MDU medico-legal adviser Dr Ellie Mein explains that GPs have a crucial role to play in managing patients who complain about delays in treatment caused by the pandemic and offers some tips on how to avoid complaints.
MDU medico-legal adviser Dr Ellie Mein
With latest figures from NHS England revealing that almost 390,000 people are now waiting over a year to start hospital treatment, GPs are playing a key role in reassuring and supporting patients whose care has been impacted by pandemic delays and disruption
A survey of 612 GPs by the Medical Defence Union (MDU) and GPonline found that while 82% of respondents stated that patients have been understanding of pandemic changes three quarters of GPs (74%) feared facing a complaint related to the pandemic. Over a third (38%) had already received a complaint
Key reasons for complaints
At the MDU we have been supporting members with over 3,800 complaints and adverse incidents that have arisen over the last tumultuous year. This has helped us to examine some of the key causes of complaints and to provide advice on how to manage patient expectations at this difficult time. The commonest areas for complaints according to our survey were:
- Waiting times for treatment (58%)
- Access to routine screening and tests (43%)
- Remote consultations (48%)
- Flexibility of appointments (36%)
- Technical issues with using and accessing technology (33%)
- Communication issues (32%)
- Face covering policy (27%)
While some complaints relate directly to the treatment of COVID-19, such as a failure to diagnose the virus, in many cases, complaints are about the way care for other conditions was delivered due to the necessary changes during the pandemic.
For example, that telephone consultations for COVID-19 symptoms underestimated how ill patients were or that advice to self-isolate rather than be admitted led to a delay in necessary treatment.
Despite GPs' instrumental role in the success of the vaccine programme, there have been complaints about delays in receiving the first or second doses of vaccine or queries about capacity for patients to receive a vaccine.
While the majority of dissatisfaction has been expressed via the complaints process, unfortunately the survey found that 43% of GPs had faced abuse from patients.
Tips for avoiding complaints
The MDU is here to support members with these and other difficult dilemmas. During the pandemic we have published guidance on common dilemmas that have arisen on our COVID-19 resources page.
Our tips for managing medico-legal issues include:
- Communication is key to avoid potential misunderstandings. Explaining what you are doing during a consultation and any follow-up actions can help to reduce this risk. Make eye contact with patients during remote consultations explaining that you may need to look away to make notes.
- Manage patient expectations if you can. Many complaints arise due to patients not receiving care in a way they expected or within an expected timescale. Ensure patients appreciate the potential timescale for test results or referral appointments.
- Check a patient’s understanding. With the time limitations GPs face it can be hard to cover all points, however checking with the patient that they understand the outcome of the consultation and the management plan can help to avoid difficulties later on. It gives you an opportunity to identify any misunderstandings or dissatisfaction.
- Provide safety netting advice. Give the patient a clear plan of what to do should their condition not improve or worsen; or if they do not hear from another service within a certain timeframe.
- If a patient or relative has been abusive or threatening to you or other practice staff, the practice can issue a warning letter explaining such behaviour will not be tolerated. Get advice from your medical defence union if this is the case.
- Involve others if patients lack capacity. If there is disagreement about how to proceed when treating a patient who lacks capacity, consider holding a best interests meeting involving those caring for the patient, family members, and those interested in the patient's welfare. If agreement can’t be reached, get further advice from your medical defence organisation.
- Clearly document consultations at the time. It will help others involved in the patient’s care to easily see what has been done and, in the event of a complaint, good documentation can be invaluable in responding to unfounded allegations or misunderstandings.
- Being involved in complaints is upsetting for patients and colleagues alike. Seek support from your peers or your medical defence union if you are facing a complaint – don’t go it alone.
The MDU