Cut down on complaints by managing expectations

Sally Taber

The Independent Sector Complaints Adjudication Service continues to see an increase in consultant complaints. Its director Sally Taber sets out what it is doing to try and reverse the trend.

Some three years ago, Indepen­dent Practitioner Today published an article alerting readers that, of all complaints coming to Indepen­dent Sector Complaints Adjud­ication Service (ISCAS), the highest number were about consultants and medical care.  

ISCAS, responding to consultants’ need for guidance, analysed information from decided adjudications into seven sections broken down under the headings of: 

  • Consent; 
  • Managing expectations;
  • Information and advice about procedures;
  • Record-keeping and documentation; 
  • Communication; 
  • Apologies; 
  • Information about fees.  

It then communicated to all its subscribers with suggestions for how their consultants could better relate to patients.

Now, latest data to the end of August 2023 shows that the same problems are still recurring and the number of complaints directed towards consultants is not diminishing.  

Independent Practitioner Today is, naturally, asking what subscribers are doing to oversee their consultants’ interaction with patients to reduce this unsatisfactory record.

Two causes are thought to underly the problem: 

1Unrealistic expectations as to outcomes on the part of patients: patients thinking that if they pay, it will always work.  Forty-eight per cent of such complaints were not upheld; some more were only partially upheld.  

The learning is that, in what may be intense and fast-changing circumstances for the patient, they must be given the best possible prediction of expected outcomes, and this must be recorded.

2Consultants’ sometimes poor administration of their interface with patients has been further highlighted.  

An example of poor practice was consultants not following consultations with a clinical letter, which is required in regulations and a breach of which should raise consequences for continued practising privileges.


In order to help improve the understanding and guidance to consultants, ISCAS highlights these requirements:

Provide patients with written information about the amount being charged, the associated method of payment prior to outpatient consultations and the commencement of the services. 

Be transparent about the costs of any proposed care or treatment. 

Explain to patients the reason for any proposed tests or investigations and provide details of any associated costs prior to them being carried out. 

Advise patients to check the terms of any insurance policies, where relevant, to enable them to determine their level of cover regarding any proposed tests investigations or procedures;

Where alternative treatments are available but the appropriate treatment can only be identified during surgery, consultants should provide a written estimate of costs testing out relevant options and associated fees.

ISCAS now invites providers to review how they highlight the learnings to all clinicians and their administrative staff and so help to improve patient satisfaction with their treatment.

To assist with this, we recently prepared four training videos which are relevant and available to both clinicians and their supporting administrative staff. 

These are:

  • General Complaint Handling Principles Under the ISCAS Code;
  • Stage 1: Managing Complaints Under the ISCAS Code;
  • Stage 2: Managing Complaints Under the ISCAS Code;
  • Stage 3: Managing Complaints Under the ISCAS Code.

The series is available from the ISCAS website. 

The ISCAS Code for Complaints Management, January 2022, covers complaints about doctors and other healthcare professional staff working in subscribing organisations, even if not directly employed by the organisation but have been provided with practising privileges.

As previously stated, issues identified in complaints about consultants, doctors or medical care include consent, managing expectations, information and advice about procedures, record-keeping and documentation, communication and apologies. 

The ISCAS Advisory Board will continue to discuss these issues, with the subscribers’ complaints lead personnel present. The board also always has an adjudicator present to further expand on these issues.

See ISCAS videos at 

See ISCAS Code at