Health complaints become confusing when the service complaint, professional regulator, safety regulator, data issue and compensation route are treated as one process.
ConsumerWise separates those routes. Start with the service involved, then identify whether you need local resolution, independent review, public-protection action, record correction or legal redress.
Key points
- For the same NHS complaint, choose the provider or commissioner rather than sending it to both.
- The ordinary local complaint limit is normally 12 months from the event or later awareness, with discretion for justified late complaints.
- There is no universal 25-day, 28-day or 60-day final-response deadline.
- PHSO, GMC and CQC perform different jobs.
- Immediate clinical or safeguarding risk comes before complaint correspondence.
Start with the service
Choose the part of the health system involved
Core route
The NHS complaint route in England
| Stage | What it means | Where it can lead |
|---|---|---|
| Immediate resolution | Speak to staff or use PALS where available when the problem needs practical action now. | A formal complaint can still follow if the concern is not resolved. |
| Local resolution | Choose the provider or the commissioner for the same complaint. Set the scope, evidence, questions and requested outcomes. | A reasoned written response, explanation, remedy and service learning. |
| External review | PHSO is the final external complaint route for eligible unresolved NHS complaints in England. | Investigation and recommendations where service failure or maladministration caused injustice. |
| Parallel route | Professional regulation, CQC intelligence, safeguarding, data rights or litigation may run separately. | A different body considers a different risk, right or remedy. |
The local NHS framework is not a universal internal Stage 1 and Stage 2 procedure. It is local resolution followed, where appropriate, by independent PHSO consideration.
Choose by outcome
Complaint, regulator, ombudsman or legal claim?
| What you need | Likely route |
|---|---|
| Explanation, apology, factual investigation or service improvement | Provider or commissioner complaint |
| Independent consideration of an unresolved NHS complaint | PHSO |
| Action about a doctor who may pose a serious ongoing risk | GMC |
| Regulatory intelligence about the quality or safety of a service | CQC |
| Access to records or factual data correction | Provider data-protection route, then ICO where appropriate |
| Damages for avoidable injury | Specialist clinical-negligence advice and the civil claim route |
The legal framework
The 2009 Regulations behind the NHS complaint route
The Regulations are the statutory backbone of the local NHS complaint process in England. The live check below confirms that the mapped official provisions remain available on legislation.gov.uk; it does not decide how a provision applies to disputed facts.
Complaints arrangements
Requires responsible bodies to make arrangements for handling and considering complaints.
Time limit for making a complaint
Sets the ordinary 12-month complaint limit and the discretion to accept a later complaint where the statutory conditions are met.
Procedure before investigation
Covers initial handling, including acknowledgement within three working days and an offer to discuss how the complaint will be handled.
Investigation and response
Requires an appropriate investigation and a written response once the complaint has been considered.
Checking the mapped provisions against legislation.gov.uk
Build the record
Keep the clinical issue and complaint handling separate
A response may reach a defensible clinical conclusion while still mishandling the complaint. It may also handle correspondence politely while failing to investigate the central clinical or administrative issue. Number the underlying care issues separately from delay, missing records, narrowed scope, unanswered questions and inadequate reasons.
- Create a chronology of care, contacts and complaint stages.
- Identify the precise service and organisation responsible for each event.
- Record what evidence supports each issue and what remains missing.
- Separate factual record errors from differences of clinical opinion.
- Ask for a remedy connected to each upheld failing.
Prepare the complaint
Turn what happened into issues that can be investigated
A useful health & nhs complaint is not simply a long account of a distressing experience. It gives the investigating body a controlled set of questions, the evidence needed to answer them and the outcome requested for each one. This helps prevent the response from dealing only with the easiest point.
Start with a short summary stating who received care, the service and location, the period involved, the main alleged failings and the effect on the patient. Follow it with a numbered issue list. Keep the chronology and evidence bundle separate so that the complaint remains readable.
- Define the scope. Identify the provider, service, location, clinicians or teams and the dates covered. Say expressly if other treatment is outside the complaint.
- State each issue. Use one numbered heading for each disputed act, omission or decision. Separate clinical care, communication, access, records and complaint handling.
- Give the factual basis. Link each issue to a dated entry, letter, message, witness account or other record. Where something is an inference, label it as such.
- Ask an answerable question. Ask what happened, what standard or process applied, why a decision was made and what evidence supports the conclusion.
- Request a proportionate outcome. This may include an explanation, correction, apology, review, practical action, learning or a referral to another route.
- Keep urgent care separate. A complaint does not arrange treatment or manage immediate risk. Use the clinical or emergency route needed now while preserving the complaint record.
Evidence
Build a compact health complaint bundle
Medical files can become large very quickly. Sending every record without an index can conceal the important evidence. Keep the original records intact, then create a smaller working bundle containing the material necessary to decide the numbered issues.
| Bundle item | What to record | Why it matters |
|---|---|---|
| One-page case summary | Service, period, central issues, impact and requested outcomes | Lets the investigator understand the case before opening attachments |
| Chronology | Date, event, person or team, source and significance | Shows sequence, delay, escalation and handovers |
| Issue schedule | Issue, evidence, respondent position, unanswered point and remedy | Stops distinct allegations being merged or overlooked |
| Key clinical records | Relevant notes, results, referrals, prescriptions, discharge or care plans | Provides the contemporary record while keeping the bundle proportionate |
| Communications | Letters, portal messages, call notes and appointment information | Tests what each party was told and when |
| Impact evidence | Further care, expense, time, symptoms and practical consequences | Connects the failing to the injustice or remedy claimed |
If a record appears inaccurate, quote the exact entry and explain whether you seek correction of inaccurate personal data, the addition of a patient statement, or an investigation into the underlying care. A difference of clinical opinion is not always a factual data error.
Writing
Ask precise questions and realistic outcomes
A complaint is easier to investigate when each allegation is followed by the question that would resolve it. Avoid asking the recipient to prove that the entire service was lawful or safe. Ask for the policy, clinical reasoning, record or decision relevant to the specific event.
| Weak formulation | Stronger formulation |
|---|---|
| You ignored me and broke NHS rules. | Please explain why the concern recorded on 4 May was not assessed until 9 May, identify the process that applied and address the clinical effect of that delay. |
| The notes are lies. | The entry dated 12 June states that I declined the appointment. I attach the message accepting it. Please investigate the discrepancy and explain how the record will be corrected or annotated. |
| I want everyone disciplined. | Please investigate the identified conduct, explain the findings and state what proportionate action or learning follows. I understand confidential employment action may not be disclosed. |
| Pay compensation immediately. | Please address the evidenced financial loss and avoidable impact, state what local remedy is available and explain any separate legal route that must be used. |
The outcome must fit the body's powers. A provider can explain and improve its service. PHSO can investigate eligible unresolved complaints and make recommendations. A professional regulator protects the public. A court determines a legal claim and damages.
Response audit
Test whether the final response actually resolves the complaint
A long response is not necessarily a complete one. Audit it against the numbered complaint rather than reacting only to its conclusion. Make a table showing whether each issue was upheld, partly upheld, not upheld or not addressed, together with the evidence and reasons relied on.
- Does the response identify the complaint scope and the evidence considered?
- Does it answer every numbered issue and distinguish fact from clinical opinion?
- Where accounts conflict, does it explain which evidence was preferred and why?
- Does it address the impact on the patient, not only whether staff followed a process?
- Are apologies, corrections, reviews and service-learning actions specific and measurable?
- Does it give the correct next route and explain any applicable time limit?
- If the investigation was delayed, were reasons and meaningful updates provided?
If a material issue is missing, identify it by its original number and ask for a focused supplementary response. Do not restart the entire narrative. If local resolution is complete or further correspondence would add nothing, prepare the external referral around the unresolved issues and injustice.
Escalation
Use parallel routes without confusing their jobs
One event may justify more than one route, but that does not turn the bodies into interchangeable appeal stages. Keep a route table showing the question asked of each body, the outcome it can provide, the submission date and the next deadline.
| Route | Use it for | Do not expect it to |
|---|---|---|
| Provider or commissioner | Investigation, explanation, apology, correction, local remedy and learning | Decide a court claim or professional fitness to practise |
| PHSO | Eligible unresolved NHS service failure or maladministration causing injustice | Act as an emergency clinical service or replace legal advice |
| CQC | Information relevant to safety and quality of regulated services | Take most individual complaints forward or award personal compensation |
| Professional regulator | Serious concerns about fitness to practise and public protection | Resolve routine dissatisfaction, waiting times or ordinary refunds |
| ICO or data route | Information rights and compliance with data-protection law | Determine whether clinical treatment was negligent |
| Legal claim | A pleaded cause of action and legally recoverable remedy | Pause merely because a complaint or regulator report is underway |
Tell each body about material parallel proceedings and keep the factual chronology consistent. Do not allow a complaint, PHSO referral or regulatory report to obscure a separate statutory, contractual or court deadline.
Practical questions
Common questions before and after sending
Can someone complain for the patient?
Often yes, with the patient’s authority or another lawful basis. The organisation may need consent or evidence of authority and must still protect confidential information. Different considerations can apply where the patient is a child, lacks capacity or has died.
Must the complaint be made on a special form?
Usually the substance matters more than the format. Use the provider’s published route where practical, keep proof of submission and make clear that the message is a formal complaint under the NHS complaints arrangements where that framework applies.
Can a late complaint still be considered?
The ordinary NHS local complaint limit is 12 months from the event or from later awareness. The responsible body has discretion to consider a later complaint where there was good reason for delay and it remains possible to investigate fairly.
Is there a fixed final-response deadline?
The Regulations require timely and efficient handling but do not impose one universal 25, 28 or 60 working-day deadline for every complaint. The organisation should discuss handling and timescales, keep the complainant informed and explain delay.
Should I name individual staff publicly?
Use names where necessary in the confidential complaint and evidence. Public identification can create privacy, fairness and legal risks, particularly while facts remain disputed. Send relevant information to the body able to investigate it.
What if the patient needs care from the same service?
Say that clearly and ask for communication arrangements, reasonable adjustments or a contact who is separate from the disputed events. A complaint should not be allowed to interrupt clinically necessary care, but an alternative provider cannot always be guaranteed.
Official sources
Check the current rules behind this guide
- NHS England: feedback and complaints about NHS services
- NHS complaints regulations 2009
- PHSO: complaints about the NHS
- GMC: concerns about doctors
- CQC: report a concern
This guide focuses on England. Health complaint structures, regulators and ombudsmen differ elsewhere in the UK. Official contacts, procedures and service responsibilities can change, so check the live source before relying on a deadline or route.