Side-by-side comparison
| PALS | Formal NHS complaint | |
|---|---|---|
| Legal basis | None — internal service | NHS Complaints Regulations 2009 |
| Applies to | Hospital, mental health, community trusts | GPs, hospitals, dentists, pharmacies, ICBs |
| Acknowledged in | ~3 working days | 3 working days (statutory) |
| Resolved in | 5–30 working days (no deadline) | Up to 6 months, usually 40 working days |
| Written investigation | No | Yes, with a response letter |
| Escalation to PHSO | No (you must complete formal first) | Yes, after Stage 1 response |
| Deadline to raise | None enforced | 12 months from event or from knowing |
When PALS is the right tool
PALS is best when the issue is recent, specific, and likely to be solvable by a phone call to the ward, clinic or department concerned. Examples that PALS handle well:
- A missed or wrong appointment letter, or an appointment lost in the system.
- A communication breakdown between two teams in the same hospital.
- Disrespectful or confusing reception behaviour at an outpatient clinic.
- A simple question that the clinical team haven't answered.
- Wanting an explanation, an apology or a follow-up — not a formal record.
The advantage: speed and low friction. The trade-off: nothing PALS produces is automatically a binding answer, and PALS responses are not enough on their own to take to the Ombudsman.
When you need a formal complaint
Use the formal route when any of these are true:
- The issue involves potential clinical harm (delay in diagnosis, missed referral, medication error).
- You've been dismissed more than once for the same symptom.
- You need a written, dated investigation outcome — for example for an insurer, employer, or for the Ombudsman.
- PALS has already tried and failed.
- The issue is with a GP (PALS can't handle this) — go to the practice manager or your ICB.
A formal complaint triggers an obligation under the NHS Complaints Regulations 2009 to acknowledge within 3 working days and respond in writing, usually within 40 working days, with a Stage 1 outcome letter. That letter is what unlocks PHSO.
Quick decision tree
- Is it about a GP? → Formal complaint to the practice manager or ICB. PALS can't help directly.
- Is it about a hospital visit, and you want a fast informal fix? → PALS.
- Has anyone been (or could be) clinically harmed? → Formal complaint.
- Has PALS already responded and not fixed it? → Convert to formal.
- Do you want the Ombudsman to be an option later? → Formal complaint, in writing, dated.
Escalating beyond both
If the formal Stage 1 response doesn't resolve it, your next step is the Parliamentary and Health Service Ombudsman — see our Ombudsman guide. For ongoing GP dismissal of symptoms, the most effective lever isn't usually a complaint at all — it's a formal, NICE-cited request to investigate, sent in writing so it lands on the medical record. Finally Seen writes that for you for £49.
Frequently asked questions
›Is PALS a complaint?
Technically no. PALS is an informal concern-resolution service. Raising a PALS issue does not trigger an investigation under the NHS Complaints Regulations 2009. A formal complaint does.
›Can I do both?
Yes. You can raise a PALS concern and, if it isn't resolved or your issue is serious, escalate to a formal complaint. Using PALS first does not waste your right to complain formally, and you have 12 months from the event (or from knowing about it) to make a formal complaint.
›Which is faster?
PALS is usually faster — concerns are often resolved within 5–20 working days. Formal complaints can take 40 working days or more, but produce a written investigation outcome.
›Which can lead to compensation?
Neither directly. PALS and the NHS complaints process can produce an apology, explanation and process change, but not compensation. For financial redress you need a clinical negligence claim.
›Does PALS apply to GPs?
No. PALS sits inside hospital and community trusts. For a GP, the formal route is a written complaint to the practice manager (Stage 1) or to your Integrated Care Board (ICB) — see our GP complaints guide.