Making a complaint against the NHS and other medical practitioners – what you need to know

Please note: this guide concerns making a complaint to the NHS in England, there are slightly different procedures for making a complaint in Wales, Scotland and Northern Ireland.

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What should I do if not happy with NHS treatment?

Not many people are familiar with it, but the NHS constitution promises you:

the right to have any complaint you make about the NHS properly investigated
the right to receive an appropriate explanation
the right to compensation where you have been harmed by negligent treatment
they will ensure that lessons are learned to avoid similar incidents in the future

Find out more about whether you should consider making a claim against the NHS.

FAQs

How to complain to the NHS

Who can make a complaint against the NHS? Can I complain on behalf of my relative or friend?

You can make a complaint on behalf of a family member or friend, but you will usually need their permission to do so. It is also possible to complain on behalf of a child or someone who does not have mental capacity.

If you are being assisted by a patient advocacy service, such as: Patient Advice and Liaison Service (PALS), the Citizens Advice Bureau (CAB) or SEAP (Support, Empower, Advocate, Promote) you can request that they deal with all matters related to the complaint on your behalf.

What is a formal or informal NHS complaint?

Informal Complaint

You could make an informal complaint if the matter is not serious or complicated or you would like something done right away. For example, if you notice the meals are not being taken away very quickly once they are finished, or your relative is having trouble reaching the call bell, this would be an informal complaint.

To make an informal complaint you should speak with a member of staff or a manager. As an informal complaint, it is unlikely that any record will be kept.
Formal Complaint

The formal complaints process is for more serious or complicated concerns.

For example, if you think that you or a loved one may not have received the correct treatment, this treatment has made you worse not better, or perhaps you were ‘lost to follow up’ and as a result your condition has progressed to a point where it is now worse than it otherwise would have been.

How long do you have to complain to NHS?

Yes, you must make your complaint within 12 months of the incident in question, or within 12 months of the knowledge of that incident.

How do I make a formal complaint against the NHS?

A formal complaint can be made verbally (if you formally complain verbally the NHS must keep a record and send it to you), electronically or in writing.

You must first decide to whom to complain, you may complain directly to the institution that treated you who will have their own complaints procedure, or you may complain to:

The Commissioner (for primary care services such as GPs or Dentists): NHS England Complaints Manager, PO Box 16738, Redditch B97 9PT, Email: [email protected], Tel: 0300 311 22 33 (Mon-Fri 8am to 6pm)
Clinical Commissioning Group (for hospital services and some community services): Clinical Commissioning Groups, Find the appropriate clinical commissioning group at www.nhs.uk/service-search
Care Quality Commission (CQC) for mental health services. Care Quality Commission, CQC Mental Health Act, Citygate, Gallowgate, Newcastle upon Tyne NE1 4PA, Tel: 03000 616161

How do I write a letter of complaint to the NHS?

To ensure that you get a full and frank response, you need to try to be as specific as possible. You will need to say who or what you are complaining about, as well as where and when things took place; names and dates are really useful.

It may be helpful to say whether you have complained about this previously, perhaps informally, and mention what was done. It is also useful to set out how you want your complaint resolved, perhaps with a meeting, or perhaps you would just like some answers. Maybe you are even looking for further action to be taken.

What response can I expect to my complaint against the NHS?

Under the NHS complaints procedure, you can expect to receive an explanation or an apology and/or a statement detailing how such incidents will be avoided in future. You are very unlikely to receive any financial compensation as a result or achieve any form of formal disciplinary action against a member of staff.

You may receive a written response to your complaint in the first instance, or you may be asked to attend a meeting before a written response is made. Meetings can be a really useful part of the process.

In order to ensure that you get the most out of a meeting it is a good idea to take a list of questions with you or send them to the complaints manager in advance. It may also be advantageous to ask for the minutes of the meeting one it has concluded. You may wish to take someone with you to help you explain your concerns, this may not be a legal representative but it could be a friend, family member or patient advocate.

Whether you have attended a meeting or not, you should always receive a formal written response which should address all of the issues which you have raised. You should ensure that you fully understand what is being said within the response and that any medical terms used have been fully explained.

If there is anything you don’t understand you can ask them to explain or expand upon certain points. However, if you are still not satisfied with the response you may take further action by asking the Parliamentary Ombudsman for Health to review your complaint.

How long will it take for the NHS to deal with my complaint?

There is no formal time limit; the time limits should be agreed with you as part of the process.

If you feel that your complaint is not being dealt with quickly enough, patient advice charities such as AvMA would suggest that six months is too long to wait, you may wish to take things further by contacting the Parliamentary Ombudsman for Health. https://www.ombudsman.org.uk/ .

Do the NHS pay out for complaints? How?

No, the NHS does not usually pay out compensation for complaints. If compensation is your goal, you will need to instruct an experienced clinical negligence solicitor to pursue a claim on your behalf. The complaints process can, however, often provide useful information which clarifies whether a compensation claim is likely to succeed.

If a subsequent claim is successful, once your compensation has been agreed we can give you advice on how best to fund your care. The court will decide whether the compensation should be paid in a lump sum or instalments, which are normally used if you need extensive long-term care.

Any compensation you receive after a successful medical negligence claim is designed to fund the extra levels of care and support you’ll need for your injuries. We can help you protect the real value of your compensation by placing it in a compensation protection trust. This means that you and/or your partner can continue to claim any means-tested benefits.

How do I choose a solicitor to handle my medical negligence claim?

In theory, you can choose any practising solicitor to handle a claim. However, in practice it is essential to make sure that they have expertise and experience in clinical negligence claims.

Ask your solicitor if they’re a member of a specialist panel, either the Law Society Clinical Negligence Accreditation Scheme or the Action against Medical Accidents (AvMA) Specialist Clinical Negligence Panel. If they’re not members themselves, they must be supervised by a panel member.

It may also be worth seeking out specialists in your particular area of claim, such as cerebral palsy claims or cauda equina claims.

Do all NHS complaints need to be put in writing?

Yes, you will always be asked to put your complaint in writing. Most hospitals and GP surgeries will have leaflets setting out their complaints processes which will be made available to you. Sometimes a meeting is offered at which you can put your views orally, after the process has been started. You are also always entitled to a full written response to your complaint.

Are NHS complaints confidential?

Yes, the complaints process is confidential. Anonymous details of your case may be added to the organisation’s recorded statistics, which may then be shared with other organisations to assist in performance monitoring of the NHS.

Example medical negligence complaint letter

Below you will see a template that we have created based on a fictional account of medical negligence, in order to guide you as to how to draft your letter of complaint.

Date

Dear [Sirs/Name if known]

Re: NHS Complaint – [Insert name, date of birth and NHS/hospital number]

I am writing to complain about my treatment at [insert name of NHS Trust], on [insert date of incident/alleged negligence].

For context, I have suffered from lower back pain for several years and was managing it with paracetamol and ibuprofen. On the 22^nd of May 2022, I was lifting a heavy box when I felt an electric pain shooting up my back passage. This sensation was unfamiliar and different to any I experienced before. I called out for my sister, who rushed to see whether I was okay. The pain was radiating past my buttocks and down my legs. My sister contacted my GP who prescribed co-codamol and amitriptyline.

Between the end of May and July 2022, the pain persisted, and I continued to take medication to alleviate it. On the morning of the 1^st of August 2022, I noticed a change in symptoms. I felt heavier, experienced bladder disturbance as it became weaker, and struggled to walk. I also began to experience a new area of numbness in my genitals. Consequently, I phoned my GP who was concerned and advised me to go to A&E immediately.

I arrived at A&E at Fellow Hospital at 1pm and was given morphine. An MRI scan took place at 3:30pm. I was then seen by a consultant who advised I had a herniated disc. I alerted the consultant of the numbness; however, as I had taken pain relief that day, he attributed it to side-effects of the medication.

The doctor asked what I wanted to do, which seemed strange as he was the professional and should know the best cause of action. I was advised that some people prefer to manage the pain at home so, on that basis, I decided to do so. Nobody warned me of the severity of the situation and that it would be safer for me to be admitted to hospital. The MRI scan results were sent to Orchard Hospital for review. No “red flag” advice was provided and there was no mention of cauda equina syndrome at this time.

During the afternoon of the 2^nd of August 2022, my symptoms were mostly the same although I kept feeling like I needed to urinate, however, couldn’t pass bowel motion. I received a call from Orchard Hospital who advised that my MRI scan had been reviewed. It was crucial that I came to the hospital for an urgent appointment at the neurology department. I arrived at 6pm and was seen by a spinal surgeon who diagnosed me with cauda equina syndrome. I was taken for an emergency decompression surgery just before midnight.

Post-surgery, I currently self-catheterise approximately five times day. I take regular laxatives to ensure bowel movement and have also completely lost sexual function, as well as any feeling in my genitals. While my mobilisation has improved, I struggle to bend over and walk.

I would be grateful if you would provide answers to the following questions:

Why was I not admitted to hospital after an MRI had been taken on the 1^st of August?

Should I have been discharged on 1^st of August, or transferred to Orchard Hospital for surgery?

Why was I not provided with effective “red flag” advice before discharge from A&E at Fellow Hospital on 1^st August?

Why were existing “red flags” such as genital numbness not heeded on 1 August?

Would I have been in any better position if I had the surgery 24 hours earlier?

Explain what you would like to happen as a result of your complaint. You may like to consider the following examples:

A face-to-face meeting to discuss your concerns with the relevant medical professionals;

Reassurance there will be changes to policy and procedures;

Further treatment to support your health and wellbeing; or

The Trust to take accountability and apologise for their actions.

I would appreciate if you could carry out a full investigation to address my concerns and provide a full response in accordance with the NHS Complaints Procedure, and within the stated timescale.

I look forward to receiving your reply. I understand I will be kept informed of the progress if I do not receive a response within one calendar month. Please do not hesitate to contact me if you need any further information.

Yours sincerely

[Your signature]

[Print your name]

If you are sending copies of your letter to other parties, show this here:

[Name of other party]

Your records

Accessing medical records: knowing your rights

Obtaining your own medical records, or the records of someone you care for, can often be an essential element in making a successful clinical negligence claim. However, people are often confused about whether or not they have the right to obtain records, or how they can do this.

What are medical records?

The term medical record is inclusive of any record held or created by a healthcare professional (GP, hospital trust, dentist or other healthcare provider) which relates to a person’s mental or physical health condition. The records can be either electronic or paper, and can include correspondence such as referral or discharge letters, test records, and x-rays and film.

Do I have a right to my own medical records?

According to the General Data Protection Regulation (GDPR) every living person has the right to apply for their own records, whether held as paper versions or on a computer. This right is inclusive of both NHS and privately held records.

You can request your medical records verbally, by letter, by form or through email according to the GDPR. What is more, under the GDPR your medical records must be provided free of charge. A charge should only be expected in situations where you make an unfounded or excessive request; for example if you request three separate copies of the same records.

Once a request for medical records has been made, the records ought to be provided within one month from the date of the request. If the request is complex – for example if the records are in many different hospital sites or are a very large set of records – and will take longer to fulfil, then the record holder can take up to two months to provide the records, but they must inform you that this is the case within the first month of your request.

Who can apply to see medical records?

As a patient you always have a right to request your own medical records.

If you have Parental Responsibility for a child under 16 years of age then you also have the right to request their records. However, if the child is 16-17 then they may be required to give their consent to your request as well. If you have legal authority to act on someone’s behalf, such as through a Power of Attorney, then you also have the right to request their medical records for them.

If you lack the legal authority to obtain someone else’s medical records on their behalf then you may still request their records, provided that you have their written consent to do so.

Accessing medical records where someone has died

Rights to medical records under the GDPR only apply to people who are alive. Rights in relation to accessing records for someone who has died derive from the Access to Health Records Act (AHRA) 1990. According to the AHRA, either Personal Representatives or those who hold Letters of Administration have the right to request medical records on the deceased’s behalf. Lastly, you may also be granted to the records if you can demonstrate that there is a potential claim arising from the death.

The Information Commissioner

If you have requested records and are disappointed in how this request has been dealt with by the healthcare provider, then you can make a complaint to the Information Commissioner’s Office (ICO). Any complaint made to the ICO should be made within three months of your final correspondence with the medical organisation in question.

Retention of medical records

Medical records should be be retained by a service provider for a minimum period, depending on the type of record, and who is holding them.

Important examples include the following:

dental records are kept for 10 years after you are last seen;
GP records are kept for 10 years after a person has died. Electronic Patient Record should never be destroyed;
care records generally are kept for 8 years after you are discharged from care or from when you were last seen;
children’s services records are kept up until the individual’s 25^th birthday
general hospital records should be kept for 8 years after the conclusion of treatment or death.

Making a complaint about a doctor

As a patient, raising a concern regarding the care afforded to you can seem like a daunting process. This guide explains how a complaint can be made and what the outcome of a complaint might be.

Who do you complain to about your GP or doctor?

The regulatory body that governs doctors is the General Medical Council (GMC). This is where you should make a complaint if you have a concern about an individual doctor’s professionalism or ability to practice medicine.

If you have a complaint about the treatment you have received from either a nurse or a midwife, then the regulatory body that you should consider contacting is the Nursing and Midwifery Council (NMC). Find out more about making a complaint to the NMC in our guide here.

Before you contact either regulatory body, you should make a complaint to the hospital Trust that employs the health professional. All NHS organisations have to follow the NHS complaints procedure which you can find out more about here.

What is the GMC’s role?

As a regulatory body, part of the GMC’s role is to investigate complaints about individual professionals in order to consider whether or not they are fit to practice. When considering whether or not a doctor is fit to practice, the GMC will consider a doctor’s behaviour including:

serious or repeated mistakes;
violence or criminal offences;
dishonesty;
abuse of a professional position;
discrimination; and
serious breaches of patient confidentiality.

How long do you have to make a complaint?

The GMC will only consider complaints arising within five years of an incident, but we advise that any concerns should be raised as soon as possible. If the incident you wish to complain about took place more than five years ago or your complaint has been rejected on this basis then you can write to the GMC Chief Executive to appeal this decision.

How do you complain to the GMC?

If you are not satisfied with the response of a hospital Trust to your complaint through the NHS process, you can complain about an individual doctor’s skills or behaviour to the GMC through an online form.

You should also send the GMC copies of the complaint you made to the Trust and the response you received.

How long does a GMC complaint take?

Most complaints that the GMC receives are not investigated further. This may be because the complaint does not reach the GMC threshold or because they are matters that the GMC cannot investigate. Even if the allegation is not investigated further by the GMC then your concern will still be shared with the doctor involved and be considered as part of their ongoing professional appraisal.

If the GMC is concerned that the doctor in question may not be fit to practice then they will open an investigation. Once this happens, as the complainant you may become a witness in the fitness to practice procedure.

If the GMC do decide to carry out an investigation then this can take as long as a year, and in complicated matters could take even longer. As the complainant you will be updated by the GMC every eight weeks about how the investigation is progressing.

Any investigation may also include a review of your medical notes, which you would be asked to consent to if required.

Possible conclusions to a GMC investigation

Once an investigation by the GMC has concluded the examiners will review the evidence and consider whether any action should be taken.

The possible outcomes of a GMC investigation can range from:

No further action

This could be because the doctor has made every effort not to repeat their mistakes or because there is not enough evidence against the doctor.
Limit the doctor’s ability to practice

If the GMC believes that immediate action is necessary, then it may apply for the Medical Practitioners Tribunal Service to make an immediate order to suspend the doctor or restrict the ways they can work, such as not performing operations without senior supervision.
Warning

The GMC may give the doctor a warning, which states that their behaviour was below the standard acceptable for a professional. Warnings are published on the GMC website for two years.
Undertakings

These are formal agreements between the doctor and the GMC and they will set out specific conditions which the doctor will have to abide by. These conditions may include supervision of their work, limiting what work they can carry out or where they are able to work. These are published on the GMC website for 10 years.
Referral to the Medical Practitioners Tribunal Service (MPTS)

The doctor would have to attend a hearing at which s/he may be struck off from the GMC register (and so unable to practice as a physician).

Making a complaint about nurses or midwives

If you receive poor care from a nurse, midwife, or nursing associate then you may wish to raise a complaint. This guide provides information about how you can do this.

When can a complaint be made?

The Nursing and Midwifery Council (NMC) is the regulatory body for nurses, midwives and nursing associates and investigates complaints made about individual professionals.

The NMC will investigate incidents that involve:

serious professional misconduct;
criminal offences;
concerns about a professional’s competence; and
addictions or mental illnesses that may affect a professional’s ability to practice.

The NMC will only consider complaints calling into question the individual’s current fitness to practice. The term “fitness to practice” concerns the professional’s skill, knowledge and character, and whether these attributes (or a lack of them) negatively impact their ability to carry out their job safely.

How do I complain to the NMC?

In almost all cases you should raise your complaint first with the Trust or private organisation that employs the nurse or midwife you are concerned about. An internet search can help you identify the Trust that runs the hospital or medical centre where you received poor care.

If you are concerned that a professional poses a continued threat to patient safety, or where you are not satisfied about the outcome of your complaint to the hospital Trust, then you can write to the NMC.

Any concerns or complaints made to the NMC should be submitted in an online form which can be found here, or you can make your complaint in a letter or email. In your complaint, you should set out the events that took place and your concerns about the health professional involved. The NMC will also have to identify the nurse or midwife involved so, if you are able, include the name of the professional, the date and time that you saw them, and the address of where the treatment took place. If you have made a complaint to the Trust, then you should include copies of your complaint and the response you received.

You will also need to agree to your complaint being disclosed to the nurse or midwife involved in order for them to provide a response.

How do NMC deal with complaints?

When the NMC receives a new complaint it will begin by screening it to make sure that they are able to make an effective investigation. This includes checking that you have provided enough information about what happened and about the identity of the health professional involved. The NMC will also consider whether or not the allegations are serious enough that the nurse or midwife may pose a risk to members of the public and whether or not there is evidence that your concerns or complaints have already been addressed by the individual.

The NMC may not take your complaint any further at the screening stage if they do not feel that the matter relates to a nurse or midwife’s ability to practice safely, if they do not have enough information to identify the healthcare professional, or if they cannot obtain evidence in support of your complaint.

If it is decided that further investigation is necessary, then an investigator will be assigned to your complaint and should contact you within three weeks. The investigation can take up to one year. An investigator is likely to require access to your medical records which you will be asked to agree to.

The NMC will then consider whether the actions of the individual mean that they may not be competent to practice as a nurse or midwife. They will look at the incident that took place as well as the professional’s knowledge, skill and judgment to decide whether the nurse or midwife is not fit to practice due to:

Misconduct

Professional conduct falling short of what is expected of an individual.
Lack of competence

This is most likely in continued incidence of poor performance which could put patients at risk.
Cases investigated by the police which have not led to a conviction
Poor knowledge of English

This is where a poor standard of English could result in wrong prescriptions, poor record keeping or a failure to handover information about a patient’s treatment due to a language barrier.

After the investigation, a report will be produced and the individual being investigated will have 28 days to comment on the findings. After this 28 day period, the NMC will decide on the next necessary steps. They may:

give a warning to the healthcare professional or agree a plan to ensure that they are safe to continue working with patients;
close the case with no further action;
decide to refer the case to a fitness to practice committee.

Fitness to Practice Committees (FtPC)

If your case goes to a fitness to practice committee then it will likely be dealt with by a FtPC meeting.

During a fitness to practice meeting the committee will meet with legal assessors and consider the paperwork produced up until this point. The meeting is private and so neither you nor the healthcare professional will be present during the meeting. The results of the meeting, the committee’s decision and reasons for their decision will be made public.

In some cases, the FtPC may conduct a live hearing and you may be called as a witness. It is normal for the nurse, midwife or nurse associate to have legal representation at a hearing, and you can as well, although this is less common. The decision of the FtPC hearing will be sent to you in writing.

What sanctions can be imposed as a result of the FtPC?

After the meeting or hearing, the FtPC can impose the following sanctions on a nurse or midwife:

a caution of 1-5 years;
conditions of practice for a period of up to 3 years;
suspend the healthcare professional for up to 1 year;
strike off the individual from the register.

Private healthcare: how to make a complaint

Whenever you receive substandard medical treatment you are entitled to make a complaint. This document provides information about making a complaint about private healthcare.

First steps before making a complaint

If you are concerned about the treatment that you have received then you should always discuss this with the clinician or nurse who treated you. They may offer a useful explanation and advice on how to overcome any immediate concerns. If you do not find the response useful, then you should next discuss any other potential treatment options with your GP, especially as you may require a referral for a second opinion.

Making a complaint to the medical organisation

Whether you received care from a hospital or a clinic, by law it is required that they must operate a complaints procedure. Therefore if you intend to make a complaint about private healthcare then you should enquire about the organisation’s complaints policy. Usually this is clearly available on their website but if not then you can request it from them directly.

If you cannot access their complaint’s policy, or if you cannot get a response to your complaint then you should make a complaint to their regulatory body as appropriate, depending on their role, e.g. the General Medical Council, The Nursing & Midwifery Council or the Care Quality Commission.

Is there a time limit to make a complaint?

A complaint should be made within six months of the incident occurring, or within 6 months of you learning of its consequences. If this time period has lapsed then you should write at the earliest opportunity and request that they extend their deadline to explore your complaint.

Tips to make the complaints procedure easier

If you need to make a complaint on behalf of a family member then you will require their written consent.

The process of making a complaint can be a lot easier if the complainant has gathered sufficient information to prove the major elements of their complaint. This may include keeping a record of any telephone calls, copies of any correspondence from the organisation and any meetings that you attend.

The Independent Sector Complaints Adjudication Service (ISCAS)

The ISCAS provides a framework that sets out how private care providers may deal with complaints made either by patients or someone else, on the patient’s behalf.

This framework sets out three progressive steps that can be used in order to deal with a complaint:

Local resolution

At this stage it is the responsibility of the treatment provider to look into and respond to the complaint. A simple conversation between the professional and the patient may be all that is required. If this does take place then it will be beneficial to request a full written response that reflects what was discussed and agreed during the meeting. If the complaint is about an individual practitioner, then any complaint should be addressed to them. Although you can make a verbal complaint, it is easier to evidence a written complaint. It is reasonable to expect a response within 20 days.
Internal appeal

If you are not happy with the outcome of the local resolution then you can apply for an internal review which should be made in writing within 6 months of your final written response from the treatment provider. The complaint will then be considered by the investigating director and they will review the actions that were taken at the local resolution stage.
Independent external adjudication

If you are still dissatisfied with how your complaint has been managed at this stage, then you can request an independent external adjudication. This should be requested for in writing. Once a decision has been made by the adjudicator then this can be sent to the Care Quality Commission.