NHS complaints process: step-by-step guide

The NHS complaints process is there for concerns that cannot be fixed by a normal conversation, but it works best when you are clear, specific and realistic about the outcome you want. In England, you usually complain to either the NHS provider or the commissioner, not both, and you escalate to the Parliamentary and Health Service Ombudsman only after the local process has finished. If care is unsafe right now, deal with the urgent clinical problem first, then complain once the immediate risk is contained.¹

The NHS complaints route in England

The formal NHS complaints process in England usually has two stages. First, local resolution: the organisation involved investigates and responds. Second, if local resolution does not answer the complaint properly, you can take the case to the Parliamentary and Health Service Ombudsman, often shortened to PHSO.³

NHS England explains that complaints can be made to the service provider, such as a hospital, GP practice, dentist, optician or pharmacy, or to the commissioner of the service. You should not usually complain to both about the same issue because only one organisation should handle the formal complaint.¹

For primary care services such as GP practices, dentists, pharmacies and opticians, the correct route may be the provider or the relevant integrated care board. In practice, if you are unsure where to send the complaint, ask the provider or local integrated care board which route is correct before submitting it.¹

Before you make a formal complaint

First decide whether you need urgent care, quick problem-solving or a formal investigation. If symptoms are worsening, treatment is missing, discharge is unsafe, or a medication error is active, escalate clinically first. That may mean the ward team, consultant secretary, GP, NHS 111, emergency department or 999 depending on risk.

For non-urgent problems inside a hospital, Patient Advice and Liaison Service, or PALS, can often help with communication, appointments, lost property, practical concerns and advice on how to complain.² PALS is not a substitute for a formal investigation where harm occurred, but it can sometimes unblock a problem before it becomes bigger.

Before writing, gather the basics: names if known, dates, appointment times, ward or clinic, NHS number, copies of letters, screenshots of appointment messages, medicine labels, photos where relevant, and a short account of impact. Avoid sending a huge folder at the start. Lead with the most important facts, then say you can provide supporting documents if needed.

Check timing as well. NHS complaints should normally be made within 12 months of the event or within 12 months of becoming aware that you had something to complain about, although organisations can still consider complaints outside that period if there is a good reason and investigation remains possible.¹

How to write the complaint

Use a simple structure. Start with one sentence saying that this is a formal NHS complaint. Identify the patient, the service, the relevant dates and your relationship to the patient if you are complaining for someone else. If you need consent or authority to act, ask what the organisation requires.

Then set out the issue in numbered points. Each point should be a specific allegation or concern, not a general feeling. For example: "The discharge letter said medication X was stopped, but the ward supply and verbal advice said to continue it", or "The urgent referral was discussed on 3 March 2026, but the receiving clinic confirmed on 2 April 2026 that no referral had arrived."

After the facts, explain the impact. This might be avoidable pain, anxiety, delayed diagnosis, missed work, extra costs, worsening symptoms, loss of trust, safeguarding risk, or the need to seek private care. Then state the outcome you want. Reasonable outcomes include an explanation, apology, correction of records, appointment, medication review, referral, learning action, staff training, policy change, or reimbursement of direct costs where appropriate.

Do not threaten legal action in the first paragraph unless that is genuinely the route you are taking. A complaint, a clinical negligence claim, a safeguarding referral, a regulator complaint and a subject access request are different tools. Mixing them together can slow the practical response.

What to expect from the response

The organisation should acknowledge the complaint, explain how it will be handled, investigate and provide a response. The response should address the substance of the complaint, explain what happened, say whether failings were found, apologise where appropriate, and describe learning or actions. NHS England's complaints policy sets out principles for fair handling, including being accessible, responsive and focused on learning.⁵

When the response arrives, check whether it answers each numbered point. It is common for responses to include general statements about pressure on services while missing the specific issue. If an answer is unclear, ask for clarification. If factual errors remain, request correction. If records are wrong, ask how they will be amended or annotated.

Keep a complaint log: date sent, acknowledgement, named handler, promised response date, extensions, final response, and any follow-up. If deadlines slip, chase politely in writing. The log matters if you later go to the ombudsman.

When and how to escalate

Escalation is appropriate when local resolution is complete and the response is inadequate, incomplete, factually wrong, dismissive, or fails to address injustice. PHSO explains that it looks at complaints about NHS organisations in England, but usually expects you to have completed the organisation's complaints process first.³

PHSO guidance on making complaints recommends being clear about what happened, what impact it had, what has been done so far, and what outcome you want.⁴ Send the final response, your original complaint, key evidence, and a short explanation of why the response is not adequate. Do not simply resend the entire history without a summary.

You may also need a different route. The Care Quality Commission can receive information about poor care but does not usually investigate individual complaints. Professional regulators such as the GMC or NMC deal with fitness-to-practise concerns, not ordinary service complaints. Legal advice may be needed if there is possible clinical negligence and significant harm. Advocacy services can help people who struggle to write, communicate or navigate the process.

Healthwatch explains that NHS complaints advocacy can support people with making a complaint, and local Healthwatch can help point people to local services.⁶ This is especially useful if the situation involves disability, language barriers, cognitive difficulties, serious illness, trauma, caring responsibilities or fear of retaliation.

What to ask your GP or the service

Sometimes the best first step is asking the service to identify the correct route. A GP practice may have its own complaints manager. A hospital may direct you to PALS or its formal complaints team. An integrated care board may handle complaints about commissioned services. If you need help organising the issue before writing, Start here.

Use the health library to understand the medical issue behind the complaint, and insights when you need to separate poor communication from clinical uncertainty. If the complaint involves medication, supplements or interactions, the stack builder can help prepare a clearer medication list for review.

The most effective NHS complaints are calm, specific and outcome-focused. You are not trying to write a courtroom speech. You are trying to make the problem investigable, protect current care, and create a written record that can be escalated if the local answer is not good enough.

This article is educational and does not constitute medical advice, diagnosis, or a treatment recommendation. Medication uses described as “off-label” are not licensed for that purpose in the UK and should only be considered under qualified clinical supervision. Always speak to your GP, pharmacist, or a registered specialist before starting, stopping, or changing any treatment. If you have severe or alarm symptoms - unintentional weight loss, blood in your stool, difficulty swallowing, persistent vomiting, a fever, or severe pain - seek urgent medical care.