anticipated learning outcome:
- To be aware of current guidance and best practice relating to the management of complaints.
Why have a practice complaints procedure?
A clear, concise, effective, published and easily accessible procedure is important so everybody knows what should happen if a complaint arises. This includes patients, staff, patients' relatives and carers, as well as outside bodies that might become involved, such as the primary care organisation, the Dental Complaints Service and the GDC.
You should also have a practice complaints procedure because:
- it is a GDC requirement
- it is an NHS requirement under the NHS General Dental Services Regulations
- all responsible, well led organisations, both professional and commercial, will have a carefully crafted complaints procedure
- if patients do not know how to complain to you, they may do so to somebody else, when you will no longer have any control over the process, so you should welcome complaints made directly to you or your practice.
What the GDC says
A set of universal principles for complaints handling has recently been developed by 28 organisations, including the GDC and the DDU, setting out six core principles of best complaint management practice. The GDC's Standards for the Dental Team also has a whole section on complaints, based on its principle five: 'Have a clear and effective complaints procedure'. Paragraph 5.1.1 of Standards for the Dental Team states:
'It is part of your responsibility as a dental professional to deal with complaints properly and professionally.
- ensure that there is an effective written complaints procedure where you work;
- follow the complaints procedure at all times;
- respond to complaints within the time limits set out in the procedure; and
- provide a constructive response to the complaint.
So, each and every registered dental professional working in a practice has a responsibility for complaints - not just the practice owner or manager.
What are the NHS requirements?
It is important to note that there are differences in the NHS complaints regulations in the four UK countries.
In England, the NHS complaints procedure requirements are set out in the Local Authority Social Services and National Health Service Complaints (England) Regulations 2009/309, which were revised on 1 April 2013. Similar but separate regulations apply in Scotland, Wales and Northern Ireland.
The GDC's guidance on complaints in Standards for the dental team requires private practitioners to adopt similar standards and time limits to the NHS, so one procedure should suffice for NHS, mixed and private practices.
The NHS requirements in the four UK countries can be broadly summarised as follows, and form a good basis for any complaints procedure.
- The procedure should be made known to patients, including alternatives to the practice procedure and where to get independent help.
- Who can complain; the patient, somebody authorised by the patient, and for children somebody with parental responsibility.
- There should be a complaints manager who is responsible for the day-to-day operation of the procedure, and a responsible officer, who is a partner or other senior person, to oversee it. They can be the same person.
- The time limits for registering a complaint is generally a maximum of 12 months after the matter being complained about occurred, but there are variations between England, Wales, Scotland and Northern Ireland. Later complaints should be accepted if the complainant has good reason(s) for the delay and it is still possible to investigate the complaint effectively, notwithstanding the delay. If the time limit for registering a complaint has passed, it is worthwhile considering what may happen if you refuse to investigate it. For example, the GDC would expect a complaint about NHS treatment to be investigated and a response provided, even if the NHS time limit had passed.
- All complaints must be recorded in writing. This means that a written record of verbal complaints needs to be made by the person receiving them. As mentioned in our previous article on complaints management, don't put obstacles in the way of patients by insisting they make a written complaint.
- All complaints should be acknowledged on receipt, and a full response sent following a thorough investigation. The time limits for both the acknowledgement and the response are variable between England, Wales, Scotland and Northern Ireland. If a delay is unavoidable, such as the treating dental professional being away on holiday, the complainant should be informed and advised when they can expect to receive a response. If there are delays, the GDC's Standards requires that updates be provided at least every 10 days.
- Explain to patients the need to access their confidential clinical records in order to investigate and respond to their concerns, and seek their consent to do so.
- Complaint correspondence should be stored separately from the dental records (also a GDC requirement), and retained for two years from the date the complaint was raised.
- The respondent must co-operate with the primary care organisation and any other NHS body investigating a complaint.
- Data on complaints should be kept and supplied to the primary care organisation on request.
Each and every registered dental professional working in a practice has a responsibility for complaints - not just the practice owner or manager.
Publishing your complaints procedure
It is a GDC requirement for details of the complaints procedure to appear on the practice website, along with details of who patients can contact if they are not satisfied with the response.
It should also appear in the practice information leaflet, and a notice or poster should be displayed prominently in the reception area. Printed copies of the procedure should be readily available from reception, and patients should receive a copy of the procedure with the written acknowledgement of their complaint.
It cannot be stressed too strongly that if patients are dissatisfied you should make it easy for them to complain at practice level - otherwise they may well complain elsewhere, with potentially damaging consequences. Any complaint investigated by an external body, whatever the final outcome, will inevitably involve time, trouble, expense and some stress for the dental professional concerned.
The stages of a complaint process
Stage 1: the practice procedure
This is also known as 'local resolution'. At this stage, NHS patients can choose to bring their complaint to you/the practice, or can choose to have the primary care organisation investigate it on their behalf. They must choose one of these options, and cannot change from one to the other. The effect and actions required are similar for both alternatives.
Local resolution can be divided into three parts:
You or the practice should acknowledge the complaint, attaching a copy of the practice procedure and in general promising a thorough investigation together with a full response within the timeframe set out in the procedure. If you know this is not achievable from the outset, explain the delay and the reason for it in the acknowledgement.
As soon as you receive any complaint which cannot be immediately resolved, we recommend you contact the DDU's helpline to discuss the complaint and seek the advice of one of our experienced dento-legal advisers, who are all qualified dentists. They will likely ask you to write in with details of the complaint as soon as you have investigated it but before responding substantively. Our website has more information about what to send us.
You or the practice complaints manager should thoroughly investigate all aspects of the complaint, including reviewing all the available records, as well as obtaining reports or speaking to everyone involved with the events in question.
You should aim to respond in full within the timeframe set out in the procedure, which is commonly 10 working days from receiving the complaint. This requires prompt action if you are going to thoroughly investigate the complaint and obtain the DDU's advice before responding.
If there is going to be a delay in responding you should inform the patient/complainant, explaining the reason(s) and advising them of the date on which they can expect a response. The contents of an appropriate response were discussed in the previous article on complaint management.
Only when making the final response to the complaint do you need to advise the patient again of their other avenues of complaint. These other avenues should be set out in the published procedure and should not include the GDC, which is not a complaint resolution body and is only concerned with fitness to practise issues.
If a complaint cannot be resolved at the local resolution stage, patients may decide to proceed to the second stage of the complaint process. For NHS treatment this is to the relevant Ombudsman in England, Wales, Scotland or Northern Ireland with responsibility for the NHS, depending on where the treatment in question was provided.
For private treatment it is the Dental Complaints Service (DCS), an independent, arms-length body financed by the GDC through registrants' annual retention fees.
If a patient escalates their complaint to either body, you will be contacted by that body and should co-operate fully, with advice and guidance from the DDU. It is essential you keep the DDU fully informed of any such developments, so we can assist you with appropriate responses to the Ombudsman or DCS.
If a patient is not satisfied with the outcome of a stage two investigation, although there are no formal procedures for taking it further they might take their complaint to a solicitor, to the GDC or to the police if the complaint involves alleged criminal activity.
The content of a practice complaints procedure:
Each practice should have its own procedure which accurately reflects its internal protocol for managing complaints. It is not for the DDU to be prescriptive, but the senior person responsible for complaints in a practice may wish to consider including some or all of the following content.
- We take all complaints very seriously. They are investigated thoroughly, and all complainants can expect to receive a prompt and helpful response. We use complaints not only as an opportunity to resolve the particular issues as far as possible, but also to learn and to improve our services to patients.
- If you need help with making a complaint you can contact [insert name and telephone number of the local advocacy service] or Citizens Advice on [insert telephone number].
- The complaints procedure is entirely confidential and will not affect your ongoing care. However, if it is in your best interest to make a fresh start with a new dental professional, or you ask for this, this is also an option.
- [Name of practice complaints manager] is responsible for day-to-day complaints handling within the practice, and you can contact them by phone on [telephone number], by email at [email address], and by post [address of practice].
- You can complain verbally or in writing. If you complain verbally, we will make a written record of your complaint and will check this with you for accuracy before investigating the complaint. You will also be given an opportunity to speak direct to the practice complaints manager at a mutually convenient time.
- Whether you complain verbally or in writing, you will receive a written acknowledgement of your complaint within [number of days] working days of when we receive your complaint.
- We will carry out a thorough investigation of your complaint, which may include accessing your confidential clinical records and seeking information from all those involved in your care within the practice.
- After our investigation, you will receive a detailed and helpful written response. We aim to do this within [insert number of days] of receiving your complaint. Normally the dental professionals who have provided your care will respond directly to your complaint. If for any reason you would prefer this not to happen, our complaints manager will liaise with those involved and then respond to your concerns personally. In the case of NHS treatment, as an alternative you can take up your complaint from the outset with the NHS primary care organisation, [name of organisation, address, phone number, email]. The primary care organisation will then contact us for our response.
- If there will be any unavoidable delay at any stage of the process we will write to you with information about the delay, the reason for it, and the date when you can expect to receive a response.
- The complaint correspondence is filed separately from your clinical records, and we can assure you the whole procedure is entirely confidential. Only those members of the practice staff who need to will know about your complaint.
- If you are complaining on behalf of someone over the age of 16, we will require that patient's signed authority for you to act on their behalf. If you are complaining on behalf of someone under 16, we will need to know that you have parental responsibility for them, or will need signed authority from somebody with parental responsibility for you to act on their behalf.
- If you are not satisfied with our initial response, please let us know so we can try to resolve any outstanding issues. We will make every reasonable effort to find a mutually acceptable resolution.
- When you receive our final response, if you are still not satisfied you can refer the matter for independent investigation. In the case of NHS treatment you can pursue your complaint with the NHS Ombudsman at [address].
- In the case of private treatment you can pursue your complaint with the Dental Complaints Service, 37 Wimpole Street, London W1G 8DQ, 020 8253 0800 (Monday - Friday, 9am - 5pm), web enquiry form.
It is worthwhile considering having both a published practice complaints procedure for use by patients along the above lines, and an internal complaints protocol that staff are required to follow and which forms the basis of regular whole team training within the practice.
It is essential that all members of staff are familiar with the practice procedure and know exactly what to do when a patient expresses any dissatisfaction.
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David qualified from Newcastle Dental School in 2002. His post-graduate training included qualifications from the Eastman Dental Hospital and the Royal College of Surgeons, after which he worked in a number of dental settings in the UK and abroad. He has always pursued an interest in the legal aspects of dentistry and has a Master of Laws degree in the Legal Aspects of Medical Practice.
See more by David Lauder
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