What should I do first when I receive a complaint?
A complaint can feel personal, even when it is mostly about a system. Feeling upset, defensive or anxious is normal. The aim in the first few days is not to fix everything. It is to avoid making things worse and to get the right support.
- Pause before you reply: Do not respond straight away, especially by email or message. A reply written while upset is rarely the one you would choose a day later.
- Read the complaint carefully: List each concern the person has raised. Complaints often contain several separate points, and a good response addresses all of them.
- Tell your manager or the complaints lead: Most complaints are handled through your organisation's complaints process. Find out who is coordinating the response and what they need from you.
- Get advice: Contact your union, professional body or medical defence organisation, particularly if the complaint is serious, mentions a regulator or could lead to a claim.
- Look at the records: Review the clinical notes and any relevant policies. Write your own factual account while your memory is fresh, but never alter or add to the original records.
- Look after yourself: Talk to a trusted colleague, supervisor or occupational health. Most complaints are resolved locally, and most do not reach a regulator.
How does the NHS complaints process work?
The details differ between England, Scotland, Wales and Northern Ireland, so check your own organisation's policy. In England, the general shape is as follows.
- A complaint can be made verbally or in writing, to the organisation that provided care or to the commissioner.
- Complaints should normally be made within 12 months of the event, or of becoming aware of it, although this can be extended where there is good reason.
- The organisation should acknowledge the complaint within three working days and offer to discuss how it will be handled.
- The organisation investigates and responds. This stage is called local resolution.
- If the person remains unhappy, they can ask the Parliamentary and Health Service Ombudsman for an independent review.
Complaints are separate from regulatory referrals. Most complaints never involve the GMC, NMC or HCPC. Regulators generally become involved only where there may be a concern about a professional's fitness to practise.
How do I write a good response to a complaint?
Usually the complaints team sends one combined response, and your job is to provide a clear account for it. Whether you are writing that account or the letter itself, the same principles apply.
- Start by acknowledging the person's experience and apologising for the distress it caused.
- Set out what happened in a clear, factual order, based on the records.
- Answer every concern raised. Say plainly if you do not know the answer to something.
- Use plain English. Explain any medical terms and avoid abbreviations.
- Keep the tone calm and respectful. Avoid defensive, emotive or blaming language, including about colleagues.
- Explain what has been learnt and what will change as a result.
- Offer a meeting if appropriate, and include information about the next step if they remain unhappy.
I followed the correct procedure at all times. The delay was caused by the ward being extremely busy, and the patient's daughter was very demanding during the conversation.
I am sorry that your mother waited so long for pain relief and that you felt your concerns were not listened to. The ward was very busy that evening, but that does not change how distressing the wait was for you both. I have reflected on how I prioritised that evening, and I now check pain scores again within the hour for anyone waiting for a review.
The stronger version still gives context, but it does not use it as an excuse. It recognises the person's experience, takes appropriate ownership and shows what has changed.
Is saying sorry an admission of liability?
No. This is one of the most common worries, especially for professionals who trained in countries where apologising is treated very differently. GMC guidance on the professional duty of candour, which draws on NMC standards, states that apologising does not mean admitting legal liability. It refers to the Compensation Act 2006 in England and Wales. It also notes that NHS Resolution supports saying sorry and says it will not refuse cover on a claim because an apology was given.
A meaningful apology is personal, specific and sincere. Saying "I am sorry that this happened to you" is very different from a general statement that the organisation "regrets any upset caused". If something went wrong in your care, the duty of candour also expects you to explain what happened and what will be done.
How do I reflect on a complaint?
A reflection on a complaint is not a second response letter, and it is not a defence. It is a record of your own learning. Any reflective model works. Gibbs' cycle and What? So What? Now What? are both common. What matters is depth and honesty.
- Describe the situation briefly and anonymously.
- Look at the complaint from the patient's point of view. What did they experience, regardless of your intentions?
- Separate what was in your control from system factors, and be honest about both.
- Link your analysis to the relevant standards, such as the NMC Code, Good medical practice or the HCPC standards of conduct, performance and ethics.
- Set out specific changes, and how you will check they are working.
- Include positives too. Reflecting on what went well in a difficult interaction is part of insight.
A worked example: reflecting on a complaint about communication
What happened: a relative complained that I was dismissive when she asked why her father had not been seen by a doctor. She said I "barely looked up" from the computer. The complaint was resolved locally, but it stayed with me. Why it happened: I was coordinating the shift with two staff short. When she approached, I was mid-way through an escalation, and I answered without stopping. I meant to explain the delay, but she experienced it as being brushed off. Her father was frail and confused, and she had been waiting for hours. From her side, my body language said more than my words. What I learnt: being busy explains my behaviour but does not excuse how it felt to her. The NMC Code asks me to treat people with kindness, respect and compassion, and that includes moments when I am under pressure. What I have changed: when someone approaches me during a task, I now stop, make eye contact and say when I will come back, then do so. I also give families a realistic update on delays without waiting to be asked. I discussed this reflection with my ward manager, and I will ask for feedback from colleagues at my next appraisal.
Should I share my reflection with my regulator?
If a complaint has become a regulatory concern, take advice from your union or defence organisation before submitting anything. The UK regulators' joint statement on reflective practice says they will not ask registrants for personal written reflections when investigating a concern. You can choose to provide reflection as evidence of insight, and many professionals do, but it should be prepared carefully and anonymised.
Evidence of insight is usually strongest when reflection is supported by action. That might be relevant training, feedback from colleagues, supervision notes or a change in practice that others can confirm.
Getting support and building your skills
If you want to strengthen how you handle complaints, Communication, Attitude and Responding to Complaints covers response writing, tone and reflection in more depth. Difficult Conversations with Patients and Families helps with the conversations that often come before a complaint, and with meetings afterwards. If the complaint involved something going wrong in care, Duty of Candour Training explains what you are expected to say and record, and why it matters.
Frequently asked questions
How should a nurse or doctor respond to a patient complaint?
Pause before replying, read the complaint carefully and inform your manager or complaints lead. Get advice from your union or defence organisation. Provide an honest, factual account based on the records. Acknowledge the person's experience, apologise, answer each concern in plain English and explain what has been learnt. Avoid defensive or blaming language.
Does apologising to a patient mean admitting fault?
No. GMC guidance on candour states that an apology does not mean admitting legal liability, citing the Compensation Act 2006 in England and Wales. NHS Resolution supports apologising and says it will not refuse cover because an apology was given. A sincere, personal apology is usually the right step.
Will a complaint be reported to the NMC or GMC?
Most complaints are handled locally through the organisation's complaints process and never involve a regulator. A referral is usually only made where there may be a concern about a professional's fitness to practise. If you are worried, ask your manager and get advice from your union or defence organisation.
How long does a patient have to make a complaint in England?
In England, complaints should normally be made within 12 months of the event or of becoming aware of it. This can be extended where there is good reason and it is still possible to investigate. The rules differ in Scotland, Wales and Northern Ireland, so check your organisation's policy.
What should I include in a reflection after a complaint?
Briefly describe what happened, anonymised. Consider the patient's experience, analyse why things happened, separating personal and system factors, and link to your professional standards. Explain what you learnt, set out specific changes, and say how you will check they are working. Discussing it with a supervisor adds value.
Do I have to give my reflection to my regulator?
No. The UK regulators' joint statement says they will not ask for your personal written reflections when investigating a concern. You can choose to share reflection as evidence of insight. Take advice from your union or defence organisation first, and make sure it is anonymised and focused on learning.
Should I contact the patient who complained?
Usually not on your own. Work through your organisation's complaints lead, who coordinates the response and any meeting. Contacting the complainant directly can seem defensive or cause confusion. If a meeting is offered, prepare with your manager and focus on listening and explaining.
Related courses
Communication, Attitude and Responding to Complaints
This course looks at why concerns about communication and attitude arise, how patients and colleagues experience a rude, dismissive or rushed manner,…
Difficult Conversations with Patients and Families
This course gives you practical, published approaches for conversations that involve anger, disagreement, complaints or expectations that cannot be…
Duty of Candour Training
This course explains the two duties of candour that apply in UK healthcare: the professional duty that applies to every registered professional, and…
Sources and further reading
- Openness and honesty when things go wrong: the professional duty of candour. General Medical Council.
- Responding to complaints: England. MDDUS.
- Benefits of becoming a reflective practitioner (joint statement). Chief executives of the UK statutory health and care regulators.
- The Code: professional standards of practice and behaviour. Nursing and Midwifery Council.
- The reflective practitioner: guidance for doctors and medical students. General Medical Council.
Practitioner Insight is an independent education provider. It is not affiliated with or endorsed by the GMC, MPTS, NMC, HCPC, GPhC or any NHS organisation, and this information is not legal advice. If you have been referred to a regulator, speak to your defence organisation, trade union or legal representative.
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