complaint handling

Advicesheet

B11Handling private practicecomplaints

© BDA April 2010

© BDA April 2010 1

Advicesheet

Handling private practicecomplaints B11

Handling complaints positively 2

Learning from complaints 2

General approaches to handling complaints 3

What do customers expect? 3

Treatment costs 3

Customer involvement 4

What sort of complaints are we talking about? 4

Your in-practice procedures 4

Complaints manager 5

Acknowledgement 5

Investigation 5

Response 5

Failure to resolve 6

Records 6

Training 6

Publicity 6

Dental Complaints Service and GDC 7

Procedure 7

GDC professional guidance 7

Further information 8

Appendix 1 - Model Complaints policy 9

Code of practice for patient complaints 9

Appendix 2 - Model complaints letters 10

Letter 1 - Acknowledgement of complaint 10

Letter 2 - Written response to patient where 11

complaint is well founded

Letter 3 - Written response to patient where 12

complaint is not justified

Valuable lessons can be

learned from complaints.

In any case, with a

service such as private

dental care where

reputation and customer

goodwill are paramount it

is important to deal swiftly

and effectively with

complaints. Patients may

have grounds for breach

of contract claims; your

private capitation

schemes may require you

to have an in-house

practice complaints

procedure; or a patient

may take the matter to

the formal Dental

Complaints Service for

private patients, which

was established by the

General Dental Council

(GDC).

This advice sheet focuses

on complaints in private

practice. It shows how

complaints can be used

as a positive

management tool and

provides guidance on

formulating and following

an in-house practice

complaints procedure,

with model letters. It also

describes the GDC

founded Dental

Complaints Service.

contents page

© BDA April 2010 2

A complaint is any expression of dissatisfaction by a patient about a dental

service or treatment, whether justified or not. Complaints can be about any part

of the service the surgery provides. Many complaints may well not be about the

technical skill or the quality of care. Patients often complain because their

expectations of a good level of service have not been met. More often than not

this is merely due to the lack of communication.

Complaints are a good thing. Skilful handing of complaints is essential to

modern business management. A complaint, if handled properly, can enhance

relations with the complainant, turning a potential lost customer into a satisfied

customer. It can also offer an opportunity to improve the management of the

practice, ensuring that the same mistake, which may have caused other

customers silently to leave the practice, does not happen again. It is an

important part of clinical governance.

In a small practice reception area it can be hard to view complaining customers

in a positive way. At the very least they can be an irritant, and at worst they

may lead to a Dental Complaints Service investigation, GDC inquiry or legal

action. Also, sometimes losing a patient is inevitable and there are times when

it is better for the patient to seek treatment elsewhere if the relationship has

completely broken down. Nevertheless, in most situations it can be resolved.

When a complaint is made at the practice reception, you know that everyone in

the room will be watching the interchange between patient and receptionist.

Whatever the background to the complaint, it is hard to see it as a positive

opportunity to improve your practice – more a source of embarrassment than a

‘moment of truth’! But it is really a golden opportunity to demonstrate to

customers how professional your practice is and what a high standard of care

and service is provided.

In a small organisation, blame cannot be passed on to another department or

an absent colleague, and it is tempting to counter complaints with

defensiveness. But complaints are part of the communication process and are a

very important aspect of your relationship with your customers. Successful

private practice is built on the relationship between the practice and the

customer and a complaint can be part of this relationship building.

Most patients who are unhappy with the treatment or service they have

received at a practice do not complain: they go to another dentist and tell at

least a dozen other people why. Preventing this is another important reason for

developing an efficient system for handling complaints.

Private patients paying the full cost of good dentistry will be expecting more

from you and will feel entitled to complain. There is also the other group of

patients who expect to be disappointed in any service they receive and

complain very often. It is tempting just to try to soothe and pacify those

customers and not to take their grievances seriously. They may, however, be

highlighting real shortcomings - expressing what many customers are feeling

but are too reluctant to tell you. Valuable lessons can be learned from

complaints.

Do you keep a log of the complaints and negative comments you receive about

the practice? Do your staff ask customers directly after they have made an

appointment or paid for their treatment whether there is anything else that you

can do for them? This gives the customer the opportunity to provide feedback.

Do you analyse the number of patients who leave the practice after a short time

and find out why? Do you discuss complaints at staff meetings or with

individuals if the complaint is directed towards them? Try some of these

activities but do not at this stage focus on the amount or type of adverse

comments you receive. Look at what you are doing in response to help to

Handlingcomplaintspositively

Learning from Complaints

© BDA April 2010 3

minimise the need to complain. These opinions were there anyway and now

that you know about them you can choose whether or not to take action and

rectify them.

Even if you do not receive any complaints or negative comments, it is a very

good idea to encourage customers to comment on the care and service they

receive from you. Your professional relationship with your patients as customers

requires you to answer complaints satisfactorily, put the matter right, and use

the information provided to improve your service.

To deal properly, easily and consistently with complaints, all that is needed is a

simple procedure which is written down and understood by staff and patients.

In general dental practice it is obviously in the interests of both patient and

dentist for a complaint to be resolved at practice level, thereby avoiding the

need for a formal and stressful investigation by a third party. Dental complaints

can however be difficult to resolve, particularly if the patient has experienced

pain, distress and/or inconvenience for which they expect recompense.

What do patients expect?

When making a complaint a patient usually wants to know:

� what happened

� why it happened

� what will be done to put it right

� whether anyone is to blame. If so, what action will be taken

� what action will be taken within the practice to ensure that it does not

happen again

For most healthcare complainants, financial compensation is not the main

motivation for complaining. In dentistry, where most patients pay towards their

treatment, complainants may reasonably want to recoup the cost of failed

treatment or the cost of rectifying it. Litigation could be at the end of a

complaints process if the patient wants compensation. However, it is not

inevitable that every patient who makes a complaint will be doing so for

financial gain. Many want an explanation or to know their future treatment

options.

Where a complaint is valid, it is good business sense to offer a system of

replacement or reimbursement. You might in appropriate circumstances, offer a

full refund or to re-do the work free of charge.

It is much better that a patient’s objectives are achieved by communication

between the patient and practice, rather than the patient’s solicitors and the

dentist’s defence organisation’s solicitors and there is no reason why this

should not happen with the help of a clear procedure. The Dental Complaints

Service recommends that an attempt should be made in-house first, to try to

resolve the complaint, but if the patient wishes to go directly to them, they will

investigate it.

Treatment costs

Having the essential information in order to make choices goes a long way to

avoiding complaints in the first place. The Office of Fair Trading (OFT) in its

report The private dentistry market in the UK (March 2003) on private dentistry

found that many private practice complaints concerned the lack of clarity over

treatment costs. The OFT emphasised the importance of giving patients a

general indication of fees and a specific estimate before treatment commences.

This can be addressed through a prominent price list and ensuring that you

provide a full written estimate of costs to patients along with their treatment

plan. Should treatment plans change during in course of treatment make sure

that you also update the written estimate.

General Approaches toHandling Complaints

© BDA April 2010 4

Customer Involvement

One way of involving patients in the development of the practice is to include

them in the complaints process. A complaint might, for example, be directed to

one of a panel of four patients (who have agreed to undertake the role and are

appropriately reimbursed) in the first instance. Here the customer first

discusses the complaint with a fellow customer, who can help to resolve it - a

fellow patient can empathise with the customer but also explain practice

circumstances. The panel might also be useful for dealing with difficult

customers: for example those who regularly fail to attend appointments, they

can explain the detrimental effect this has on other patients.

What sort of complaints are we talking about?

The following are examples of complaints that practices have told the BDA they

have received. It may be a useful exercise at practice meetings to think about

some of the complaints you might receive and how you might deal with them.

Complaints about private care cover a wide range of issues, for example:

� the cost of treatment not being fully explained

� the cost of treatment being seen as unreasonable

� restorations that need to be repaired or replaced

� the customer’s initial request or expectation not being met

� poor cosmetic result.

Another source of complaint might be if you are changing from NHS to private

practice. In these circumstances customers might feel that:

� the change to treatment on a purely private basis not being fully explained

� they were told that they would receive better quality care, but they see no

evidence of greater quality care

� they were told that more time would be available for each appointment, but

it is just as difficult for them to see their dentist as before or appointments

are still abrupt

Other typical complaints about treatment:

� Why did the same crown come out three times in three months?

� Why does the crown not match the shade of the patient’s neighbouring

teeth?

� Why did it take multiple injections to anaesthetize one tooth?

� Why has the patient lost feeling in part of her tongue after an extraction and

why was she not warned?

� Why can the receptionist not fit in the patient with a broken tooth until the

day after tomorrow?

� Why did the dentist shout at her child when she could not keep still?

These examples provide valuable indications of issues that you need to look at

further - they may or may not be valid complaints but they are pointers that

something is not right. How would you deal with each of these typical

complaints? What would you say? What might others say?

An in-practice patient complaints procedure is just a set of general instructions

to the practice on how you should communicate with a customer who

complains. Your procedure should be simple, widely available to patients and

well publicised. An example is provided in Appendix 1.

Complaints must be handled confidentially. Communications to complainants

should be marked “private and confidential” or “personal”. Ideally send

communications by first class post. If you respond by email, then double check

that the patient is happy to receive email responses. For complaints made in

person at the practice a private area should be available for discussion.

Your in-practiceprocedure

© BDA April 2010 5

Appoint a person to deal with complaints. There should be one senior person in

the practice (usually the practice owner or the practice manager) who has

specific responsibility and authority to deal with complaints and comments.

When responding to a complaint, the responsible person might be referred to

as the customer liaison officer or complaints manager. You might of course

choose not to give the person an extra title if it is not appropriate in your

practice.

A customer may make a complaint by letter, telephone or in person. Whenever

possible, find an immediate solution. Resolving the complaint at the earliest

possible stage gives the least work to the practice and the highest level of

satisfaction to the customer. If the complaint is over an administrative or

management issue, the complaints manager might be given the authority to

rectify it. If it is clinical, the patient should be given the opportunity to discuss

the matter with the dentist immediately or as soon as possible afterwards.

Practices need to acknowledge complaints promptly, say, within three working

days. The acknowledgement can be written or verbal. It is suggested that it is

better to acknowledge in writing so that you can keep track of how you

responded to each complaint. The acknowledgement should offer the

complainant the opportunity for a discussion at a mutually convenient time. The

purpose of the discussion is to determine how the complaint is to be handled,

the timeframe in which to seek resolution and to find out any further information

about the complaint from the patient.

Investigate complaints as thoroughly and speedily as possible. The dentist and

DCPs involved are asked for their views and suggestions. If appropriate, advice

can be sought from the BDA or the dentist’s defence organisation, but an

adversarial stance should be avoided. Aim for the investigation to take no

longer than ten working days, in most cases a much shorter period is easy to

achieve.

The complainant must be kept informed, as far as reasonably practicable, of

the progress of the investigation. Ask the complainant and make a note of how

they wish to be kept informed – perhaps verbally, in writing or by e-mail. If you

do not respond within a reasonable time the patient may seek to take their

complaint further – to legal action or to the Dental Complaints Service.

Following the investigation, it may be necessary to invite the complainant to

meet the complaints manager and the dentist to resolve the situation. During

the meeting someone else from the practice should be present to take notes

(though if your note taker should not be anyone directly involved in the

complaint). The results of the meeting should be communicated in writing to the

customer, normally within ten working days of the initial complaint.

If the customer does not wish to attend a meeting, a letter should be sent

containing the practice’s response. It is a good idea for the complaints manager

to telephone as well to ensure that the patient received the letter and that there

are no misunderstandings. Letters to complainants should be sent by first class

post and marked “private and confidential” or “personal”.

Where the complaint was justified and the quality of care and service provided

was not as high as the patient had a right to expect, an explanation of what

happened and an apology should be supplied with an indication of how the

occurrence will be prevented in the future. Reasonable redress should be

offered. It may be that the patient would prefer a change of dentist within the

practice, having the work redone free of charge or at reduced cost, or a full or

partial refund of fees. Any offer of redress should be made on the basis that it is

being done as a gesture of goodwill and without the dentist admitting liability.

Check out the wording of any letter with your defence organisation.

Complaints manager

Acknowledgement

Investigation

Response

© BDA April 2010 6

Alternatively, the Dental Complaints Service will give assistance to dentists on

how to handle a complaint, the Service can be contacted on

[email protected] or 08456 120 540.

In cases where the practice and its staff are not at fault, it is equally important

to attempt to resolve the complaint at this stage. The complainant must be

given an explanation of what happened and why it happened. Any cause that

was beyond the practice’s control should also be given, but avoid saying or

implying that the practice is right and the customer is wrong, or that the

customer made a mistake, or giving the impression that the complainant cannot

be expected to understand clinical dentistry.

Where there was no basis for complaint, it is important to make it clear that the

dentist or DCP acted properly. Nevertheless, try to acknowledge how the

customer feels. Give as much explanation of the situation as possible.

Following your investigation and explanation, customers who are still

dissatisfied should be told how to contact the Dental Complaints Service, to

whom the complaint must be directed, where possible. The Dental Complaints

Service seeks to help practices and patients resolve concerns, rather than

apportion blame (see the section Dental Complaints Service and GDC below).

Patients may also seek to bring legal action, probably for breach of contract. If

a patient threatens legal action or you receive a court claim you must seek

independent legal advice.

It is essential that full records are kept of complaints, investigations and

responses. These records should not be kept with the clinical notes, but in a

complaints file. Within the complaints file record:

� the date of receipt of the complaint

� how the complaint was received (verbally, telephone, letter) and by whom it

was received

� details of the complaint and the results of the subsequent investigation

� contemporaneous notes of telephone conversations and meetings

� a record of the outcome of the complaint and action taken by the practice

� correspondence between the customer and the practice.

In the customer’s clinical record card make a note stating ‘Complaint received

on [DATE]’

Along with a good, simple procedure, training of the people who are handling

complaints is also vital. The practice team need to know and understand the

practice complaints procedure. Arrange training for every member of the

practice in: customer care and communication skills, particularly in handling

angry, aggressive or upset customers. Your complaints manager might also

benefit from training in such areas as negotiation, conflict resolution and

assertiveness.

It is important to make sure that your customers know how to complain and are

aware of the procedure that will be used. It demonstrates that you care whether

they have a positive experience of your practice. Mention the procedure in your

patient information leaflet. Produce separate information to give to those who

ask about it.

Improvements to services which result from complaints can be publicised in

practice newsletters.

Failure to resolve

Records

Training

Publicity

© BDA April 2010 7

The General Dental Council (GDC) established the Dental Complaints Service

to resolve complaints about private dental care. Its aim is to “resolve complaints

fairly, efficiently, transparently and quickly, benefiting patients and dental

professionals.” It covers all aspects of private dental care or treatment and

covers all members of the dental team. The Service also advises patients on

their options if they wish to complain and, as mentioned above, assists dentists

in dealing with in-practice complaints. The Dental Complaints Service applies to

England, Scotland, Wales and Northern Ireland.

The Dental Complaints Service deals with any matter arising from private dental

services not matter how trivial. However, it does not deal with: complaints

arising before February 2006; situations concerning NHS treatment; or

allegations of professional misconduct or unfitness to practise. Where a matter

concerns mixed private and NHS care the Dental Complaints Service liaises

with the NHS authorities over which of them should deal with the complaint.

Patients are expected to raise their concerns with the practice before going to

the Dental Complaints Service. If a patient has not contacted the practice first

then they are asked to do so.

If the Dental Complaints Service receives a patient complaint it will contact the

dentist or dental care professional concerned. Initially the Service will offer to

act as an intermediary between patient and practice. It will look to identify and

suggest possible solutions. If the patient and practice cannot agree on a

resolution the Service will investigate the complaint, discussing the matter with

both parties and looking at copies of the dental records.

An independent panel will probably be established to consider unresolved

complaints. Panels are made up of two trained lay members and one dental

practitioner. The panel invites the dental professional and the patient to a

meeting to discuss the issues. The panels are often held in the same locality as

the practice.

After considering the situation the panel will write to both parties with their final

recommendation. The recommendation may be that:

� the complaint be closed with no further action

� the dental professional apologise

� the dental professional give a refund or pay towards remedial treatment

� changes be made to future practising arrangements.

The panel’s recommendation is not binding but a practice would need a solid

reason not to follow a recommendation. The patient would be able to rely upon

panel’s report in any subsequent legal action or complaint of professional

misconduct if the practice fails to abide by the recommendations. Where a

dental professional does not follow the recommendation the Dental Complaints

Service will consider whether to refer the matter to the GDC.

The Dental Complaints Service states that it aims to resolve complaints within 7

- 10 days. However, where it needs to investigate further or set up a panel it will

take longer but will keep both sides informed about the timescale and the

progress of the complaint. Generally speaking most complaints are resolved

well before the panel stage.

Standards for Dental Professionals is the main GDC guidance on what is

expected of dental professionals and contains the principles and values through

which all registrants are required to operate. Practitioners are also expected to

deal properly and professionally with complaints. Full details of their guidance

can be found in the GDC document Principles of Complaint Handling, which

can be downloaded from www.gdc-uk.org.

If an allegation of unfitness to practise is made to the GDC you must seek

advice from your protection society or your provider of indemnity insurance.

DentalComplaints

Service and GDC

Procedure

GDC professionalguidance

© BDA April 2010 8

The BDA offers help and advice with private practice.

British Dental Association

64 Wimpole Street

London

W1G 8YS

Website: www.bda.org

BDA Business Team

E-mail: [email protected]

Telephone: 020 7535 5864

BDA Practice Support Team

E-mail: [email protected]

Telephone: 020 7563 4574

Dental Complaints Service

The Lansdowne Building

2 Lansdowne Road

Croydon

Greater London

CR9 2ER

Website: www.dentalcomplaints.org.uk.

Telephone: 08456 120 540

General Dental Council

37 Wimpole Street

London

W1G 8DQ

Website: www.gdc-uk.org

Telephone: 0845 222 4141

Furtherinformation

© BDA April 2010 9

[Insert name] Dental Practice

Code of Practice for Patient Complaints

In this practice we take complaints very seriously indeed and try to ensure that

all our patients are pleased with their experience of our service. When patients

complain, they are dealt with courteously and promptly so that the matter is

resolved as quickly as possible. This procedure is based on these objectives.

Our aim is to react to complaints in the way in which we would want our

complaint about a service to be handled. We learn from every mistake that we

make and we respond to customers’ concerns in a caring and sensitive way.

1. The person responsible for dealing with any complaint about the service

which we provide is [insert name of your designated complaints manager],

our Complaints Manager.

2. If a patient complains on the telephone or at the reception desk, we will

listen to their complaint and offer to refer him or her to the Complaints

Manager immediately. If Complaints Manager is not available at the time,

then the patient will be told when they will be able to talk to the dentist and

arrangements will be made for this to happen. The member of staff will

take brief details of the complaint and pass them on. If we cannot arrange

this within a reasonable period or if the patient does not wish to wait to

discuss the matter, arrangements will be made for someone else to deal

with it.

3. If the patient complains in writing the letter will be passed on immediately

to the Complaints Manager.

4. If a complaint is about any aspect of clinical care or associated charges it

will normally be referred to the dentist, unless the patient does not want

this to happen.

5. We will acknowledge the patient’s complaint in writing and enclose a copy

of this code of practice as soon as possible, normally within [insert number

of days, suggest: three] working days.

6. We will seek to investigate the complaint within [insert number of days,

suggest: ten] working days of receipt to give an explanation of the

circumstances which led to the complaint. If the patient does not wish to

meet us, then we will attempt to talk to them on the telephone. If we are

unable to investigate the complaint within [insert number of days, suggest:

ten] working days we will notify the patient, giving reasons for the delay

and a likely period within which the investigation will be completed.

7. We will confirm the decision about the complaint in writing immediately

after completing our investigation.

8. Proper and comprehensive records are kept of any complaint received.

9. If patients are not satisfied with the result of our procedure then a

complaint may be made to:

� The Dental Complaints Service, The Lansdowne Building, 2

Lansdowne Road, Croydon, Greater London CR9 2ER (Telephone:

08456 120 540) for complaints about private treatment

� The General Dental Council, 37 Wimpole Street, London, W1M 8DQ

(Telephone: 0845 222 4141), the dentists’ regulatory body for

complaints about professional misconduct

� The [insert name and address of Primary Care Organisation] or [insert

name and address of relevant health service ombudsman for

England, Scotland, Wales or Northern Ireland] for complaints about

NHS treatment*

* Delete the reference to NHS treatment if inapplicable to your practice

APPENDIX 1 -MODEL

COMPLAINTSPOLICY

© BDA April 2010 10

These letters are illustrative of the way in which you may reply to complaints.

They will need adapting for the specific circumstances of each individual

complaint and it is often vital to consult your protection society or defence

organisation before responding in writing to a formal complaint.

Appendix 2 -Model complaintsletters

Letter 1 – Acknowledgement of complaint

[Insert date]

[Insert Patient’s name and address]

Dear [Insert Patient’s name]

Thank you for your letter of [Insert date]. As a patient centred practice, we

take complaints very seriously and shall do our best to resolve the matter.

I enclose a copy of our Code of Practice for Patient Complaints and I hope

that you will be satisfied by this procedure.

{A meeting has been arranged for [Insert time and date] so we can discuss

the matter further. Present at that meeting will be me and [Insert name andposition of person who will be taking notes]}*. Alternatively if you would rather

discuss your matter by telephone, please do contact me on [Insert telephonenumber] to arrange a convenient time.

I will investigate your concerns thoroughly and anticipate that my

investigation will be complete by [Insert estimated date]. I will then contact

you with my full report about the situation.

As a valued patient to our practice, I hope that we can resolve the matter to

your satisfaction. Please do not hesitate to contact me if you wish to discuss

the procedure or any other aspect of this investigation. In the mean time, if

there is anything you feel we can do to help resolve your issue then we are

happy to hear your suggestions when we discuss this matter further.

Yours sincerely

Patient Complaints Manager

* Delete as appropriate.


Letter 2 – Letter to patient where complaint is well founded.

[Insert date]



I am writing to inform you of the results of our investigation regarding your

complaint about [Insert a short summary of the complaint].

As we explained, the practice takes complaints very seriously and we do our

best to resolve patient’s concerns. I have investigated your complaint by

[Insert a brief description of the investigation – meetings held, members ofthe practice team who you discussed the matter with and records that youchecked].

I am sorry that the circumstances leading to your complaint arose. [Insert anexplanation of the situation].

I hope that this explanation is satisfactory. As a gesture of goodwill and

without admitting liability, I would like to offer [Insert suggested remedies,such as replacement treatment or a refund of fees].

To ensure that nothing similar happens again the practice has [Insert adescription of changes to procedures or new procedures that the practice willadopt]. I am satisfied that the practice has already implemented these

changes and that they will prevent a similar problem from recurring.

I hope that the matter is now resolved and you will continue to be a valued

patient of our practice. Should you not be satisfied with this response you

can refer the matter to the Dental Complaints Service, The Lansdowne

Building, 2 Lansdowne Road, Croydon, Greater London CR9 2ER. You can

also contact them by telephone on 08456 120540 or email them at:

[email protected].

If you have any queries, or I can help in any other way, please do not

hesitate to contact me.

Yours sincerely



Letter 3 – Letter to patient where complaint is not justified.

[Insert date]



I am writing to inform you of the results of our investigation with regards to

your complaint about [Insert a short summary of the complaint].

As we explained, the practice takes complaints very seriously and we do our

best to resolve patient’s concerns. I have investigated your complaint by

[Insert a brief description of the investigation - meetings held, members ofthe practice team who you discussed the matter with and records that youchecked].

We have carefully considered your concerns. However, in our view [Insert anexplanation of the practice’s view of the situation. Detail why you feel that thepractice has acted properly.]

I hope that the matter is now resolved and you will continue to be a valued

patient of our practice. Should you not be satisfied with this response you

can refer the matter to the Dental Complaints Service, The Lansdowne

Building, 2 Lansdowne Road, Croydon, Greater London CR9 2ER. You can

also contact them by telephone on 08456 120540 or email them at:

[email protected].

If you have any queries, or I can help in any other way, please do not

hesitate to contact me.

Yours sincerely


British Dental Association

l 64 Wimpole Street l London W1G 8YS l Tel: 020 7563 4563 l Fax: 020 7487 5232

l E-mail: [email protected] l www.bda.org l© BDA April 2010

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