Unfortunately, most dental professionals will receive a complaint from a patient at some time in their career. Dental Defence Union dento-legal adviser, David Lauder explains how best to respond
When complaints arise following orthodontic treatment, they can be complex to resolve. This is because patients will often be undergoing a longer course of treatment than for other forms of dental care. And there may be an additional complication if the complaint relates to more than one dental professional, such as the treating dentist and an orthodontic specialist. For example, when a patient is unhappy about an extraction carried out by their GDP which is part of a treatment plan prescribed by an orthodontist. In which case, it might be appropriate to provide a joint response.
Whatever the nature of the complaint, the important thing is how you respond to dissatisfied patients. This can make the difference between re-establishing the patient’s trust and an unresolved complaint which escalates to the Ombudsman or Dental Complaints Service (DCS).
In the DDU’s experience, resolving complaints at an early stage is best achieved through an effective in-house complaints process and a professional and positive approach. Here are some key points to bear in mind:
Confirm the complainant’s identity
Don’t assume that someone complaining on behalf of a patient has the authority to do so. Anyone aged 16 and over should normally complain themselves but children under 16 who are competent to do so may also make their own complaint. If the complaint is made on behalf of a patient with capacity, check they have consented to disclosure of clinical and other confidential information. Where a relative or solicitor is acting for a patient without capacity, the practice must be satisfied that the complainant is acting in the patient’s best interests.
Respect the patient’s right to complaint
Be calm and constructive when dealing with complainants. Bear in mind that a defensive approach can easily aggravate the situation and make the complaint harder to resolve. Similarly, removing someone because they have made a complaint is seldom justified and may attract censure from the Ombudsman, DCS or GDC.
Have a well-publicised practice complaints procedures
Your practice’s approach to complaints should be consistent with GDC ethical principles of professionalism, openness, accountability and respect for confidentiality and be in line with the NHS complaints procedure1. The DDU recommends that complaints from NHS and private patients are approached in the same way.
Written complaints procedures should be well-publicised on practice websites and noticeboards and include information to help patients make a complaint, timescales for responses, and a commitment to full investigation and transparency.
Respond to verbal complaints immediately
Resolving verbal complaints within 24 hours is better for the complainant and verbal complaints about NHS treatment do not have to be declared in your annual NHS complaints report.
All other complaints should be acknowledged in writing within the timescales set out in the practice complaints procedure (usually three working days in England but this differs by region) and dealt with promptly and efficiently. If the complaint cannot be resolved within the time limits, write to the complainant to explain why. The GDC expects you to update them every 10 days.
If the reason for the complaint is unclear, talk to the complainant to ensure the investigation and response adequately addresses their concerns. Equally, if a patient phones the surgery to complain, try to arrange a face-to-face meeting to discuss the matter. Answering a complaint over the phone may prove difficult. Meetings can benefit from the presence of a conciliator, if the patient agrees.
Conduct a thorough investigation
The practice complaints manager will usually ask for input from the treating clinician but for more complex complaints (eg those involving more than one member of the dental team) the practice could hold a significant event meeting. This is an opportunity to discuss the complaint in detail, analyse what went wrong and learn lessons. Practices will need to be satisfied that patients are aware that their data might be used for this purpose and do not object. Keep a record of the meeting and ensure you have agreed a date for taking agreed actions.
Provide a detailed and positive response
When the investigation is completed, provide a full written response. This will usually be in the first person from the treating clinician but if more than one dental professional is involved, the complaints manager could coordinate a joint letter that covers all concerns raised in respect of each person involved. It is rarely appropriate to express an opinion on the acts and omissions of a colleague, even with their consent.
The response should be jargon-free and ideally include:
– a factual description of events in chronological order
– an explanation of the investigation findings in relation to each concern raised
– an acknowledgement of any errors made by the practice and an explanation of action taken to address them
– (if appropriate) an apology and practical solutions such as remedial treatment. Telling a complainant ‘I am sorry for what has happened to you’, or ‘I am sorry your treatment has not produced the results that we were both seeking’, is not an admission of liability.
– details of how the complainant
Your dental defence organisation can help draft and check responses.
Keep a written record of complaints
This should include the name of the complainant, the subject of the complaint and the date and a copy of the response and be held in a complaint file separate from the clinical records. Practices should use this to monitor their performance in complaint-handling. It could also provide evidence for complaints that go to the Ombudsman or DCS.
Consider the learning points and act on them
Ideally, the complaints and clinical governance functions within practices will dovetail, as the purpose of both is to learn lessons, ensure patient safety and improve service quality.
Have a system in place to ensure lessons are learnt from complaints and any changes to systems or practice are shared with the rest of the dental team. This will also include a follow-up to ensure that any changes have been actioned and have had the desired effect.
NHS practices must send a copy of their annual report on complaints to their local commissioning group which should include any improvements to services made as a result.
1 Local Authority Social Services and National Health Service Complaints (England) Regulations 2009; The National Health Service (General Dental Services) (Scotland) Regulations 2010; The National Health Service (Concerns, Complaints and Redress Arrangements) (Wales) Regulations 2011.
David Lauder qualified in 2002. His post-graduate training included time at 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 is currently studying for an LLM.