Dealing with complaints

T he GOC is currently consulting on a new code of conduct for professionals, aiming to give practitioners more guidance on the standard of professional care expected of them.
Many of the principles in the code are straightforward. Practitioners must: 'Make the care of your patient your first and continuing concern; treat every patient politely and considerately.'
There is detail on financial dealings, obtaining consent, good standards of practice and care. It also explains what to do if a practitioner is concerned about a colleague's fitness to practise, and the obligations on a practitioner if they are the subject of a complaint.

Causes of complaints
Good communication is key in avoiding complaints, according to the administrator of the Optical Consumer Complaints Service (OCCS), Richard Highton.
'Spending an extra few seconds explaining what patients should expect can avoid spending hours on a complaint. Patients sometimes expect too much from a new appliance Ð it should be made absolutely clear what can be expected in order to cut down on the possibility of disappointment,' he says.
The OCCS recommends the use of leaflets to back up verbal explanations. One area where this can be useful is for elderly people with early signs of cataract.
Patients have the right to be told as much as possible about the condition of their eyes, without causing unnecessary anxiety and alarm. A clear and simple written explanation for the patient to take away can help.
If the patient is referred due to reduced vision, practitioners must be careful to demonstrate what visual improvement, if any, can be obtained with a new prescription. The OCCS advises that patients should be aware of 'the temporary nature of any new spectacles'.
Progressive lenses lead to 18 per cent of complaints handled by the OCCS. To help reduce the likelihood of a varifocals complaint, patients need to understand how the lenses work, and what to expect of them. They should be warned of potential problems when the spectacles are being fitted and encouraged to return after a short period of adjustment.
Just 9 per cent of complaints are about spectacle frames, but an increasing proportion of these refer to rimless styles. Patients need to be told about the delicate nature of this lightweight appliance, and perhaps even be given an idea of the cost of repairs before they decide on this type of frame. As with all eyewear, it is particularly important here to give the patient advice on care and cleaning.
Most complaints are resolved in the practice. However, some complaints may be more intractable. If there is no progress at practice level, practitioners can always call in the OCCS. Highton points out, 'OCCS is unbiased, and we're just trying to get a fair resolution all round'.
A common difficulty is where a complaint arises and the eye examination has taken place at a different practice from the one where the spectacles have been dispensed. Staff need to open up good channels of communication between practices to avoid a patient being bounced from one place to another.
In difficult disputes it may be necessary to bring in an independent arbitrator. The OCCS can correspond with both practices and will refer the patient back for a re-test if necessary. It can also try and evaluate what has happened and, where necessary, will pay for the patient to have an independent assessment.
Domiciliary practitioners have for some time received a disproportionate number of complaints, but GOC registrar Peter Coe believes there are plenty of ways to minimise the risk of receiving one.
'Inform the nursing home of your visit in advance,' he suggests. 'Allow plenty of time; make sure you ask for the patient's notes; talk to the trained staff at the nursing home and be civil to the patient. Take exemplary notes because the patient may be confused or on medication, so many things can go wrong,' he adds.
He also advises that practitioners should retain one copy of the records and leave another in the patient's nursing home file, and that if a test is not carried out, make sure you record why. For example: 'Fields attempted Ð demonstrated to nurse in charge could not be done because Px too confused.'
It is also vital to ensure your notes are legible, says Coe, who also emphasises the importance of accurate referrals. 'If there might be a problem with a patient's eyes, it's vital that the optometrist knows the local system, to ensure referrals get to the right place, at the right time.'
Over the last year, the GOC has made efforts to streamline fitness-to-practise procedures. Practitioners should now be notified earlier of a complaint together with an explanation of the procedure they should follow, with complaints now going straight to an investigating committee, cutting out a preliminary assessment stage. Furthermore, hearings can now take place on an increased number of days, cutting the time taken for a complaint to reach the disciplinary committee.
On average it takes eight months for a case to reach the disciplinary committee, three months for cases relating to criminal convictions. According to Coe, in future, the GOC will have a range of ways to support practitioners in need of professional development.
'Practitioners find it very difficult to improve their practice if suspended Ð it's better if they can practise under supervision. Compulsory training could be imposed alongside a fine,' he says.
If you are ever in the position of receiving notification from the GOC about a complaint, Coe has a few initial tips: 'First, tell your representative body. Don't make contact with the patient. Think about how you'd handle the press. And plan how you are going to tell your staff about the complaint.'

legal advice and support.
AOP lawyer Fiona Mitchell has 10 years' experience as a practising optometrist, as well as five years in her current post.
She recommends getting advice when a complaint first occurs. 'We'd rather be bothered with non-serious complaints than have practitioners think something isn't serious and try to deal with it alone,' she explains.
'Issues can appear to be contractual, but a throw away line at the bottom of a letter saying Ò...and I wasn't happy with the eye testÓ can lead to a complaint to the GOC or possibly even civil litigation.
'Furthermore it is vital that your insurers are notified promptly of any complaint before any reply is made to the patient. Failure to notify your insurers can affect your professional indemnity cover,' she points out.
Early advice holds true whether you are confident you know what to do about a complaint or not. It is vital to get legal advice if you are the subject of a complaint to the GOC or a NHS trust, or if a patient instructs a lawyer to act on their behalf.
'Occasionally, practitioners make mistakes,' says Mitchell. 'Fortunately, it doesn't occur very often. If you have made an error, we'll try to minimise the impact and fight to keep you registered and practising.'
She finds good communication keeps patients happy and protects the practitioner. Record keeping is key to a good defence, and many GOC disciplinary hearings involve numerous box files full of documentation.
'You can't prevent all complaints, but with good records you'll be able to offer a rational and reasonable explanation for your actions,' she continues. 'Your records can never be too full. Note down everything you say to a patient, even if it's advice given standing outside the consulting room door. Also, make sure that your staff note down their comments and actions. Take care in particular to note down advice the patient finds unpalatable Ð for example if you have to tell someone to stop wearing their contact lenses, note down the reasons for your advice. There seems to be a correlation between good record keeping and defending a complaint successfully,' she adds.

Helping patients
Patients often need assistance when making a complaint, and it is useful to provide a practice complaints leaflet with the contact details for local organisations. Community health councils have been helping patients with complaints for 28 years, but later on this year they will be replaced by 'Patients' Forums'.
However, the handover is proving problematic, and Patients' Forum staff may not be trained to take over until 2004.
NHS Direct (0845 4647) offers information on how to complain. Every NHS and Primary Care Trust in England is establishing its own Patient Advice and Liaison Service to provide on-the-spot support and information and can also help patients seeking more details on how to complain.T he GOC is currently consulting on a new code of conduct for professionals, aiming to give practitioners more guidance on the standard of professional care expected of them.
Many of the principles in the code are straightforward. Practitioners must: 'Make the care of your patient your first and continuing concern; treat every patient politely and considerately.'
There is detail on financial dealings, obtaining consent, good standards of practice and care. It also explains what to do if a practitioner is concerned about a colleague's fitness to practise, and the obligations on a practitioner if they are the subject of a complaint.

Causes of complaints
Good communication is key in avoiding complaints, according to the administrator of the Optical Consumer Complaints Service (OCCS), Richard Highton.
'Spending an extra few seconds explaining what patients should expect can avoid spending hours on a complaint. Patients sometimes expect too much from a new appliance Ð it should be made absolutely clear what can be expected in order to cut down on the possibility of disappointment,' he says.
The OCCS recommends the use of leaflets to back up verbal explanations. One area where this can be useful is for elderly people with early signs of cataract.
Patients have the right to be told as much as possible about the condition of their eyes, without causing unnecessary anxiety and alarm. A clear and simple written explanation for the patient to take away can help.
If the patient is referred due to reduced vision, practitioners must be careful to demonstrate what visual improvement, if any, can be obtained with a new prescription. The OCCS advises that patients should be aware of 'the temporary nature of any new spectacles'.
Progressive lenses lead to 18 per cent of complaints handled by the OCCS. To help reduce the likelihood of a varifocals complaint, patients need to understand how the lenses work, and what to expect of them. They should be warned of potential problems when the spectacles are being fitted and encouraged to return after a short period of adjustment.
Just 9 per cent of complaints are about spectacle frames, but an increasing proportion of these refer to rimless styles. Patients need to be told about the delicate nature of this lightweight appliance, and perhaps even be given an idea of the cost of repairs before they decide on this type of frame. As with all eyewear, it is particularly important here to give the patient advice on care and cleaning.
Most complaints are resolved in the practice. However, some complaints may be more intractable. If there is no progress at practice level, practitioners can always call in the OCCS. Highton points out, 'OCCS is unbiased, and we're just trying to get a fair resolution all round'.
A common difficulty is where a complaint arises and the eye examination has taken place at a different practice from the one where the spectacles have been dispensed. Staff need to open up good channels of communication between practices to avoid a patient being bounced from one place to another.
In difficult disputes it may be necessary to bring in an independent arbitrator. The OCCS can correspond with both practices and will refer the patient back for a re-test if necessary. It can also try and evaluate what has happened and, where necessary, will pay for the patient to have an independent assessment.
Domiciliary practitioners have for some time received a disproportionate number of complaints, but GOC registrar Peter Coe believes there are plenty of ways to minimise the risk of receiving one.
'Inform the nursing home of your visit in advance,' he suggests. 'Allow plenty of time; make sure you ask for the patient's notes; talk to the trained staff at the nursing home and be civil to the patient. Take exemplary notes because the patient may be confused or on medication, so many things can go wrong,' he adds.
He also advises that practitioners should retain one copy of the records and leave another in the patient's nursing home file, and that if a test is not carried out, make sure you record why. For example: 'Fields attempted Ð demonstrated to nurse in charge could not be done because Px too confused.'
It is also vital to ensure your notes are legible, says Coe, who also emphasises the importance of accurate referrals. 'If there might be a problem with a patient's eyes, it's vital that the optometrist knows the local system, to ensure referrals get to the right place, at the right time.'
Over the last year, the GOC has made efforts to streamline fitness-to-practise procedures. Practitioners should now be notified earlier of a complaint together with an explanation of the procedure they should follow, with complaints now going straight to an investigating committee, cutting out a preliminary assessment stage. Furthermore, hearings can now take place on an increased number of days, cutting the time taken for a complaint to reach the disciplinary committee.
On average it takes eight months for a case to reach the disciplinary committee, three months for cases relating to criminal convictions. According to Coe, in future, the GOC will have a range of ways to support practitioners in need of professional development.
'Practitioners find it very difficult to improve their practice if suspended Ð it's better if they can practise under supervision. Compulsory training could be imposed alongside a fine,' he says.
If you are ever in the position of receiving notification from the GOC about a complaint, Coe has a few initial tips: 'First, tell your representative body. Don't make contact with the patient. Think about how you'd handle the press. And plan how you are going to tell your staff about the complaint.'

legal advice and support.
AOP lawyer Fiona Mitchell has 10 years' experience as a practising optometrist, as well as five years in her current post.
She recommends getting advice when a complaint first occurs. 'We'd rather be bothered with non-serious complaints than have practitioners think something isn't serious and try to deal with it alone,' she explains.
'Issues can appear to be contractual, but a throw away line at the bottom of a letter saying Ò...and I wasn't happy with the eye testÓ can lead to a complaint to the GOC or possibly even civil litigation.
'Furthermore it is vital that your insurers are notified promptly of any complaint before any reply is made to the patient. Failure to notify your insurers can affect your professional indemnity cover,' she points out.
Early advice holds true whether you are confident you know what to do about a complaint or not. It is vital to get legal advice if you are the subject of a complaint to the GOC or a NHS trust, or if a patient instructs a lawyer to act on their behalf.
'Occasionally, practitioners make mistakes,' says Mitchell. 'Fortunately, it doesn't occur very often. If you have made an error, we'll try to minimise the impact and fight to keep you registered and practising.'
She finds good communication keeps patients happy and protects the practitioner. Record keeping is key to a good defence, and many GOC disciplinary hearings involve numerous box files full of documentation.
'You can't prevent all complaints, but with good records you'll be able to offer a rational and reasonable explanation for your actions,' she continues. 'Your records can never be too full. Note down everything you say to a patient, even if it's advice given standing outside the consulting room door. Also, make sure that your staff note down their comments and actions. Take care in particular to note down advice the patient finds unpalatable Ð for example if you have to tell someone to stop wearing their contact lenses, note down the reasons for your advice. There seems to be a correlation between good record keeping and defending a complaint successfully,' she adds.

Helping patients
Patients often need assistance when making a complaint, and it is useful to provide a practice complaints leaflet with the contact details for local organisations. Community health councils have been helping patients with complaints for 28 years, but later on this year they will be replaced by 'Patients' Forums'.
However, the handover is proving problematic, and Patients' Forum staff may not be trained to take over until 2004.
NHS Direct (0845 4647) offers information on how to complain. Every NHS and Primary Care Trust in England is establishing its own Patient Advice and Liaison Service to provide on-the-spot support and information and can also help patients seeking more details on how to complain.T he GOC is currently consulting on a new code of conduct for professionals, aiming to give practitioners more guidance on the standard of professional care expected of them.
Many of the principles in the code are straightforward. Practitioners must: 'Make the care of your patient your first and continuing concern; treat every patient politely and considerately.'
There is detail on financial dealings, obtaining consent, good standards of practice and care. It also explains what to do if a practitioner is concerned about a colleague's fitness to practise, and the obligations on a practitioner if they are the subject of a complaint.

Causes of complaints
Good communication is key in avoiding complaints, according to the administrator of the Optical Consumer Complaints Service (OCCS), Richard Highton.
'Spending an extra few seconds explaining what patients should expect can avoid spending hours on a complaint. Patients sometimes expect too much from a new appliance Ð it should be made absolutely clear what can be expected in order to cut down on the possibility of disappointment,' he says.
The OCCS recommends the use of leaflets to back up verbal explanations. One area where this can be useful is for elderly people with early signs of cataract.
Patients have the right to be told as much as possible about the condition of their eyes, without causing unnecessary anxiety and alarm. A clear and simple written explanation for the patient to take away can help.
If the patient is referred due to reduced vision, practitioners must be careful to demonstrate what visual improvement, if any, can be obtained with a new prescription. The OCCS advises that patients should be aware of 'the temporary nature of any new spectacles'.
Progressive lenses lead to 18 per cent of complaints handled by the OCCS. To help reduce the likelihood of a varifocals complaint, patients need to understand how the lenses work, and what to expect of them. They should be warned of potential problems when the spectacles are being fitted and encouraged to return after a short period of adjustment.
Just 9 per cent of complaints are about spectacle frames, but an increasing proportion of these refer to rimless styles. Patients need to be told about the delicate nature of this lightweight appliance, and perhaps even be given an idea of the cost of repairs before they decide on this type of frame. As with all eyewear, it is particularly important here to give the patient advice on care and cleaning.
Most complaints are resolved in the practice. However, some complaints may be more intractable. If there is no progress at practice level, practitioners can always call in the OCCS. Highton points out, 'OCCS is unbiased, and we're just trying to get a fair resolution all round'.
A common difficulty is where a complaint arises and the eye examination has taken place at a different practice from the one where the spectacles have been dispensed. Staff need to open up good channels of communication between practices to avoid a patient being bounced from one place to another.
In difficult disputes it may be necessary to bring in an independent arbitrator. The OCCS can correspond with both practices and will refer the patient back for a re-test if necessary. It can also try and evaluate what has happened and, where necessary, will pay for the patient to have an independent assessment.
Domiciliary practitioners have for some time received a disproportionate number of complaints, but GOC registrar Peter Coe believes there are plenty of ways to minimise the risk of receiving one.
'Inform the nursing home of your visit in advance,' he suggests. 'Allow plenty of time; make sure you ask for the patient's notes; talk to the trained staff at the nursing home and be civil to the patient. Take exemplary notes because the patient may be confused or on medication, so many things can go wrong,' he adds.
He also advises that practitioners should retain one copy of the records and leave another in the patient's nursing home file, and that if a test is not carried out, make sure you record why. For example: 'Fields attempted Ð demonstrated to nurse in charge could not be done because Px too confused.'
It is also vital to ensure your notes are legible, says Coe, who also emphasises the importance of accurate referrals. 'If there might be a problem with a patient's eyes, it's vital that the optometrist knows the local system, to ensure referrals get to the right place, at the right time.'
Over the last year, the GOC has made efforts to streamline fitness-to-practise procedures. Practitioners should now be notified earlier of a complaint together with an explanation of the procedure they should follow, with complaints now going straight to an investigating committee, cutting out a preliminary assessment stage. Furthermore, hearings can now take place on an increased number of days, cutting the time taken for a complaint to reach the disciplinary committee.
On average it takes eight months for a case to reach the disciplinary committee, three months for cases relating to criminal convictions. According to Coe, in future, the GOC will have a range of ways to support practitioners in need of professional development.
'Practitioners find it very difficult to improve their practice if suspended Ð it's better if they can practise under supervision. Compulsory training could be imposed alongside a fine,' he says.
If you are ever in the position of receiving notification from the GOC about a complaint, Coe has a few initial tips: 'First, tell your representative body. Don't make contact with the patient. Think about how you'd handle the press. And plan how you are going to tell your staff about the complaint.'

legal advice and support.
AOP lawyer Fiona Mitchell has 10 years' experience as a practising optometrist, as well as five years in her current post.
She recommends getting advice when a complaint first occurs. 'We'd rather be bothered with non-serious complaints than have practitioners think something isn't serious and try to deal with it alone,' she explains.
'Issues can appear to be contractual, but a throw away line at the bottom of a letter saying Ò...and I wasn't happy with the eye testÓ can lead to a complaint to the GOC or possibly even civil litigation.
'Furthermore it is vital that your insurers are notified promptly of any complaint before any reply is made to the patient. Failure to notify your insurers can affect your professional indemnity cover,' she points out.
Early advice holds true whether you are confident you know what to do about a complaint or not. It is vital to get legal advice if you are the subject of a complaint to the GOC or a NHS trust, or if a patient instructs a lawyer to act on their behalf.
'Occasionally, practitioners make mistakes,' says Mitchell. 'Fortunately, it doesn't occur very often. If you have made an error, we'll try to minimise the impact and fight to keep you registered and practising.'
She finds good communication keeps patients happy and protects the practitioner. Record keeping is key to a good defence, and many GOC disciplinary hearings involve numerous box files full of documentation.
'You can't prevent all complaints, but with good records you'll be able to offer a rational and reasonable explanation for your actions,' she continues. 'Your records can never be too full. Note down everything you say to a patient, even if it's advice given standing outside the consulting room door. Also, make sure that your staff note down their comments and actions. Take care in particular to note down advice the patient finds unpalatable Ð for example if you have to tell someone to stop wearing their contact lenses, note down the reasons for your advice. There seems to be a correlation between good record keeping and defending a complaint successfully,' she adds.

Helping patients
Patients often need assistance when making a complaint, and it is useful to provide a practice complaints leaflet with the contact details for local organisations. Community health councils have been helping patients with complaints for 28 years, but later on this year they will be replaced by 'Patients' Forums'.
However, the handover is proving problematic, and Patients' Forum staff may not be trained to take over until 2004.
NHS Direct (0845 4647) offers information on how to complain. Every NHS and Primary Care Trust in England is establishing its own Patient Advice and Liaison Service to provide on-the-spot support and information and can also help patients seeking more details on how to complain.