Raising and acting on concerns about patient safety

Question 1

Duty to raise concerns

Answer 1

1. All doctors have duty to raise concerns where they believe that patient safety or care is being compromised by practice of colleagues or systems, policies and procedures; must also encourage and support a culture in which staff can raise concerns openly and safely.
2. You must not enter into contracts or agreements with your employing or contracting body that seek to prevent you from or restrict you in raising concerns about patient safety.

Question 2

Overcoming obstacles to reporting

Answer 2

1. You may be reluctant to report a concern for a number of reasons
   
   • because you fear that nothing will be done or
   • that raising your concern may cause problems for colleagues;
   • have a negative effect on working relationships; have a negative effect on your career;
   • or result in a complaint about you
2. If you are hesitating about reporting a concern for these reasons, you should bear the following in mind.
   
   • You have a duty to put patients’ interests first and act to protect them, which overrides personal and professional loyalties
   • The law provides legal protection against victimisation or dismissal for individuals who reveal information to raise genuine concerns and expose malpractice in the workplace
   • You do not need to wait for proof – you will be able to justify raising a concern if you do so honestly, on the basis of reasonable belief and through appropriate channels, even if you are mistaken

Question 3

Steps to raise concerns

Answer 3

1. You must follow the procedure where you work for reporting adverse incidents and near misses
2. If you have reason to believe that patients are, or may be, at risk of death or serious harm for any reason, you should report your concern to the appropriate person or organisation immediately. Do not delay doing so because you yourself are not in a position to put the matter right.
3. Wherever possible, you should first raise your concern with your manager or an appropriate officer of the organisation you have a contract with or which employs you – such as the consultant in charge of the team, the clinical or medical director or a practice partner. If your concern is about a partner, it may be appropriate to raise it outside the practice – for example, with the medical director or clinical governance lead responsible for your organisation. If you are a doctor in training, it may be appropriate to raise your concerns with a named person in the deanery – for example, the postgraduate dean or director of postgraduate general practice education.
4. You must be clear, honest and objective about the reason for your concern. You should acknowledge any personal grievance that may arise from the situation, but focus on the issue of patient safety.
5. You should also keep a record of your concern and any steps that you have taken to deal with it.

Raising a concern with a regulator

1. You should contact a regulatory body such as the GMC or another body with authority to investigate the issue in the following circumstances.
   
   • If you cannot raise the issue with the responsible person or body locally because you believe them to be part of the problem.
   • If you have raised your concern through local channels but are not satisfied that the responsible person or body has taken adequate action.
   • If there is an immediate serious risk to patients, and a regulator or other external body has responsibility to act or intervene.

Making a concern public

1. You can consider making your concerns public if you:
   
   • have done all you can to deal with any concern by raising it within the organisation in which you work or which you have a contract with, or with the appropriate external body, and
   • have good reason to believe that patients are still at risk of harm, and
   • do not breach patient confidentiality.

But, you should get advice before making a decision of this kind.

Help and advice

1. If you are not sure whether, or how, to raise your concern, you should get advice from:
   
   • a senior member of staff or other impartial colleague
   • GMC’s Confidential Helpline
   • your medical defence body, your royal college or a professional association
   • the appropriate regulatory body if your concern relates to systems or organisations rather than individuals
   • Public Concern at Work – a charity which provides free, confidential legal advice to people who are concerned about wrongdoing at work and are not sure whether, or how, to raise their conce

Question 4

Acting on a concern

Answer 4

All doctors

1. All doctors have a responsibility to encourage and support a culture in which staff can raise concerns openly and safely.
2. Concerns about patient safety can come from a number of sources, such as patients’ complaints, colleagues’ concerns, critical incident reports and clinical audit. Concerns may be about inadequate premises, equipment, other resources, policies or systems, or the conduct, health or performance of staff or multidisciplinary teams.
   
   • If you receive this information, you have a responsibility to act on it promptly and professionally.
   • You can do this by putting the matter right (if that is possible), investigating and dealing with the concern locally, or referring serious or repeated incidents or complaints to senior management or the relevant regulatory authority.

Doctors with extra responsibilities

1. If you are responsible for clinical governance or have wider management responsibilities in your organisation, you have a duty to help people report their concerns and to enable people to act on concerns that are raised with them.
2. If you have a management role or responsibility, you must make sure that:
   
   • there are systems and policies in place to allow concerns to be raised and investigated
   • you do not try to prevent employees or former employees raising concerns about patient safety
   • clinical staff understand their duty to be open and honest about incidents or complaints with both patients and managers
   • all other staff are encouraged to raise concerns they may have about the safety of patients, including any risks that may be posed by colleagues or teams
   • staff who raise a concern are protected from unfair criticism or action, including any detriment or dismissal.