How to deal with a vexatious complainant

  • Safety

Dealing with a complainant can be challenging enough, but it can become even more so when the complainant becomes vexatious.

Support

The GP Support Team at Londonwide LMCs can provide you with bespoke advice in relation to the management of a complaint and can be contacted by the following means:

Your medical defence organisation will also be able to provide you with advice and support.

Scope of this guidance

This guidance is not intended to provide detailed advice in relation to complaints handling, rather it is intended to cover the following matters:

  • How to recognise a vexatious complainant
  • Principles you should apply when managing a vexatious complainant

How to recognise a vexatious complainant

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

The NHS England Complaints Policy does not use the term vexatious but does provide helpful guidance and definitions about persistent and unreasonable contact (which amounts to vexatious behaviour) at Appendix 3 (page 23), which is set out below for ease of reference:

“Definition of persistent and/or unreasonable contact

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

  • Persist in pursuing an issue when the procedures have been fully and properly implemented and exhausted.
  • Do not clearly identify the precise issues that they wish to be investigated, despite reasonable efforts by staff, and where appropriate, the relevant independent advocacy services could assist to help them specify their complaint.
  • Continually make unreasonable or excessive demands in terms of process and fail to accept that these may be unreasonable e.g. insist on responses to complaints being provided more urgently than is reasonable or is recognised practice.
  • Continue to focus 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.
  • Change the substance of a complaint/concern or seek to prolong contact by continually raising further issues in relation to the original contact. Care must be taken not to discard new issues that are significantly different from the original issue. Each issue of concern may need to be addressed separately.
  • Consume a disproportionate amount of time and resources.
  • Threaten or use actual physical violence towards staff.
  • Have harassed or been personally abusive or verbally aggressive on more than one occasion (this may include written abuse e.g. emails).
  • Repeatedly focus on conspiracy theories and/or will not accept documented evidence as being factual.
  • Make excessive telephone calls or send excessive numbers of emails or letters to staff.”

The guidance goes on to highlight that the following matters (inter alia) should be considered before deeming a complainant’s contact to be persistent and/or unreasonable:

  • “You must ensure that the details of the complaint are not lost because of its presentation.
  • You must be confident that the complainant has been kept up to date and that communication has been adequate with the complainant prior to them becoming unreasonable or persistent.
  • You must check that new or significant concerns are not being raised, that require separate consideration
  • You must act with care, fairness, and consideration of the complainant’s circumstances – bearing in mind that physical or mental health conditions may explain difficult behaviour. This should include the impact of bereavement, loss or significant/sudden changes to the complainant’s lifestyle, quality of life or life expectancy.
  • You must consider the proportionality and appropriateness of any proposed action in comparison with the behaviour, and the impact upon staff.”

Principles you should apply when managing a vexatious complainant

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

Example 1 – if a complainant repeatedly raises the same issue, it would be reasonable to direct them back to the previous response(s) and to indicate that you are not going to enter into any ongoing correspondence in relation to this matter, however you must not overlook any new issues that are raised, which should receive a response in accordance with your practice complaints procedure (which as an aside, should be compliant with the NHS Complaints procedure).

Example 2 – if the complainant floods the practice with rude and abusive emails which do include a legitimate complaint, then it is important to respond to the complaint in accordance with your practice complaints procedure but to deal with the rude and abusive nature of the email (ie the behaviour) separately (please refer to the guidance below under the heading In what circumstances would it be appropriate to warn and/or remove a vexatious complainant from the list?).

Strategies that may be useful (depending on the circumstances):

  • It is important that all correspondence is couched 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).
  • It is important to retain all the 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 designating a single point of contact to deal with the ongoing complaint (for example – the practice complaints lead).
  • Support the person who is dealing with the complaint – it can be emotionally draining and time consuming to deal with a vexatious complainant.
  • 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 (especially if the complainant’s ire is directed towards them).
  • Consider defining a clear and defined communication channel for the complainant in order to avoid wider members of the team being unnecessarily troubled by the correspondence.

Reach an agreement with the complainant about how their concerns will be investigated and within what timeframe they should expect to receive a response.

  • Treat each complaint on its merits – serial and/or vexatious complaints may still have legitimate cause for complaint.
  • Suggest that the complainant might want to seek the support of an advocate (for example – via VoiceAbility | 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).
  • 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).When offering a meeting, it is important to consider the following matters:
    • The meeting should be arranged at a mutually agreed time and format (usually it is preferable to meet face-to-face, however there may be reasonable reasons to conduct the meeting virtually).
    • The meeting should be held in protected time for the staff members in attendance.
    • You should consider which staff members should be in attendance and in what capacity they are attending (for example – it would be helpful to have a note-taker present).
    • The complainant should be informed in advance as to who will be in attendance and in what capacity.
    • The complainant should be invited to bring a supporter or advocate should they so wish.
    • The agenda should be agreed with the complainant in advance of the meeting.
    • The time allocated to the meeting should be agreed in advance and the meeting should not be allowed to over-run (unless there are extenuating circumstances).
    • The staff members attending the meeting should have de-briefing time after the meeting.
    • The complainant should be provided with a copy of the meeting notes in draft form and invited to comment on their factual accuracy.
    • It is important that all agreed actions are followed up and that the complainant is kept updated.
    • Depending on the circumstances, it may be helpful to have a follow-up meeting.
  • 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.
  • 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). Furthermore, if you feel that you have taken all reasonable steps to resolve the complaint, it is open to you to suggest to the complainant that the matter should be escalated to the PHSO (and/or the ICO).
  • 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 advice and support.

Londonwide LMCs have produced some detailed guidance in relation to removing patients from the practice list.

If you are contemplating warning or removing a vexatious complainant from the practice list, then please contact the GP Support Team at Londonwide LMCs and/or your medical defence organisation for bespoke advice before doing so.