Dealing with vexatious complaints

The BMA concisely define vexatious complaints as those that are submitted purely to cause annoyance to the practice in their Dealing with complaints made against you in primary care guidance.

There is no one single feature of unreasonable behaviour. Examples of behaviour may include:

• Persistently pursuing an issue when the complaint has been fully and appropriately investigated and addressed.
• Not clearly identifying the precise issues that they want investigated, despite reasonable efforts by staff, and where appropriate, an independent advocacy services to help them specify their complaint.
• Focussing on a ‘trivial’ matter to an extent that it is out of proportion to its significance. It is recognised that defining ‘trivial’ is subjective and careful judgment must be applied and recorded.
• Changing the substance of a complaint/concern or seeking to prolong contact by continually raising additional issues in relation to the original complaint. Care must be taken not to overlook new issues that are significantly different from the original issue. Each issue of concern needs to be addressed separately and separately and appropriately.
• Consuming a disproportionate amount of time and resources in constructing repetitive or lengthy communications to the practice.
• Threatening or using actual physical violence towards staff.
• Harassing or being abusive or verbally aggressive (this may include written abuse e.g. emails).
• Repeatedly focussing on conspiracy theories and/or not accepting documented evidence as being factual.
• Making excessive telephone calls or sending excessive numbers of emails or letters to staff.

The practice should:

• Ensure that all issues in the complaint(s) are appropriately addressed within the required timescales.
• Ensure the complainant has been kept up to date and that communication has been adequate with the complainant prior to deeming any communication from them as unreasonable or persistent.
• Carefully check that new or significant concerns are not being raised, that require separate consideration.
• Act with care, fairness, and consideration of the complainant’s circumstances. Reasonable adjustments may be necessary to appropriately address a patient’s complaint.
• Consider the proportionality and appropriateness of any proposed action in comparison with the behaviour, and the impact upon staff.
• Ensure all communications with the complainant are appropriately documented in the respective complaint file.

Whilst dealing with a vexatious complainant, it is important to separate their behaviours from their complaint and manage the two issues separately.

If the complainant floods the practice with rude and abusive emails which do include a legitimate complaint:

• It is important to respond to the complaint in accordance with your practice complaints procedure and to deal with the rude and abusive nature of the email (i.e. the behaviour) separately. This could either be in a separate letter or by inviting the patient to a meeting to discuss the issue.

If a complainant repeatedly raises the same issue:

• Review previous complaints and responses to ensure each issue raised by the patient has been appropriately addressed.
• If the patient has complained regarding exactly the same issues, the complaint should be recorded and retained in the relevant complaint file and the patient directed back to the original response with a clear statement that the practice has fully and appropriately addressed the issues raised in the patient’s previous complaint letter and that the practice will not respond further regarding these issues.
• If the patient makes further contact regarding the same issues, the complaint should be recorded and retained in the appropriate complaint file, but no response should be sent regarding the previously appropriately addressed issues. The correspondence does need reading carefully however, to ensure that if any new issues are raised, they are appropriately responded to. Any new issue should receive a response in accordance with your practice complaints procedure.
• The complainant should be informed of their right to escalate their concerns to The Parliamentary and Health Service Ombudsman (PHSO), if they remain unhappy at the conclusion of the local resolution procedure (if the complaint in whole or in part relates to the processing of data, then the complainant should escalate their concerns to the Information Commissioner’s Office (ICO)). If you have addressed a particular issue and have informed the complainant of their right to escalate their concerns to the PHSO and/or ICO, it is reasonable to state that you are not going to enter into ongoing correspondence on that issue and to adhere to that stance (you would of course be obliged to respond to any new issues that the patient raises as part of a new complaint.
• In the complaint response letter to the patient the practice may want to remind the complainant that they may wish to exercise their right to reregister at an alternative practice, given their loss of confidence in the practice.
• If the patient continues to submit letters or emails regarding the same issues that have been previously addressed, the practice may want to consider if it is appropriate to send a warning letter to the patient regarding the tone of the emails (if relevant) and the detrimental effect their continuous communication has on the surgery and that, should this continue, the practice may need to consider removing them from the practice list. That would ensure the patient has had a clear written warning that their removal is due to repeated, correspondence for which they have already been advised the practice will no longer engage in further correspondence. Removing a patient from the practice list solely due to a complaint or claim is not an acceptable reason for removal. While practice’s sometimes wants to remove a patient, they consider to be making vexatious complaints from the practice list, this needs careful consideration, and adherence to the relevant contractual processes. If you find yourself in this position, please contact the GP support Team at Londonwide LMCs or your Medical Defence Organisation for advice prior to taking any action. We have produced some detailed guidance in relation to removing patients from the practice list and on how to handle and mitigate abuse from patients.

• Complaints should be dealt with in accordance with the practice complaints policy (which should be compliant with the NHS Complaints procedure as set out in The Local Authority Social Services and National Health Service Complaints (England) Regulations 2009).
• It is important that all correspondence is written in measured, empathic, professional and reasonable terms (apart from the fact that such an approach is more likely to lead to a resolution of the complaint, this will reflect well on you in the event that the complaint is escalated to the PHSO/ICO).
• It is important to retain all the finalised complaint correspondence in the complaint file together with contemporaneous notes of any relevant telephone conversations and steps that have been taken to investigate the complaint.
• Consider defining a clear and clearly set out communication channel for the complainant in order to avoid wider members of the team being unnecessarily troubled by the correspondence.
• Limiting the number of staff involved in challenging interactions can be helpful, as well as ensuring those members of staff have suitable time available to debrief following any interactions that were challenging. For example, one of the GP partners could be identified as the GP providing regular care whenever they are available, with an alternative GP partner identified to provide care when the regular GP is on leave. This could be set out in writing to the patient.
• Consider whether it would be appropriate to use chaperones in all consultations with this patient and to have a second person in meetings to ensure accurate records and support for those involved. This could be set out in writing to the patient.
• Support the staff members who are dealing with the complaint – it can be emotionally draining and time consuming to deal with a vexatious complainant. The practice should consider regularly reviewing who should provide care for the patient, as staff involved may need to be changed in order to give those involved a break from the stress.
• Support the team – it can be unnerving, distressing and anxiety-provoking for the wider members of the staff team to have contact with a vexatious complainant.
• Treat each new complaint on its merits – serial and/or vexatious complaints may still have legitimate causes for complaint.
• Suggest that the complainant might want to seek the support of an advocate (for example VoiceAbility who provide NHS complaints advocacy) – an advocate can be helpful in relation to not only supporting the complainant but also advising them as to the reasonableness of their concerns).
• An option that can sometimes be useful is to remind the complainant that it is open to them to register at an alternative practice should they so wish.
• Behavioural contracts can sometimes have a role in managing patient behaviour; however, they are contingent on the patient’s agreement and compliance. The GP Support Team at Londonwide LMCs can provide you with bespoke advice in relation to behavioural contracts.
• In (thankfully) rare cases, complainants may pursue a course of behaviour that amounts to an offence under the Protection from Harassment Act (1997) – if you believe that this may be a possibility, please contact the GP Support Team at Londonwide LMCs, who will be able to signpost you to relevant sources of legal advice and support.
• Meetings can be useful both in relation to complaints management and behaviour management, however the offer of a meeting should be approached cautiously in the context of a vexatious complainant (the key principle being not to conflate the issues relating to the complaint with the issues relating to their behaviour).
• Contact Londonwide LMC GP Support Team for further bespoke advice and support at GPSupport@lmc.org.uk.