Clinical Governance

Clinical Governance VTS 24.11.10

Clinical Governance “a system through which NHS organisations are accountable for continuously improving the quality of their services and safeguarding high standards of care by creating an environment in which excellence in clinical care will flourish”. Liam Donaldson

Plan for the afternoon • 14.15 - Dealing with patient complaints • 15.15 – Tea! • 15.30 – Local clinical governance structures • 15.45 – Patient access to records • 16.00 – Appraisal and Revalidation

Patient Complaints VTS Teaching 24.11.10 Tom Lawes

Aims and objectives Review our existing knowledge of handling complaints Scenarios on handling complaints: Face-to-face, and Written Personal case discussions if time

Complaints procedures Both a legal and contractual obligation for NHS organisations (and their contractors) to have systems in place. New Regulations 2009 Care Quality Commission

NHS Constitution • Patients have the right: • To have complaints dealt with efficiently and have them properly investigated • To know the outcome of any investigation • To take complaints to the Ombudsman if not satisfied with how complaints are dealt with by the NHS

‘Spotlight on complaints’Healthcare Commission 2008 GPs most common subject of complaint 45% of complaints were upheld by HC Many complaints could be reconciled before needing secondary level investigation if dealt with appropriately.

Complaints Quiz

You receive a complaint that involves your practice and a local nursing home. After investigating the complaint, how should you write your response to the complainant? Each organisation should write a separate response Each individual involved should write a response The organisations involved should write a single response

You receive a written complaint from a 20 year old patient. Within what time period should you acknowledge receipt of the complaint? Within three working days Within five working days Within seven working days

You receive a phone call from a patient who is unhappy about the care she received from another doctor at the practice. What should you do? Listen to the patient and record the details of the complaint Ask her to speak to the doctor she wants to make a complaint about Ask her to speak to the practice manager

You receive a written complaint from a 55 year old man who is a patient at your practice. After reading the complaint you find that it is about social services and not the practice. What should you do first? Forward the complaint to the correct organisation Contact the patient to explain that the complaint has been made to the wrong organisation Return the written complaint to the patient and ask them to contact social services

Which one of the following statements about why patients make complaints is correct? Patients usually want financial compensation Patients usually complain because of a perceived or actual failure to investigate or treat Patients often want to prevent other people experiencing the same problems

A 40 year old woman makes a complaint and wants to see her records. When she has gone you realise there are many letters from the hospital specialist in her records. You wonder whether you should ask this doctor for permission to copy his letters. What is the best course of action? You must get permission from the hospital specialist before releasing copies of his letters You don't need the hospital specialist's consent before releasing copies of his letters

Your practice recently wrote a response to a patient who made a complaint about waiting times for appointments at your practice. The patient does not feel the response has dealt with her concerns. What should you advise her to do? Contact the health service ombudsman Contact the primary care trust Contact the Department of Health

Which one of the following statements about the role of the health service ombudsman is correct? Patients can direct their initial complaint to the ombudsman The ombudsman will assess whether the patient has a valid case that needs addressing

A patient at your practice has made six complaints about access to the car park at your practice. You have responded to the complaint and the patient’s case was not upheld by the health service ombudsman. You feel that the patient is an unreasonable complainant. How should you manage the situation? Make sure one person from your practice oversees the situation Remove the patient from the practice list Contact the health service ombudsman

A 55 year old man has had chronic bronchitis for many years and was diagnosed with mesothelioma three months ago. He worked as an electrician for years and has also worked as a docker. He is very unhappy with the care he has received from you and from the local hospital and wants to make a complaint. He also wants to see his records. You say you will sort this out, but he wants to see the records immediately. How quickly must you comply with his request to see the records? You must give him a copy of the records immediately You must give him a copy of the records within 20 days You must give him a copy of the records within 40 days

Role-play Scenario

Responding to written complaints Initial response: • Should be within 3 days • Acknowledge patient’s complaint • Should offer a discussion to agree on how complaint will be handled and reasonable timescale • Otherwise give timescale in initial letter

Responding to written complaints Full response: Avoid being defensive Address every issue raised Fully explain all findings of an investigation Apologise where appropriate Detail any changes being made as a result Advise the patient of their right to complain to the Ombudsman if not satisfied

Investigating complaints Assess seriousness and likelihood of recurrence (low-extreme) Consider SEA or RCA Remember to seek consent if forwarding information to other bodies or discussing with patient’s relatives.

Practice arrangements Make complaints procedures freely available to patients (e.g. posters, leaflets) Should have a ‘Responsible Person’ (partner) and Complaints Manager (can be same person) Annual reports to PCT

Quiz Answers