The referral of National Health Service complaints to the Parliamentary and Health Service Ombudsman occurs when a complainant in the NHS remains unhappy at the conclusion of the initial complaints process, for example, in an NHS trust or general practitioner practice. The level of referrals to the Parliamentary and Health Service Ombudsman will be impacted by a number of factors, including how the complaint is initially handled, or the extent to which NHS organisations highlight the complaints process and the consequent level of awareness amongst potential complainants.