Complaints

3.1 Visibility

Information on how to make a complaint is available on the RACGP website.

3.2 Accessibility

This Complaints Policy and associated procedures are is easily accessible, simple to understand and well published to ensure ease of implementation. Selected Staff of the RACGP have been trained to receive and deal with complaints.

3.3 Responsiveness

Each complaint received is assigned a case number using the case management system and the case number is provided to the complainant. Expectations of complaint resolution timelines are provided to the complainant at the time the complaint is acknowledged and recorded.

3.4 Objectivity and No Detriment

Each complaint will be handled in an objective and impartial manner.

All parties will be afforded natural justice and procedural fairness in the handling of complaints by the RACGP including:

• ensuring all parties to the complaint know what to expect during the complaint handling process;
• carrying out the complaint handling process in a transparent but confidential manner;
• providing all parties with equal opportunity to participate in the process;
• treating all parties in a respectful manner; and
• providing reasons for decisions made.

Complainants will be treated respectfully and will not be disadvantaged or suffer detriment through lodging a complaint in good faith, regardless of the outcome. The RACGP will not tolerate reprisals against complainants.

Reprisals will be met against perpetrators with appropriate action under the relevant Code of Conduct (Staff and Member) or referral to an external investigative agency such as the police where applicable (the general public).

Complainants and respondents will be entitled to be assisted by a support person who may be a member of the person’s family, carer or other person.

Staff members involved in the handling of a complaint, investigation or adjudicating on a complaint, must not act in any complaint in which they have a conflict of interest. The RACGP is committed to managing complaints promptly, fairly, confidentially, impartially and with a view to ensuring the safety and wellbeing of all parties.

3.5 Confidentiality and Anonymity

The privacy and confidentiality of parties will be respected to the extent practicable and appropriate. Accurate records will be kept by each staff member dealing with the complaint. A complainant has the option of making a complaint anonymously. Where an anonymous complaint is received, the complainant’s anonymity will be preserved insofar as is possible. The RACGP may however be unable to act or report on a complaint where the complainant is anonymous.

3.6 Accountability

Accountability for receiving complaints resides with the Executive Team Member allocated the complaint and the Responsible Officer or Appeal Officer allocated the complaint by that Executive Team Member.

3.7 Capacity

Complaints will be handled in a timely manner, taking into account the complexity and seriousness of issues raised, to ensure all parties have access to an appropriate resolution and opportunities for further concerns to arise are minimised.

3.8 Authority

The Executive Team Member to whom a complaint is allocated will ensure Staff involved in handling complaints have the necessary authority and management support to carry out the process effectively, make decisions and have (where specific skills are required, such as mediation) access to appropriate training and resources to fulfil their role.

3.9 Outcomes

All members and staff of the RACGP will be supported in trying to resolve complaints where appropriate to promote and support timely and efficient complaints handling.

The operation of the complaints handling process and findings will be reported to Executive Team and to the Board. Preventative and corrective action can be taken to address the causes of complaints and to improve the quality of the RACGP’s policies and services.

4.1 What is a complaint?

A complaint is an expression of concern, dissatisfaction, or frustration that considers the quality or delivery of service, the need to reconsider a decision, a policy or procedure, or where the conduct of another person is unsatisfactory or unacceptable.

A complaint might include a:

• request to replace faulty goods;
• case where incorrect advice has been provided;
• situation where an incorrect policy has been applied; or
• concern about the time taken to provide a good or service.

A complaint is not:

• a request for information;
• a compliment or expression of satisfaction;
• an explanation of a decision or policy; or
• a request for a refund.

4.2 Receipt of a Complaint

All complaints must be made via the complaints form on the RACGP website. Phone complaints must be redirected to the complaints form on the RACGP website.

A complaint may be made anonymously. Anonymous complaints will be treated in the same way as identified complaints and follow the same process subject to any necessary modifications resulting from the anonymous nature of the complaint. For example, it may not be possible to notify the complainant of progress if no contact details have been provided. In some cases, it may not be practical to investigate the complaint if vital additional information cannot be obtained because the complainant cannot be contacted.

Members and Staff of the RACGP should always be treated with respect and courtesy when handling complaints.

Where a person involved in a complaint behaves in a threatening, rude, or harassing manner toward Staff, the RACGP may decline to further consider the complaint. The RACGP reserves the right to take appropriate action against any complainant that engages in threatening, rude, or harassing manner toward Staff under applicable codes or policies of the RACGP or refer the matter to an external agency such as the Police.

Where the Complaints Manager is the subject of the complaint, the complaint is to be allocated to the relevant Executive Team Member. The Executive Team Member must then proceed according to this policy.

Complaints:

• in writing are to be forwarded by the recipient to the Complaints Manager. This includes any complaints directed to the CEO or Executive Team members or any complaints received at a Staff RACGP email address;
• made directly to any Board member by email or other means are to be forwarded to the Company Secretary who will forward them to the Complaints Manager;
• by phone are to be transcribed into the form.

All complaints, upon receipt, are to be logged by the initial recipient in the case management system.

4.3 Refusal of Complaints

The Complaints Manager may reasonably refuse a complaint where, in their opinion:

• a person involved in a complaint behaves in a threatening, rude, or harassing manner toward Staff;
• the complaint is false, frivolous, vexatious or lacking in substance;
• is outside the jurisdiction of this Policy under clause 2;
• the complaint is malicious or not made in good faith;
• a significant period of time has elapsed since the conduct in question has taken place such that any complaint would be futile;
• the complaint is substantially the same as a previous complaint between the parties which has already been the subject of a determination under a proceeding;
• in the case of an anonymous complaint, it is not possible to obtain information from the complainant to properly determine whether the complaint is likely to be substantiated or not;
• the complaint is the subject of existing legal proceedings or other forms of review or appeal;
• in the case of a GP training activity, a dispute resolution process under another policy has not been utilized or finalized; or
• the complainant does not have a sufficient interest in the matter.

The Complaints Manager may refuse an appeal which:

• is lodged later than 14 calendar days after the complainant being notified of the decision in the original complaint;
• does not fall within the grounds for an appeal as described in clause 4.8 (e.g. is an appeal on the merits); or
• has no or little new information upon which to base an appeal.

The Complaints Manager may split or limit a complaint to particular issues to avoid refusing the complaint.

Where the Complaints Manager proposes to split or limit a complaint, the Complaints Manager may discuss the proposal with the complainant to reach an alternative arrangement. If the complainant refuses to accept the Complaints Manager’s proposal or an alternative arrangement cannot be reached, then the Complaints Manager may still refuse the complaint.

4.4 Redirection of a Complaint

The Complaints Manager may at any time decide a complaint is better dealt with under an alternative policy.

For example, a complaint may be made which the Complaints Manager identifies as a complaint which qualifies as a protected disclosure under the Whistleblower Policy. The Complaints Manager then refers the complaint to the Whistleblower Officer under the Whistleblower Policy.

The Complaints Manager may direct any person dealing with a complaint to:

• continue dealing with the complaint under a different policy specified by the Complaints Manager;
• cease dealing with the complaint and forward all documentation back to the Complaints Manager; or
• cease dealing with the complaint and reallocate the complaint under a different policy specified by the Complaints Manager to the most appropriate person.

Where the Complaints Manager redirects a complaint, all relevant information will be transferred to the staff member to whom the complaint has been redirected.

In some instances, following discussion with General Counsel and Executive, the RACGP may refer the complaint directly to an external investigatory body such as Victoria Police, WorkSafe or other agency.

4.5 Withdrawal of a Complaint

A complainant may withdraw a complaint at any time by notifying the RACGP in writing. The withdrawal of a complaint does not prevent the RACGP from continuing to investigate or otherwise act on the complaint.

4.6 Complaint Process

The Complaints Manager may allocate any complaint to the most appropriate Executive Team Member unless the complaint is about an Executive Team Member. The Executive Team Member may delegate the complaint to the most appropriate officer (the Responsible Officer).

The Executive Team Member to whom a complaint has been allocated must not delegate the complaint to any officer who is the subject of the complaint.

If an Executive Team Member is the subject of a complaint, the Complaints Manager must allocate the complaint to the CEO who becomes the Responsible Officer.

Within ten business days from the acknowledgment of the receipt of the complaint, the Responsible Officer must:

• review the complaint documentation;
• seek any additional information from the complainant within a specified time;
• provide both parties with the opportunity to make submissions regarding the complaint within a specified time;
• discuss the complaint with both parties if necessary;
• seek to mediate or determine the complaint as necessary; and
• otherwise investigate the complaint as they see fit.

If a complainant fails to respond to a request for information within the time specified by the Responsible Officer, the Responsible Officer may continue to determine the complaint on the available evidence.

Having considered all the evidence, the Responsible Officer must decide whether the complaint is substantiated, partially substantiated or not substantiated.

The Responsible Officer must make a recommendation to the allocated Executive Team Member as to the outcome of the complaint, detailing the results of the investigation, their rationale for the decision along with any proposed actions.

The Responsible Officer must notify the parties of their decision once the Executive Team Member has been advised of the outcome of the investigation. The Responsible Officer must provide the parties with basic reasons for the decision reached.

The Responsible Officer is responsible for ensuring implementation of the outcome of the investigation within a reasonable time.

Board members must not become involved in the complaints process at any point as this represents a legal risk to the organisation and is inconsistent with good independent decision making and the international standard on complaints handling upon which this policy is based (ISO 10002: 2018).

4.7 Possible outcomes

Outcomes from complaints may include:

• written or verbal partial or full apologies;
• monetary compensation or refund;
• provision of documents;
• reprovision of a service or good at no or discounted charge;
• commitment to change procedures or processes in response to the complaint;
• commitment to refer a matter to an external agency; or
• any other appropriate action.

4.8 Appeals Process

A complainant may appeal the results of a decision or an investigation by submitting a fresh complaint using the means described in clause 4.2 referring to the same identifier as the original complaint and outlining the grounds for appeal. The appeal is to follow the process in clause 4.2.

An appeal must be made within five business days of the complainant being notified of the decision in the original complaint.

Appeals cannot be made on the merits of the decision. An appeal can only be made on the basis that the original complaints handling process was flawed in some way.

There is no charge for appeals unless specified in Appendix 2. Appendix 2 lists appeals against decisions which attract a fee.

Once an appeal is received by the Complaints Manager, the Complaints Manager may refuse, redirect or split the appeal in accordance with clauses 4.3 and 4.4.

The Complaints Manager must:

• allocate the appeal to an Executive Team Member other than the Executive Team Member whose business unit was allocated the original complaint; and
• notify the Responsible Officer for the original complaint an appeal has been received.

Upon receipt of an appeal, a Responsible Officer who is implementing an outcome from the decision on the original complaint must suspend any action to implement that outcome.

The Executive Team Member must:

• not allocate the appeal to the Responsible Officer who dealt with the initial complaint;
• allocate the appeal to an appropriate officer (the Appeal Officer) who is more senior than the Responsible Officer who dealt with the original complaint; and
• if the only officer more senior than the Responsible Officer is the Executive Team Member themselves, then the Executive Team Member must act as the Appeal Officer.

Within ten business days from the receipt of the appeal, the Appeal Officer must:

• consider all the information from the original complaint investigation;
• consider the new or additional information provided with the appeal; and
• otherwise investigate the appeal as they see fit.

Having considered all the evidence, the Appeal Officer must decide whether the appeal is substantiated, partially substantiated or not substantiated.

The Appeal Officer must make a recommendation to the Executive Team member detailing the results of the investigation along with any proposed sanctions or other outcome.

The Appeal Officer must notify the parties of their decision once the Executive Team Member has been advised of the outcome of the investigation.

The Responsible Officer remains responsible for ensuring implementation of the outcome of the investigation within a reasonable time.

4.9 Appeals Principles

The appeal process must adhere to the following principles:

• Decision makers must:
  • ensure an appellant has an adequate opportunity to put their case;
  • ensure the appeal is not being decided by the person who made the original decision;
  • have no conflict of interest in the subject of the appeal;
  • hear the appeal in an expedient manner;
  • ensure all relevant information is considered in making a decision; and
  • make decisions in writing, which are appropriately recorded and communicated to appellants within a reasonable time of determination.
• Appellants must:
  • only bring appeals when other avenues for dispute resolution have been exhausted;
  • not bring appeals which are false, frivolous, vexatious or lacking in substance;
  • provide information requested for by an appeal panel; and
  • not seek to obstruct or otherwise abuse the appeals process.

4.10 Further Appeals

There are no further appeals. Any decision on an appeal is final.

4.11 Record keeping

The Responsible Officer and Appeal Officer must log all relevant details of the complaint and appeal in the case management system including as a minimum:

• how and when the complaint or appeal was received;
• a description of the complaint or appeal and supporting information;
• the RACGP service being complained about or decision being appealed;
• any immediate action taken;
• dates of decisions including notification to relevant Executive Team members and parties to the complaint or appeal, and date of completion of investigation activities;
• records of outcomes;
• names and contact details of complainants and where possible, persons the subject of the complaint;
• the outcome (if any) sought by the complainant; and
• any other relevant information.

5.1 Reports

The Compliance Manager must compile a report quarterly which contains:

• the total number of cases and appeals logged year to date and the number logged on a monthly basis;
• the time taken to resolve complaints and appeals which have been finalised in the last 12 months on a rolling basis, including the average time;
• the number of open cases and appeals at the current time;
• the numbers of complaints and appeals refused;
• sufficient details of any individual complaints (excluding whistleblower disclosures) which in the opinion of the Complaints Manager expose the RACGP to a significant risk;
• the length of time elapsed on current open cases and appeals;
• the number and type of complaints referred to external agencies, and what agencies received referrals;
• the number of open cases and appeals per member;
• any other data which the Complaints Manager believes would inform the Executive Team; and
• any data specifically requested by any member.

The Report is to be provided quarterly to the Executive Team and escalated as appropriate to the Board.

5.2 Monitoring

The Complaints Manager must monitor the progress of investigations and maintain the data relating to complaints. Responsibility for progress and finalisation for complaints lies with the Executive Team member to whom the complaint has been allocated. The Complaints Manager will however monitor progress on complaints and may raise specific issues regarding individual complaints with relevant Executive Team Members. As a general guide, the Complaints Manager will:

• for complaints older than ten business days, perform follow-up action; such as status/progress checking with the Responsible Officer the complaint was referred to;
• for complaints older than 15 business days, report and escalate the status/progress check to the Responsible Officer’s Executive Team Member; and
• for complaints older than 20 business days, report and escalate the status/progress check to the CEO.

The target for resolution of all complaints is 30 business days.

An overview of the complaints process and its relation to ISO 10002:2018 is found in Appendix 1.

The Chief Member Experience Officer may, without the consent of the RACGP Board, make Minor, Moderate and Consequential Amendments to this policy at any time.

If the Chief Member Experience Officer makes amendments, they must advise the RACGP Board of those amendments as soon as practicable.

The CEO may make amendments to this policy at any time.