Raising concerns about patient safety
November 2006
1. In our core guidance for doctors, Good Medical Practice we advise that:
- You must protect patients from risk of harm posed by another colleague's conduct, performance or health. 1
- If you have good reason to think that patient safety is or may be seriously compromised by inadequate premises, equipment, or other resources, policies or systems, you should put the matter right if that is possible. In all other cases you should draw the matter to the attention of your employing or contracting body. If they do not take adequate action, you should take independent advice on how to take the matter further. You must record your concerns and the steps you have taken to try to resolve them. 2
2. We also produce guidance for doctors who have a management role. This makes clear that such doctors have a duty to:
- Ensure that reporting procedures are in place and that staff are aware of them. 3
- Respond promptly and professionally to incidents and complaints. 4
3. This supplementary guidance is intended to provide more detail about how to comply with these principles. Th e purpose of this guidance is to help you to raise any concerns you have that patients might be at risk, and to advise on the help and support available to you. Whilst it provides suggestions about what to do and who to approach, it cannot be exhaustive. You will therefore need to use your judgement to apply the principles to your particular circumstances. If you are unsure of how they apply to your situation, then you should seek advice.
Obstacles to reporting
4. You may be reluctant to report concerns for a variety of reasons including, for example because you fear that this may cause problems for colleagues, adversely affect working relationships, have a negative impact on your career or result in a complaint about you. If you are hesitating about reporting a concern for these reasons, you should bear in mind that:
- your duty to put patients' interests first and act to protect them must override personal and professional loyalties
- the Public Interest Disclosure Act 1998 provides legal protection against victimisation or dismissal for individuals who disclose information in order to raise genuine concerns and expose malpractice in the workplace
- you will be able to justify raising a concern – even if it turns out to be groundless – if you have done so honestly, promptly, on the basis of reasonable belief and through appropriate channels.
Routine reporting
5. Early, routine notification of adverse incidents or near misses can allow issues to be addressed, problems rectified and lessons learned without patients coming to any harm. You should familiarise yourself with, and use, the clinical governance and risk management structures and processes within the organisations for which you work or to which you are contracted.
Raising a concern
6. 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 straight away. Do not delay doing so because you yourself are not in a position to put the matter right.
7. Wherever possible, raise your concerns with your manager or an appropriate officer of your employing/contracting body - such as the consultant in charge of the team, the Medical Director or a practice partner - in the first instance. If your concern is about a partner then it may be appropriate in that instance to raise it outside the practice – for example with the Medical Director or Clinical Governance Lead at your Trust or Health Board. If you are a doctor in training then 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. You should follow any procedure where you work for reporting adverse incidents and concerns. 5
8. Be clear, honest and objective about the reason for your concern. Acknowledge any personal grievance that may arise from the situation, but focus on the issue of patient safety.
9. Keep a record of your concerns and any steps that you have taken to resolve them.
10. You should contact an external body with authority to investigate the issue (such as those listed at the end of this guidance) 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 there is an immediate risk to patients from a colleague and an external body needs to be alerted straight away (though in such cases you should also, at the same time or immediately afterwards, make the employing/contracting body aware of your concerns and the action you have taken)
- if you have raised your concern through local channels but are not satisfied that the responsible person or body has taken adequate action.
Making a concern public
- have done all you can to resolve your concerns by raising them within the organisation in which you work/to which you are contracted, or with the appropriate external body; and
- have good grounds to believe that patients are still at risk of harm
you may consider making your concerns public, provided that patient confidentiality is not breached. You should consult a defence body or professional association before making a decision of this kind.
Help and advice
12. If you are unsure whether, or how, to raise your concern, you should seek advice from:
- a senior member of staff or other impartial colleague
- your medical defence body or a professional association such as the BMA
- the GMC (or, if your concern relates to a colleague in another profession, the appropriate regulatory body)
- Public Concern at Work – a non-statutory, charity which provides free, confidential legal advice to people concerned about wrongdoing at work who are not sure whether or how to raise their concern.
Useful contacts
Advice and help
British Medical Association
BMA House 020 7387 4499
Tavistock Square www.bma.org.uk
London WC1H 9JP
Medical and Dental Defence
Union of Scotland
Mackintosh House
120 Blythswood Street 0141 221 5858
Glasgow G2 4EA www.mddus.co.uk
Medical Defence Union Limited
230 Blackfriars Road 020 7202 1500
London SE1 8PJ www.the-mdu.com
Medical Protection Society
33 Cavendish Square 020 7637 0541
London W1G 0PS www.mps.org.uk
Public Concern at Work 020 7404 6609
Suite 301 helpline@pcaw.co.uk
16 Baldwins Gardens www.pcaw.co.uk
London EC1N 7RJ
Regulatory/investigatory bodies
General Dental Council 020 7887 3800
37 Wimpole Street www.gdc-uk.org
London W1G 8DQ
General Medical Council 0845 357 8001
St James Buildings www.gmc-uk.org
79 Oxford Street
Manchester M1 6FQ
Healthcare Commission 020 7448 9200
Finsbury Tower www.healthcarecommission.org.uk
103 – 105 Bunhill Row
London EC1Y 8TG
Health Professions Council 020 7582 0866
Park House www.hpc-uk.org
184 Kennington Park Road
London SE11 4BU
National Patient Safety Agency 020 7927 9500
4-8 Maple Street www.npsa.nhs.uk
London W1T 5HD
Nursing and Midwifery Council 020 7637 7181
23 Portland Place www.nmc-uk.org
London W1B 1PZ
Royal Pharmaceutical Society 020 7735 9141
for Great Britain www.rpsgb.org
1 Lambeth High Street
London SE1 7JN
1 Good Medical Practice (2006), paragraph 43
2 Good Medical Practice (2006), paragraph 6
3 Management for Doctors (2006), paragraph 15
4 Management for Doctors (2006), paragraphs 44 and 45
5 Health Service Circular 1999/198 states that every NHS Trust and Health Authority should have in place policies and procedures which comply with the Public Interest Disclosure Act, and as a minimum, include:
- Guidance to help staff who have concerns about malpractice raise these reasonably and responsibly with the right parties
- The designation of a senior manager or non-executive director with specific responsibility for addressing concerns which need to be handled outside the usual management chain
- A clear commitment that staff concerns will be taken seriously and investigated
An unequivocal guarantee that staff who raise concerns responsibly and reasonably will be protected against victimisation.