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Understand
Complaints, incidents and the duty of candour
Respond to concerns about care with openness, compassion and accuracy while keeping complaint, incident and legal processes distinct.
A complaint is not itself a finding of fault. Respond to the patient's experience, protect immediate safety, preserve evidence and meet professional and organisational candour duties. Obtain defence advice where the response could affect a claim, inquest, employer process or GMC matter.
By the end of this module, you should be able to:
- Distinguish complaint handling, incident review and statutory or professional candour.
- Prepare a factual, compassionate response without speculation.
- Understand how the four national NHS complaints systems differ.
A complaint is information, not a verdict
Complaints may identify harm, poor communication, delay, behaviour, access problems or an experience the clinical record does not capture. Acknowledge the concern without deciding liability. The organisation should establish consent and scope, identify records and staff, and explain the process and timescale under the applicable national framework.
England, Wales, Scotland and Northern Ireland have different complaints pathways and ombudsman arrangements. In Wales, Putting Things Right integrates concerns, redress and learning. Always use the current local policy.
- Acknowledge experience.
- Clarify scope and consent.
- Use the correct national process.
Act on immediate safety first
Do not wait for the complaint investigation if current patients may be at risk. Escalate urgent clinical issues, preserve relevant equipment or data where required, complete incident reporting and ensure follow-up. These actions should not be delayed by uncertainty about blame.
Safety action and fairness can coexist. A temporary change to duties may be a neutral risk control, but its purpose, scope and review should be explicit.
- Protect current patients.
- Preserve evidence.
- Record interim controls.
Professional and statutory candour
Good medical practice requires openness when things go wrong, including putting matters right where possible, offering an apology and explaining fully and promptly. Statutory organisational or professional duties of candour vary by nation and setting. An apology is not necessarily an admission of legal liability, but wording and process should follow local policy and advice.
Candour does not require speculation. Explain known facts, what remains under review, current care, contact arrangements and learning. Avoid defensive language, premature causation conclusions or promises about outcomes outside your authority.
- Be open and timely.
- Distinguish known facts from review.
- Follow nation-specific statutory duties.
Write a safe complaint response
Use chronology, clinical reasoning, communication, current outcome and learning. Answer the questions asked. Translate technical language. If you cannot remember, say so and rely on the contemporaneous record rather than reconstructing certainty. Identify system factors without shifting responsibility unfairly.
A draft written on behalf of an organisation may require governance approval. A personal statement has a different function. Confirm who owns the response, whether it may be disclosed elsewhere and whether you are writing as treating clinician, manager or witness.
- State role and source of knowledge.
- Do not claim memory you do not have.
- Separate organisational and personal responses.
Apology, reflection and learning
A meaningful apology recognises the person's experience and avoids conditional or self-protective wording. Learning should be specific and proportionate: what changed, who owns it, how implementation is checked and whether the action addresses the actual cause. A generic online course completed after every complaint is not automatically meaningful remediation.
Discuss personal reflections with an adviser where litigation or regulatory action is possible. Reflection should demonstrate understanding and action without unnecessarily reproducing confidential patient detail.
- Apologise meaningfully.
- Match learning to the issue.
- Evidence implementation.
When complaints connect to other processes
A complaint may trigger incident investigation, disciplinary action, a claim, inquest or GMC referral. Tell advisers about parallel processes and keep accounts consistent while answering each request for its legitimate purpose. Do not assume the complaint response is confidential or cannot be used elsewhere.
If asked to meet or provide a statement during another investigation, clarify status, scope, disclosure and representation. The existence of a complaint does not remove fair-process rights.
- Map parallel consequences.
- Clarify how material will be used.
- Seek representation early.
Worked example: concern after delayed review
A generic complaint alleges that a patient deteriorated while waiting for senior review and that the family received little explanation. The immediate clinical task is to ensure continuing care and identify any similar current risk. The complaint task is to acknowledge the experience and answer the family’s questions. The incident task is to examine demand, escalation and handover. The doctor’s statement should explain their own actions and limits of knowledge.
A safe response does not decide negligence. It states the timeline from authorised records, identifies where recollection is limited, explains known clinical reasoning, acknowledges communication failures where established and describes proportionate learning. The organisation should not ask one doctor to provide an organisational conclusion outside their remit.
- Patient experience.
- Clinical facts.
- System learning.
Complaint-response quality check
Before submission, check whether the response answers each question; distinguishes fact, recollection and opinion; uses plain language; includes an appropriate apology; avoids blaming the patient or another team; explains action and review; and identifies who can answer issues beyond the writer’s role. Confirm that names, dates and medicines agree with the record.
Where there is potential serious harm, inquest, police involvement or claim, route the draft through governance and the defence organisation. This is compatible with candour: advice should improve accuracy and process, not create concealment or delay necessary communication.
- Answer the questions asked.
- Check accuracy against records.
- Escalate high-risk drafts for advice.
Can your draft show compassion, facts, uncertainty and learning without blaming, speculating or becoming defensive?
Keep in mind
Three takeaways
- 1A complaint is a route to response and learning, not proof of misconduct.
- 2Candour is compatible with accuracy and legal advice.
- 3Use the correct four-nation complaints framework and map parallel processes.
Situational judgement exercise
Check your understanding
Six questions on Complaints, incidents and the duty of candour test process and practical judgement. This is educational: it does not assess your health, evidence sufficiency or decide a legal issue.
Question 1 of 6
Choose one answer to continue.
Recommended workbooks
Do not enter patient identifiers or copy material you are not entitled to retain.
Check the source
Official and professional guidance
Open the current source and confirm its jurisdiction before applying it.
GMC: Good medical practice 2024UK ↗NHS England: Feedback and complaints about NHS servicesEngland ↗Welsh Government: Putting Things Right guidanceWales ↗NHS inform: Feedback, complaints and rightsScotland ↗nidirect: Complaints about health servicesNorthern Ireland ↗MDU: Fitness to practise proceduresUK ↗
Page last reviewed 7 September 2026. Independent educational guidance, not an individual legal, employment or regulatory assessment.