There are many reasons why doctors working as locums may be more at risk of receiving a complaint. Sara Chambers, NASGP’s appraisal and revalidation lead, and Charlotte Hudson, writer at MPS, provide tips on protecting yourself from complaints and the current complaints process.
The key to most complaints is how they are handled early on at a local level. According to MPS in their helpful complaints series, studies show that most complainants have altruistic motives. An early, sincere apology showing an understanding of the problem that the patient experienced, and demonstrating that changes are in place to prevent it happening again, will often satisfy the complainant. In some cases, this will also lead to positive changes in practice – the ideal outcome for all.
Failure to fully get to grips with the complaint can lead to escalation to an independent review. Often, the Ombudsman finds that the reason for the original complaint is not upheld, but poor handling of the complaint process itself becomes the main problem experienced by the complainant. Very sad if you consider the additional stress and workload experienced by the staff involved.
As GP locums, many of us will not have the ability to affect the administrative systems in practices, which can often put us on a collision course for a complaint. All we can reasonably control is our behaviour and practise.
How GP locums can protect themselves against complaints
During consultations, GP locums, perhaps more than a practice’s regular GPs, spend time looking at the patient’s record, since we deal with patients we’ve never met before and use unfamiliar computer systems. Be aware that this can appear rude. Look the patient in the eye, explain what you are doing and keep up this commentary each time you turn to use the computer. Suggested script:
“Forgive me; I just want to make sure that I’m completely up-to-date with your record, so I’m going to take a good look…”
Alternatively, try turning the screen towards the patient and looking at it together. Make sure there is no information that identifies or relates to a third party on the screen.
Have strategies to defuse hostility
The pressure is on in general practice. Remember that this affects patients as well as healthcare professionals and practice staff: struggling to get access to appointments; perceived rudeness from the receptionist; an hour spent in the waiting room with the boss on the phone; a hungry baby, or the parking meter running. All of these can leave patients at boiling point, and often that anger is directed at the next person they see as being responsible – you.
This is not fair and very unpleasant to deal with but it is always worth seeing if you can defuse their anger. Pointing out the injustice and your lack of personal culpability will risk escalating this to a complaint. Suggested script:
“Sounds as if you’ve had a shocking morning [empathise]. It’s really hard having to wait so long when you’ve got your boss breathing down your neck [acknowledge their difficulty]. I’m sorry we’ve got off to a bad start [apologise]. Please can we start again and talk about your health and what’s been troubling you?” [humbly giving them a bridge and suggesting a positive way forward].
Hopefully this will lead to a smoother consultation, and if the patient is in a calmer mood by the end, they may provide feedback on their patient experience, as well as acknowledging whether any changes in their own behaviour would have helped.
Keep good records
As we move from continuity of care by relationship with a single GP to continuity of care by a number of doctors, the quality of note-keeping for all GPs has never been so important. This is especially vital for GP locums, due to the peripatetic nature of our work and our relative vulnerability to complaints.
It takes skill to get the balance between brevity and the necessary detail: the patient’s condition; your working diagnosis and management plan and what was discussed with the patient in terms of their follow up; how to access results; handover arrangements, and safety-netting advice.
Consider periodic review of the quality of your note-keeping as a QIA for your appraisal.
Sara was a salaried GP for 4 years, and has worked as a locum GP since 2001 in over sixty different GP practices. As well as NASGP’s appraisal and revalidation lead, and mother to twins, she is also the brains behind NASGP’s Practeus platform.
Sara’s an avid reader, especially fiction, history and trains (yes, trains); loves walking, pilates and beans on toast with cheese.