A complaint or significant event can feel worrying, particularly when you are preparing for appraisal. In most cases, however, this part of the appraisal is straightforward: explain what happened, show that you have thought about it, and have a sensible discussion with your appraiser.
The quick answer
You do not need to list every difficult case, unhappy patient or piece of informal feedback. What matters is whether a complaint has been formally raised about you, or a significant event involving your care or team has been identified, whether by you or someone else. Formal complaints, ongoing investigations and important safety concerns should not be left out simply because you disagree with them.
If you are unsure, ask your employer or appraiser. It is generally better to explain a genuine uncertainty than to omit a formal concern that later comes to light.
What counts — and what usually does not?
A useful rule of thumb: formal notification, often in writing, is a strong sign that the matter belongs in your appraisal. But it is a guide, not a loophole: a serious safety or professionalism concern should be addressed even if the paperwork has not yet arrived.
- A patient says they are unhappy during a consultation
- An everyday expression of dissatisfaction is not automatically a formal complaint. You can still learn from it.
- A consultant takes you aside to give advice after a small mistake
- Usually routine feedback, rather than a formal complaint or significant event. Check if a formal process has been opened.
- You are notified of a written complaint involving your care
- Include it, explain the outcome if known, and add a brief reflection.
- You are told a Datix/incident review identifies a significant event involving you
- Discuss the event and your involvement; include relevant correspondence or outcomes where appropriate.
- You provide a statement for the Coroner
- Not automatically a significant event. Check whether a separate formal safety concern or investigation has been raised.
- A formal investigation is still under way
- Disclose it factually, state that the outcome is pending, and avoid guessing what the conclusion will be.
Complaints are not all the same
Patients can be dissatisfied for many reasons, including waiting times, access to services or communication problems beyond one doctor’s control. A complaint about a system issue is not necessarily a complaint against every clinician involved in the patient’s care. What you should consider is whether your own decisions, care or conduct are part of the concern.
Some specialties — including emergency medicine, general practice and maternity care — deal with complaints more often because of the nature of their work. Having a complaint does not, by itself, suggest that a doctor is unsafe or unprofessional.
What is a significant event?
The GMC describes a significant event as an unexpected or unintended incident that caused, or could have caused, harm to a patient. Declare and reflect on every such event you were involved in since your last appraisal, including involvement as part of the treating team. You do not need to wait for written notification.
In practice, a significant event is often identified through an incident-reporting or clinical governance process, with a senior clinician or investigating team explaining what has been raised. Not every adverse outcome is a significant event attributable to the doctors involved.
For example, a patient might be discharged from the emergency department and sadly die later. A Coroner’s investigation could follow without there being a finding that the discharge was unsafe. The serious outcome alone does not settle the question. What matters is whether a patient-safety concern has been identified and how it relates to your care.
What should I upload?
Keep it simple. Where available, provide the complaint or incident notification, any outcome or investigation summary, and your own short reflection. Remove patient-identifiable details. If you have no complaints or significant events to declare, say so; you do not need to invent evidence.
You do not need a long report. A couple of thoughtful paragraphs are often enough for an ordinary complaint, although a serious or complex event may need more discussion.
What does a good reflection look like?
A useful reflection answers four plain questions: What happened? Why might the concern have arisen? Is there anything I could reasonably have done differently? What, if anything, will I do next time?
The important thing is insight, not an automatic admission of fault. You can thoughtfully conclude that your clinical decisions were appropriate and still recognise why someone was upset, or identify a system change that would have helped. Try to avoid a defensive response that simply dismisses the patient or colleagues.
Worked example 1: Significant event — recognising deterioration
A patient under my team’s care deteriorated overnight and needed transfer to intensive care. The formal review found that recognition and escalation had been delayed.
I was not present when the patient deteriorated, but I had contributed to the earlier plan. Looking back, I could have been clearer about what staff should do if the patient became unwell. I have thought about how difficult it can be for an out-of-hours team when the escalation plan is vague.
I now make an effort to record escalation triggers, ceilings of care and who to contact. That should make the plan easier for the wider team to follow.
Worked example 2: Complaint — explaining a treatment plan
A patient made a written complaint because they left a consultation unsure about their treatment and what would happen next.
I still think the treatment decision was reasonable, but I can see why the patient was frustrated. I may have explained too much too quickly and did not check their understanding at the end.
I now summarise the plan in plain language and give patients a chance to ask questions before they leave.
Worked example 3: No individual error identified
A patient complained about a long wait in the emergency department. I reviewed my own involvement and think the clinical management was appropriate. I understand why the experience was frustrating, particularly because communication about the delay could have been better. I have considered my own communication, and I think clearer updates from the department would help patients in similar situations. I have not identified a change needed in my clinical decision-making.
it engages with the concern without pretending there was a mistake when there may not have been one.
What if the investigation has not finished?
Say what is known, who is reviewing it, and that the outcome is pending. You are not expected to prejudge an investigation. If a concern is serious, it should also be handled promptly through the relevant employer, governance or Responsible Officer arrangements; the annual appraisal should not be the first time an urgent safety issue is raised.
Will my appraiser report it to the Responsible Officer?
Appraisal is intended to be a supportive conversation. For the great majority of ordinary complaints and significant events, the discussion focuses on understanding what happened and what has been learned. Declaring a complaint does not automatically trigger escalation.
There are exceptions. Serious or repeated unsafe practice, dishonesty, major professional misconduct or an immediate risk to patients may need to be considered outside appraisal through the appropriate governance route. Appraisal is not a substitute for an investigation or a promise of confidentiality in every circumstance.
Common mistakes
- Treating every verbal concern or informal learning conversation as a formal complaint.
- Assuming that a Coroner’s statement automatically means a significant event occurred.
- Failing to mention a formal complaint because you believe it is unfair or unresolved.
- Uploading documents but giving no reflection on your own involvement.
- Writing pages of background without explaining what you have learned.
- Being defensive, or claiming you will radically change practice when no such change is justified.
Before your appraisal
If something is bothering you, contact your appraiser in advance. I am happy to discuss concerns by WhatsApp or phone before your meeting and offer a preliminary view about how I would approach them. A short conversation often helps you decide what evidence and reflection to prepare. This is informal guidance, not a replacement for any required employer or regulatory disclosure.
The key message: do not be frightened of declaring something relevant. In most cases it is discussed at appraisal, you agree any useful learning, and you move on.