This decision making tool will help you know what to do if you have a concern about patient safety.

Our guidance says that all doctors have a duty to act when they believe patients’ safety is at risk, or that patients’ care or dignity is being compromised.

If you are faced with one of these situations, it’s essential that you know what action to take and feel confident in doing so.

This interactive tool guides you through the decision making process, from incidents you can tackle yourself to challenging situations where you may need to involve a regulator or other external body.

Answer the questions and follow the prompts. You will find case studies at key steps along the pathway to help you think about what to do next and what the outcome might be. We've developed case studies with input from doctors who understand the challenges that you can face when raising concerns about patient safety.

Doctors discussing a patient
A doctor examines an x-ray

Faced with a concern about patient safety, are you yourself in a position to put the matter right?

View case studies below and select an option to continue
Medical staff talking

Take appropriate action and keep a record of your actions. (Raising concerns paragraph 2)

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Doctors in discussion

Should the matter also be dealt with through routine local incident reporting arrangements?

View case studies below and select an option to continue
A doctor

Can the matter be dealt with through routine local incident reporting arrangements?

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Doctors talking

Report your concern and keep a record of your actions. (Raising concerns paragraph 11)

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A doctor treating a patient

Are you satisfied with the response to the incident report?

A doctor washing her hands

Can you raise your concern with your manager or other responsible person in your organisation?

View case studies below and select an option to continue
A doctor taking a patient

Raise your concern with your manager or other responsible person within the organisation and keep a record of your actions. (Raising concerns paragraph 13)

Please click next to continue
A doctor in consultation

Are you satisfied with the response from your manager or other responsible person?

Key Points

Download key points (pdf)

The GMC regulates the medical profession with the aim of protecting patient safety. We do so against standards which we set. In both Good Medical Practice and our explanatory guidance we set out what is expected of doctors and their duties.

All doctors have a duty to act when they believe patients’ safety is at risk, or that patients’ care or dignity is being compromised (Raising concerns paragraphs 1-3 and 7 and Good Medical Practice paragraphs 24,25).

Make sure that you understand:

Advice and support

It is important that you seek advice and support if you are not sure whether, or how to raise a concern (Raising concerns paragraph 18). There are many sources of help:

  • contact your educational supervisor or manager
  • your medical defence body, Royal College or professional association (such as the BMA)
  • the appropriate regulator. (Raising and acting on concerns about patient safety)
  • the NHS Whistleblowing helpline (doesn't operate in Scotland or Wales) or Public Concern at work
  • the GMC Confidential Helpline (0161 923 6399)

Contact details are available in the “other useful contacts” information popup. (Raising and acting on concerns about patient safety)

Final things to remember

  • Keep a record of your concerns and the actions you have taken to resolve them (Raising concerns paragraph 15)
  • Remember that 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 (Raising concerns paragraph 10c)
A doctor examining a young patient

Are you a doctor in training?

    A doctor with a patient

    Can you raise your concern with a named person in your deanery?

    View case study below and select an option to continue
    Doctors discussing a patient

    Raise your concern with the postgraduate dean or director of postgraduate general practice education and keep a record of your actions. (Raising concerns paragraph 13)

    Please click next to continue
    A doctor and patient

    Are you satisfied with the response from your deanery?

    Doctors in discussion

    Can you escalate your concerns to a higher level within your organisation or elsewhere locally?

    View case studies below and select an option to continue
    A doctor and patient

    Escalate your concern to a higher level within your organisation or elsewhere locally, such as with the medical director or clinical governance lead and keep a record of your actions. (Raising concerns paragraph 13)

    Please click next to continue
    A doctor with a patient

    Are you satisfied that your concerns have been addressed locally?

    Key Points

    Download key points (pdf)

    The GMC regulates the medical profession with the aim of protecting patient safety. We do so against standards which we set. In both Good Medical Practice and our explanatory guidance we set out what is expected of doctors and their duties.

    All doctors have a duty to act when they believe patients’ safety is at risk, or that patients’ care or dignity is being compromised (Raising concerns paragraphs 1-3 and 7 and Good Medical Practice paragraphs 24,25).

    All doctors have a duty to act when they believe patients’ safety is at risk, or that patients’ care or dignity is being compromised (Raising concerns paragraphs 1-3 and 7 and Good Medical Practice paragraphs 24,25).

    Make sure that you understand:

    Advice and support

    It is important that you seek advice and support if you are not sure whether, or how to raise a concern (Raising concerns paragraph 18). There are many sources of help:

    • contact your educational supervisor or manager
    • your medical defence body, Royal College or professional association (such as the BMA)
    • the appropriate regulator. (Raising and acting on concerns about patient safety)
    • the NHS Whistleblowing helpline (doesn't operate in Scotland or Wales) or Public Concern at work
    • the GMC Confidential Helpline (0161 923 6399)

    Contact details are available in the “other useful contacts” information popup. (Raising and acting on concerns about patient safety)

    Final things to remember

    • Keep a record of your concerns and the actions you have taken to resolve them (Raising concerns paragraph 15)
    • Remember that 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 (Raising concerns paragraph 10c)
    Doctors treating a patient

    Can you escalate your concern to a regulator or other external body with responsibility to act or intervene?

    View case studies below and select an option to continue
    Doctors at work

    Raise your concern with the appropriate regulator or other external body and keep a record of your actions. (Raising concerns para 16)

    Please click next to continue
    A doctor and patient

    Are you satisfied that your concern has been addressed by the appropriate regulator or other external organisation?

    Doctors discussing a patient

    Seek advice on how to raise concerns further from:

    • 1. Your medical director or other colleague;
    • 2. Your medical defence body;
    • 3. The GMC Confidential Helpline;
    • 4. NHS Whistleblowing Helpline;
    • 5. Public Concern at Work.

    And keep a record of your actions.

    (Raising concerns paragraph 18)

    Please click next to continue
    A doctor at work

    Are you considering making your concern public?

    View case studies below and select an option to continue
    A doctor examining a young patient

    Before making your concern public, you must follow the guidance in paragraph 17 of Raising concerns (Raising concerns paragraph 17).

    Select next to continue
    A doctor in consultation

    Before making your concern public, you must also understand the legal protections available to you and keep a record of your actions (Raising concerns paragraph 10-18).

    Please click next to continue

    Key Points

    Download key points (pdf)

    The GMC regulates the medical profession with the aim of protecting patient safety. We do so against standards which we set. In both Good Medical Practice and our explanatory guidance we set out what is expected of doctors and their duties.

    All doctors have a duty to act when they believe patients’ safety is at risk, or that patients’ care or dignity is being compromised (Raising concerns paragraphs 1-3 and 7 and Good Medical Practice paragraphs 24,25)

    Make sure that you understand:

    Advice and support

    It is important that you seek advice and support if you are not sure whether, or how to raise a concern (Raising concerns paragraph 18). There are many sources of help:

    • contact your educational supervisor or manager
    • your medical defence body, Royal College or professional association (such as the BMA)
    • the appropriate regulator. (Raising and acting on concerns about patient safety)
    • the NHS Whistleblowing helpline (doesn't operate in Scotland or Wales) or Public Concern at work
    • the GMC Confidential Helpline (0161 923 6399)

    Contact details are available in the “other useful contacts” information popup. (Raising and acting on concerns about patient safety)

    Final things to remember

    • Keep a record of your concerns and the actions you have taken to resolve them (Raising concerns paragraph 15)
    • Remember that 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 (Raising concerns paragraph 10c)
    Back button

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      Contact us

      If you would like to find out more about our guidance Raising and acting on concerns about patient safety, you can read it online or contact the GMC to speak to one of our advisers:

      Monday to Friday – 8am to 6pm

      Saturdays – 9am to 5pm

      • Inside the UK: 0161 923 6602
      • Outside the UK: +44 161 923 6602

      We have launched a confidential helpline, which will allow individuals to raise serious concerns about patient safety when they feel unable to raise the issues at a local level.

      • GMC Confidential Helpline: 0161 923 6399

      If you have a concern about the conduct of a doctor, you can find out about our processes on our website.

      Case study:

      Has the responsible person taken ation?

      A doctor with a patient

      Dr J works in a NHS community day-surgery, and is often the only surgeon operating during the day. She is concerned about low levels of staffing, both nursing and medical, and believes that patients may be being placed at risk. Following a series of minor adverse incidents, Dr J sent an email to the Medical Director explaining her concerns and the reasons for them. She received a brief acknowledgement indicating that the issue would be considered.

      A month later she sent a further email to the Medical Director inquiring about progress. On the basis of his brusque response, Dr J formed the impression that he was not taking the matter seriously. Dr J sought advice from her medical defence body, who suggested that she raiser her concerns directly with the Chief Executive, who has a statutory responsibility for maintaining patients safety. In her letter to the Chief

      Case study 1

      Faced with a concern about patient safety, are you yourself in a position to put the matter right? (Raising Concerns para 2)

      A doctor examines an x-ray

      Dr Li, a senior consultant on an acute medical ward, manages a team which includes foundation and specialty doctors in training. The team is responsible for the specialist management of adult patients suffering from a range of medical conditions requiring urgent care, such as acute myocardial infarction and pulmonary embolism.

      With no explanation Dr Young, a specialty trainee in his third year, often arrives late for work and in one case misses his shift with no prior notice. This presents difficulties for the team, as Dr Young has a critical role in the continuous monitoring of the acutely ill patients. These patients can deteriorate very rapidly if not monitored effectively and treated promptly, so unexpected staff shortages are a risk to patient safety.

      Today Dr Li and her team are on-call, including Dr Young, but he has not turned up. Dr Li is concerned that her team will struggle with the workload: there are 3 doctors and 25 patients to be cared for in the ward. Given the risks to patient care, she re-prioritises clinical tasks and delegates Dr Young's responsibilities across the team to make the best of the current situation. She makes an appointment to speak to human resources later that afternoon to discuss her concerns about Dr Young. The HR manager advises her to meet with Dr Young as a matter of urgency to identify any underlying issues.

      The next day Dr Li calls Dr Young into her office. He is apologetic and admits to being greatly distressed following a recent family bereavement. Dr Young acknowledges the impact of his actions and agrees to seek bereavement counselling. Dr Li is sympathetic to his situation. In consultation with HR, she grants him special leave, and emphasises the importance of informing the relevant staff as early as possible in case of any future absences. She also arranges an appointment with Occupational Health and appropriate clinical cover for Dr Young during his absence.

      These case studies and photos are entirely fictional and for illustration purposes only.

      Case study 10

      Can you escalate your concerns to a higher level within your organisation or elsewhere locally? (Raising Concerns para 13)

      Doctors in discussion

      Dr Wilson, a specialty trainee in his third year, is working a night shift in a busy teaching hospital in Scotland. He is bleeped to the respiratory ward to see Mrs Cullen, an elderly female patient with community acquired pneumonia. He gives verbal instructions to Nurse Sutherland for Mrs Cullen to receive oxygen, some fluids, antibiotics and hourly observations throughout the night. Dr Wilson also writes these instructions in the patient's notes.

      Later on, Dr Wilson is again fast bleeped to the respiratory ward where Mrs Cullen has become critically unwell. Nurse Ritchie, who recently started her shift, explains that she found Mrs Cullen to be dangerously short of breath, barely conscious and clearly in a lot of discomfort. The Rapid Response team have been called and, fortunately, a critical care bed is available and Mrs Cullen is successfully transferred to the unit, where her condition is stabilised. Dr Wilson reviews the drug and observation charts, where he notes that not all of his previous instructions have been carried out.

      The following day, Dr Wilson asks Nurse Sutherland why his instructions for hourly observations had not been carried out. He stresses the risk to Mrs Cullen, who could have died as her condition deteriorated very quickly. The situation had caused great distress to Mrs Cullen's daughter, who was visiting and had been frightened that she might lose her mother. Nurse Sutherland is visibly shocked and upset. She explains that she simply misheard Dr Wilson and thought he had said Mrs Cullen required four hourly observations. It had been a particularly busy night shift and she had not cross checked the verbal instructions with those in the patient notes.

      Nurse Sutherland explains that on finishing her shift, Mrs Cullen had been stable and she had verbally handed over her care to Nurse Ritchie. This had further complicated the situation as Nurse Ritchie did not check the patient notes either. Dr Wilson accepts Nurse Sutherland's explanation. However he feels the incident and the underlying cause have serious implications for patient safety.

      Dr Wilson approaches the Ward Manager, Mrs Baxter, and they agree that it would be helpful if the Director of Quality Improvement carried out a Failure Modes and Effects Analysis (FMEA) * of the handover arrangements, to determine what steps could be taken to avoid similar problems in future. The investigation finds that Mrs Cullen's notes contained clear instructions from Dr Wilson. However, a culture of over reliance on verbal instructions, for hand over of patients' care, had developed in the department during a long running period of staff shortages.

      Nursing staff and doctors are asked to use a new communication tool - the SBAR (situation, background, assessment, recommendation) ** - to manage handovers and ensure a consistent approach to both written and verbal instructions.

      * FMEA: Scottish Patient Safety Programme.

      ** The SBAR is recommended as one of a number of tools by the Scottish Patient Safety Programme, NHS Wales and Department of Health, Social Services and Public Safety (Northern Ireland)

      These case studies and photos are entirely fictional and for illustration purposes only.

      Case study 11

      Can you escalate your concerns to a higher level within your organisation or elsewhere locally? (Raising Concerns para 13)

      A doctor and patient

      Mrs Donnell is a consultant surgeon working in a Northern Ireland hospital managed by the Health and Social Care Trust. The day-surgery cares for patients undergoing orthopaedic surgery. Mrs Donnell is often the only surgeon operating during the day, due to difficulties filling rotas for both medical and nursing staff, in recent months. She is concerned about the low levels of staffing and the impact on standards of patient care and on staff morale. She raises the issue with Dr Lund, the Medical Director, who says that a staffing review is due to be completed, within a few weeks, when the issues can be addressed.

      There are a series of incidents directly affecting patients' care. One incident involves a post-operative bleed, suffered by Mr Byrne, which is not picked up quickly enough by nursing staff for the patient to be rapidly assessed by the on call consultant. Mr Byrne is having a particularly difficult recovery from his surgery and his family is very concerned about his progress. Mrs Donnell completes an incident report form to act as a record of events, in accordance with the Trust's policy. She worries that, as the only surgeon on shift during the day, she may be called to deal with a post-operative emergency whilst still in theatre with another patient.

      Mrs Donnell sends an email to Dr Lund outlining her concerns about the low-staffing levels, and how these have contributed to the recent incidents. She receives a brief acknowledgement indicating that the issues would be considered at the next Trust management meeting. She tries to convene a meeting with Dr Lund, other staff at the centre and the risk governance team, to encourage an open discussion about the issues. But it proves difficult to get everyone to agree a date to meet.

      A month later, Mrs Donnell sends another email to Dr Lund inquiring about the outcome of the management meeting. She learns that other urgent business has delayed consideration of the issues by the management board. Based on the response, Mrs Donnell concludes that it will be some time before a firm date is set to recruit additional staff. She is also clear that some urgent action is needed, at the very least to reduce the number of booked procedures, to reduce the risk of adverse incidents happening during or after surgical procedures.

      Mrs Donnell feels that the risks to patients is not being given an appropriate level of urgency and that further attempts, at this point, to get Dr Lund to act quickly, are likely to be fruitless and merely create conflict. She seeks advice from her medical defence body, who suggest that she raise her concerns in writing with the Chief Executive, who has statutory responsibility for maintaining patient safety.

      They suggest that Mrs Donnell details the reasons for her ongoing concerns, her earlier correspondence with Dr Lund, and her suggestions about short and longer term options for managing the situation to reduce the risks to patients. Although Mrs Donnell is uncomfortable going over the head of her Medical Director, she feels she has little alternative in the circumstances, as patients are being put at risk. Mrs Donnell makes clear in her letter that she is willing to meet with the Chief Executive and the Medical Director to help find a solution.

      At the meeting, the Chief Executive shares Mrs Donnell's concerns about standards of patient care and the demands being placed on the current staff. It is agreed that to address the immediate issues, the Centre manager would reschedule a number of planned admissions and the Trust would support an increase in the use of locum staff. For the longer term, Mrs Donnell and Dr Lund agree to work with the Trust managers, to draw up an action plan to increase staffing levels at the Centre, and to develop better systems for forecasting and managing local demand for day-surgery.

      These case studies and photos are entirely fictional and for illustration purposes only.

      Case study 12

      Can you escalate your concerns to a higher level within your organisation or elsewhere locally?

      A doctor with a patient

      Dr Gibbs works as a GP partner in a rural practice in Wales. He receives a letter from the local hospital concerning an elderly patient, Mr Brown, who has an inflammatory lung condition. Mr Brown's care in hospital has been managed by Consultant Respiratory Physician, Dr Goodwin.

      The letter from Dr Goodwin explains that he has put Mr Brown on a course of azathioprine to reduce inflammation in the lungs and requests that Dr Gibbs continue the prescription. The letter states that Mr Brown will have a blood test when seen in the follow up clinic 4 weeks after discharge.

      Dr Gibbs notes that the date for the clinic appointment was four weeks ago but the letter was only sent within the last week. Dr Gibbs is aware that azathioprine can reduce white cells in the blood, reducing immunity and leading to an increased susceptibility to infection. He has a number of patients on azathioprine and is aware of local Health Board guidelines recommending blood tests every week for the first two months of use. He also notes that the hospital's shared care protocol which should have been included with the letter is missing.

      Dr Gibbs tries to call Dr Goodwin's secretary and then Dr Goodwin directly but can not reach them. He immediately rings Mr Brown to check how he is doing and learns that he has not had a blood test since starting azathioprine. Dr Gibbs explains the importance of the test to Mr Brown, who becomes upset and explains that he is scared of going back to hospital. He would be concerned about getting an infection and will be worried sick waiting for test results. Dr Gibbs tries to reassure Mr Brown and arranges an urgent blood test at the local centre. Fortunately the results of the test are satisfactory.

      Dr Gibbs is concerned that Dr Goodwin had not followed the shared care protocol for patients on azathioprine, and that the risks for Mr Brown were increased by the delay in sending the discharge letter. He completes a significant event audit form and, as this is something that might be happening more widely, submits the details to the National Reporting and Learning System (NRLS)* so they can consider whether to issue a national alert about the importance of weekly blood tests for patients on azathioprine.

      Dr Gibbs also raises his concern with the Senior GP partner at the practice and the manager of the Health Board. Following an investigation by the Medical Director, the hospital updates its discharge processes, to ensure that immediately relevant clinical information is passed on to patients' GPs without delay. A reminder is issued to all doctors about following the shared care protocol for patients on azathioprine.

      *The NRLS is run by the NHS Commissioning Board Special Health Authority: Commissioning board NHS

      These case studies and photos are entirely fictional and for illustration purposes only.

      Case study 9

      Can you escalate your concern to a regulator or other external body with responsibility to act or intervene? (Raising Concerns para 16c)

      Doctors treating a patient

      Dr Miller is a specialty trainee in her first year working at a tertiary referral hospital. She is concerned about the ratio of trainee doctors to clinical supervisors in both inpatient and outpatient care. Overall, the services within the hospital are stretched. She feels that patient care is suffering where they are being seen by trainee doctors working without appropriate clinical supervision. Most recently on her ward, a 37 year old patient, Mr George, had been admitted with acute urinary retention due to an increase in the size of his prostate. He needed a catheter inserted. However the trainee doctor managing his care did not know the specialist technique for inserting it. He could not proceed without supervision from an experienced colleague who was unavailable, attending to a patient on another ward. The resulting delay caused Mr George, and his family, a lot of distress as he was in considerable pain. Mr George had decided to make a formal complaint.

      Dr Miller discusses with her colleagues the fact that trainees are filling gaps in the rota in place of more senior doctors. A number of the trainees complain that, they feel uncomfortable assessing and treating patients with multiple co-morbidities, without appropriate input from clinical supervisors. They are primarily concerned about the risk to patient safety and the quality of care, although they also feel that the time they spend filling gaps in the rota means they have less time available for formal training.

      There has been no response so far from the hospital management about the incident reports. Despite the trainees raising their concerns with their educational supervisors within the hospital and in hospital departmental meetings, action on staff shortages is not being given priority. It seems that the restructure of the acute admissions unit is taking priority, in terms of staffing and other resources. The trainees decide to approach the Medical Director, Dr Clark, about their concerns with the rotas. Although he is sympathetic, he implies that his hands are currently tied given the demands of the restructure. The trainees feel that their concerns are not being taken seriously enough and tell Dr Clark they plan to contact the Deanery for advice.

      The trainees collectively write a letter to their postgraduate Dean outlining their concerns. A follow-up Deanery visit confirms the service and training issues. The postgraduate Dean discusses the issues with Dr Clark who agrees to reassign the rotas and make arrangements for closer clinical supervision, as a matter of priority. The postgraduate Dean kept the GMC informed of the situation and they monitor progress until satisfied that patient safety is no longer at risk.

      These case studies and photos are entirely fictional and for illustration purposes only.

      Case study 13

      Can you escalate your concern to a regulator or other external body with responsibility to act or intervene? (Raising Concerns para 16c)

      Doctors at work

      Dr Hussain is a GP trainee working in a busy inner city GP training practice with an excellent reputation within the local community. She has recently noticed that one of the GP partners, Dr Bell, is acting increasingly out of character and he is short tempered and impatient.

      During a break in an afternoon surgery, Dr Hussain goes to ask Dr Bell for advice about a patient with diabetes. When she enters Dr Bell's consulting room, she sees him removing something from the surgery's emergency drug bag and quickly dropping it into his pocket.

      When she asks him what is happening, Dr Bell tells Dr Hussain that he is self-treating for insomnia, as this is time saving for him and the practice and is nothing unusual. He explains that he has some personal issues which are temporarily affecting his sleep. Dr Hussain is aware that doctors should not self-prescribe, unless in exceptional circumstances, but does not want to harm her relationship with Dr Bell by questioning his actions. She agrees not to mention it to the other GPs.

      However, over the next few weeks, Dr Bell's behaviour continues to be erratic. Dr Hussain is convinced that Dr Bell might have a drug problem - she has some knowledge about addictive behaviour from her experience on a previous rotation in an emergency ward.

      Dr Hussain approaches Dr Bell and tentatively suggests that he might have a problem that needs help. Dr Bell rejects the suggestion and angrily tells her to mind her own business. He says she should pay more attention to forwarding her career by ensuring that she can successfully complete her placement. Dr Hussain feels she is on the right track, and has concerns the emergency drug bag may be missing supplies as a result of Dr Bell's drug use. She worries about his welfare and that his judgement towards patients may be affected. However she is anxious about telling anyone at the surgery, given the possible reaction from Dr Bell. She doesn't think it's appropriate to raise her concerns with her GP educational supervisor or her Deanery, as the issue is not specifically related to her training. However, she has heard of the GMC Confidential Helpline and decides to contact them for advice.

      The confidential helpline adviser reassures her that she was right to get in touch. The GMC has health procedures to look into concerns about the health of a doctor, as well as looking into patient safety concerns. Such cases are handled sensitively, and doctors with health issues are encouraged to recognise they have health problems and offered support. Dr Hussain is assured that the GMC can take action without disclosing the role she played in raising the concern.

      These case studies and photos are entirely fictional and for illustration purposes only.

      Case study 14

      Can you escalate your concern to a regulator or other external body with responsibility to act or intervene? (Raising Concerns para 16c)

      A doctor and patient

      Dr Sinclair, an associate specialist, regularly covers the neurosurgical high dependency unit (HDU), whilst doing a neurology on-call, due to staff shortages. Although the neurology departmental policy states that all new ward admissions should be assessed by a doctor within two hours, this is often difficult for Dr Sinclair to achieve, due to the extra demands attending to HDU patients.

      Dr Sinclair checks with the HR department for a copy of the hospital's policy on how to raise concerns about patient safety issues. He and a group of other doctors raise concerns at a meeting with the senior consultant in charge of the neurology ward, who agrees to pursue the issue with the Clinical Director. However, the rota vacancies persist for a number of months, despite regular enquiries about progress.

      Dr Sinclair and other doctors currently on the rota agree, that the continuing inability to consistently meet the two hour assessment standard is compromising patient safety. The Clinical Director, Ms Singh, meets with the group to discuss their concerns. She meets with the Medical Director, Mr Todd, who subsequently writes to the doctors assuring them that action would be taken to fill the rotas as quickly as possible. However, several weeks later, the rotas still have significant gaps and they have heard nothing about plans to recruit, reorganise rotas, or make any other changes in the service. In that time, there have been two significant near misses, due to long delays in the patients being assessed by a neurologist after admission.

      The doctors in the neurology department write formally to Mr Todd, detailing their concerns about the patient safety issues and, suggesting some short terms measures to improve the situation. However, Dr Sinclair doesn't feel confident at this stage that action will be taken quickly enough to address the risks. He goes to see Mr Todd directly, to discuss his concerns. Mr Todd angrily shouts at Dr Sinclair that he has raised the issues before and matters are being dealt with. What's more, he has concerns about Dr Sinclair's attitude and his team's performance, as he feels that they are failing to manage the rotas effectively. He is considering instituting an audit of Dr Sinclair's team. Dr Sinclair is shaken and feels that this response is an attempt to bully him out of pursuing his concerns any further. He leaves the office shocked and angry.

      Not sure what to do, he calls the Medical and Dental Defence Union of Scotland.

      The adviser asks him about his hospital's whistleblowing policy. Dr Sinclair confirms he has read the local policy and raised his concerns with the designated people. The adviser makes clear that, if he did not receive a formal response from Mr Todd, in a reasonable time, that makes clear how the issues would be addressed, Dr Sinclair and the other doctors should raise their concerns with Healthcare Improvement Scotland.

      These case studies and photos are entirely fictional and for illustration purposes only.

      Case study 15

      Are you considering making your concern public?' (Raising Concerns para 18)

      A doctor at work

      Dr Ahmed is a senior consultant working in a general hospital in Wales. Due to shortages of nursing staff over many months, patients often have a long wait to receive pain relief, other medications, and changes to wound dressings. This is a particular problem during the night when staff shortages are more severe. Patients and their families have been complaining about the poor standard of basic care and the impact on patients' dignity and safety.

      In addition, several of Dr Ahmed's team independently raise concerns with him about doctors having to work longer periods to cover gaps in the rota. They are also concerned about trainee doctors often having to make difficult treatment decisions, without ready access to the advice and support of more senior doctors. They knew of one instance where a patient was admitted with severe chest pain and, managed by trainee doctors, received little pain relief due to their concerns about the medication causing respiratory depression. The patient's condition deteriorated in the surgical assessment unit, before the consultant was available to review the patient. Dr Ahmed is concerned that many of the trainee doctors do not have the expertise to recognise the severity of a patient's illness and the triggers to escalate to consultant review.

      Dr Ahmed meets with the Clinical Director and Medical Director who are sympathetic, but they go on to outline the impact of current budget constraints. The whole hospital is under pressure due to planned restructuring and the imminent merger with another local hospital. However, they commit to reviewing the rotas, to be able to get more staff on during peak times.

      Over the following few weeks, even with more staff covering peak times, serious incidents and near misses occur, including one case where a patient developed a deep vein thrombosis after not being prescribed medication to thin his blood. Patients are still waiting too long for basic care, and the level of complaints from patients and families has risen. As the situation continues, staff become more exhausted by their extended hours and dissatisfied with the standard of care they are able to provide to patients on the wards. Patient Safety Incident reports have been completed, but so far this has not led to any formal investigation or review of services.

      Dr Ahmed formally raises his concerns in writing to the hospital management committee which includes the Chief Executive. A meeting to discuss the issues is set to happen a few weeks later. Dr Ahmed is frustrated that such serious concerns about patient safety are not being given more priority. He talks to the risk and governance team, but concludes from their response that, the issues will continue to be overshadowed by the hospital's focus on the merger and restructuring.

      After talking to other consultants, and his medical defence body, he discusses his concerns with Healthcare Improvement Wales. Although satisfied from their response that the situation will be investigated, it's clear that it may take some time before concrete action is taken within the hospital to address the immediate risks to patients.

      Unsure what else he might reasonably do, he contacts the GMC Confidential Helpline for advice about the possibility of making his concerns public. The helpline adviser points out that, as the focus is on resolving the patient safety issues, he should consider whether there are additional steps he can take within the hospital, to reduce the risks to patients. As to the idea of going to the press, the adviser refers Dr Ahmed to the GMC guidance and the expectation that such a step would not be considered unless, other options were exhausted and, patients were at immediate risk.

      Dr Ahmed worries that his position at the hospital may be jeopardised if he pursues the issues any further. The GMC adviser refers him to Public Concern at Work (PCAW) to discuss the legal protections available to him. The PCAW adviser helps him to think through what might be the advantages and disadvantages of going to the press, in terms of encouraging a more speedy or defensive response to the situation. She explains the protections available under the Public Interest Disclosure Act and encourages him to consult further with his defence body.

      These case studies and photos are entirely fictional and for illustration purposes only.

      Case study 2

      Faced with a concern about patient safety, are you yourself in a position to put the matter right? (Raising Concerns para 2)

      Doctors talking

      Dr Doyle is a specialty trainee in her third year, working in a busy medical ward at a district general hospital in Northern Ireland. She has become aware that patients on the ward, receiving blood components for post chemotherapy anaemia, are not being given adequate information about the risks associated with blood transfusion, including adverse reactions and infections. Patients are advised that they will need a transfusion. But details of the risks are not raised in conversations overshadowed by a focus on, the likely post chemotherapy improvement in the patient's health, and the longer term prognosis.

      Dr Doyle discusses with her clinical supervisor, Dr Foster, her concern that patients may not be receiving the information they would want, about an important aspect of treatment, before they make a decision about undergoing chemotherapy. As an immediate action, they agree that Dr Doyle will ensure, for the rest of the week, that patients under her care are given the NHS Blood and Transplant patient information leaflet about blood transfusions. She will answer any queries from patients about the benefits and risks, and refer any questions that she is unsure of to senior colleagues. Dr Doyle records in the patients' notes the main points of the discussion about proposed treatments, the fact that the patient has been given the transfusion leaflet, and the patient's decisions. She informs the other doctors of the whereabouts of the leaflets so they too can provide them to patients.

      Dr Foster and the Clinical Director, Dr Martin, carry out a review of the service. They identify that not enough time is being given to meeting patients' information needs, in conversations where patients are often emotionally distressed. The trainee doctors discussing treatment options with patients are not all clear about the risks associated with blood transfusion, or confident in explaining these to very ill patients.

      Arrangements are made for additional training, to improve practice in communicating risks and benefits sensitively and in ways that patients can easily understand. Checklists are introduced across the ward, which include a question about whether relevant information leaflets have been provided to patients, as a further support for good decision making.

      These case studies and photos are entirely fictional and for illustration purposes only.

      Case study 3

      Should the matter also be dealt with through routine local incident reporting arrangements? (Raising Concerns para 11)

      Doctors in discussion

      Dr Baker, a haematology specialty trainee in her third year, works at a tertiary referral centre in London. Her duties include providing care to patients with sickle cell disease, a genetic blood disorder affecting the red blood cells, which can result in a risk of various complications, such as organ failure or stroke. The treatment of these patients often requires the insertion of temporary central venous catheters (CVC) using 2D ultrasound.

      Dr Baker is concerned that there is no provision for formal training and assessment of trainee doctors in the use of 2D ultrasound for CVC insertion. Because of this lack of training, she is aware that some less experienced trainees are being asked to perform a procedure beyond their competence. She knows of one recent incident where a trainee undertook a line insertion on a patient, Mr Akintola, without using ultrasound. Fortunately, he was not harmed. But the line insertion did carry the risk for Mr Akintola of the catheter moving out of the blood vessels, and damaging the adjoining structures, potentially leading to infection as well as a risk of local bruising and bleeding.

      Dr Baker discusses her concerns with her Clinical Supervisor, Dr Meena, who encourages her to complete an incident report form for the 'near miss' incident with Mr Akintola. Dr Baker feels that even though no patients have been directly harmed in any incident to date, it is only a matter of time before something serious happens.

      A few days later, the incident report is considered by the senior management team during the weekly departmental review. The Clinical Supervisor Dr Meena is present and supports the concerns of Dr Baker. It becomes clear that a number of trainee doctors had expressed concerns, at different times, about whether they had adequate training to safely carry out 2D ultrasound CVC insertion. The team decide to make short term arrangements to improve the service, by enlisting help from the trained renal physicians to carry out some of the procedures. As a longer term solution, they agree to implement a new training programme, on the use of ultrasound for CVC insertion, to be provided to all doctors.

      These case studies and photos are entirely fictional and for illustration purposes only.

      Case study 4

      Should the matter also be dealt with through routine local incident reporting arrangements? (Raising Concerns para 11)

      A doctor treating a patient

      Dr Wang, a specialty trainee in her second year, works in a GP practice. She is asked to go on a visit to see a patient complaining of headache, nausea and a possible rash. In preparation she checks the doctors bag contains the appropriate drugs as the patient's symptoms indicate meningitis. She notes that the bag contains penicillin, but it is out of date. Fortunately there is up to date penicillin in the stock room and, in the event, the patient did not have meningitis. Dr Wang is concerned about possible future risks to patients if the doctors bag again contains out of date drugs.

      Dr Wang discusses the issue with her GP supervisor, Dr Price, and the practice manager, Mrs Tudor, later that day. She learns that there is a system in place for the practice nurse, Ms Billing, to check the drugs one month before the expiry date on any item. But that had not been done. They advise her to record the details by completing a significant event audit form. The following day a 'significant event' meeting is held.

      It transpires that checking and ensuring that the drug stocks are adequate, and up to date, is the sole responsibility of Ms Billing who has been off sick for some weeks. No-one else had taken over this responsibility.

      It is agreed that Mrs Tudor should immediately develop a shared calendar, with regular alerts for checking drug stock items, which would be accessible to and checked by the manager and practice nurse. Ms Billing returns from sick leave the following week and audits the contents of the stock cupboards and doctors bags, to ensure all items are entered onto the shared calendar. The new arrangement will be reviewed in six months to ensure it is working well.

      These case studies and photos are entirely fictional and for illustration purposes only.

      Case study 5

      Can the matter be dealt with through routine local incident reporting arrangements? (Raising Concerns para 11)

      A doctor

      Dr Bevan is an anaesthetist in the operating theatre of a large teaching hospital in Wales. In preparing for a routine hernia repair for Mr Morris, he notices a fault with one of the filters used in the breathing system for the administration of anaesthesia. If not spotted in time, the fault would mean that Mr Morris would not receive all the necessary gases from the machine. Dr Bevan's vigilance means that no harm is done to Mr Morris, as there is sufficient time to replace the filter well before he arrives in the operating theatre.

      Dr Bevan talks to the anaesthetic assistant and the stock manager, about the problem with the equipment and the 'near miss' incident. The stock manager returns the filter to identify the exact cause of the fault, and Dr Bevan completes an incident report form, following the Health Board's policy.

      At their meeting to review recent incident reports, the hospital management team decide that all the remaining filters should be specifically checked by the safety team, in addition to the scheduled routine checking process for the theatre equipment. The checks show that the filters on all the other machines are working properly.

      The management team nevertheless decide to tighten the current system by increasing the frequency of checks on the filters. The incident report form is entered into the National Reporting and Learning System (NRLS),* where any similar problems with the filters at other hospitals might be identified and a national alert issued, if appropriate.

      *The NRLS is run by the NHS Commissioning Board Special Health Authority: Commissioning board NHS

      These case studies and photos are entirely fictional and for illustration purposes only.

      Case study 6

      Can the matter be dealt with through routine local incident reporting arrangements? (Raising Concerns para 11)

      Medical staff talking

      Dr Khan is an associate specialist on a routine ward round on a geriatric ward. An elderly patient, Mr Brooks complains of pain at the site of his cannula which, on examination, Dr Khan notices has not been inserted correctly and is not functioning as it should. He removes it immediately. It is clear that Mr Brooks has not been getting the necessary fluids and has been put at a heightened risk of pain, dehydration and infection.

      Dr Khan talks to Senior Sister Middleton about the incorrectly inserted cannula. Sister Middleton is aware that there are some new nurses working on the ward and, after making enquiries, discovers that the nurse who had inserted the cannula was unsure whether she had done so correctly, but had not sought help at the time.

      Sister Middleton speaks with the other new nurses and reviews their skills in cannula insertion, which are all to a high standard. Sister Middleton and Dr Khan agree that this is solely a competence issue, relating to one individual nurse, and therefore completing an adverse event report would not be appropriate. She meets with the nurse responsible and reassures her that she should feel confident to report any training needs. The nurse discloses that, although she has been fully trained in this area, she still feels uneasy from time to time. To support her, they agree that she would be supervised, for an appropriate period of time, when inserting cannulas for peripheral IV access.

      These case studies and photos are entirely fictional and for illustration purposes only.

      Case study 7

      Can you raise your concern with your manager or other responsible person in your organisation? (Raising Concerns para 13)

      A doctor washing her hands

      Dr McDonald, a specialty trainee in her second year, works on rotation on a geriatrics ward in Scotland. She works closely with Nurse Wright, a senior nurse who is particularly supportive, as part of a multi-disciplinary team (MDT). The Health Board has a clear policy on hand washing as part of its drive to reduce hospital acquired infections (HAI). During the time Dr McDonald has been working with Nurse Wright, she has rarely seen her wash her hands after patient contact. This includes after changing wound dressings and, on a number of occasions, when moving between patients following procedures requiring mandatory hand washing.

      Dr McDonald is concerned about the heightened risk of HAIs on a ward with elderly patients with multiple conditions, where such infections could have serious consequences for their health.

      Dr McDonald does not want to jeopardise her good working relationship with Nurse Wright by confronting her directly about what she has seen. At the same time, she cannot ignore the potential risk and decides to talk with her Clinical Supervisor, Dr Cox, about her concerns. He shares Dr McDonald's concerns and tells her he will broach it with the Ward Sister, Sister Jacob, which he does.

      Following the meeting, Sister Jacob has a one to one meeting with Nurse Wright. She explains that her colleagues have observed her not washing her hands and stresses that she must in future follow the WHO five steps* to hand hygiene at all times, in line with Scotland's National Hand Hygiene Campaign**.

      At the next safety briefing session, Sister Jacob reminds all staff of the risks of HAIs, the increased risks on the geriatrics ward, and the importance of taking extra care to follow hospital policy on hand washing practices. She informs them that routine audits would take place, and asks everyone to let her know of any practical or other changes that could be made on the ward, to help everyone comply with the policy. The MDT members express renewed commitment to following the policy, and the following week Dr McDonald observes Nurse Wright washing her hands at all times.

      *WHO five steps: World Health Organisation: Clean Care is Safer Care

      **Health Protection Scotland: National Hand Hygiene Campaign

      These case studies and photos are entirely fictional and for illustration purposes only.

      Case study 8

      Can you raise your concern with your manager or other responsible person in your organisation? (Raising Concerns para 13)

      A doctor taking a patient

      Dr Quinn is a recently appointed part-time GP in a busy inner-city practice with four other GPs. She is concerned about the behaviour of another GP, Dr McCready.

      She recently observed that Dr McCready is acting aggressively towards the practice staff and has seen some patients leave his consulting room visibly upset. A few patients have made verbal complaints about his dismissive, ill-tempered behaviour. And the practice manager reports that some patients have asked to be seen by other GPs, or the practice nurse, instead of Dr McCready. Dr Quinn is concerned that his behaviour will affect patient care, if they are reluctant to honestly discuss their symptoms and health concerns, because Dr McCready creates an uncomfortable atmosphere. His behaviour is also affecting the previously positive working environment at the practice and creating additional burdens on other staff.

      Dr Quinn finds an opportunity to talk to Dr McCready about his behaviour. He tells her, he has not been feeling his usual self because of personal problems, but provides assurances that everything is now under control. He seems annoyed that she has raised the matter and clearly doesn't want to discuss it any further. However, soon after this Dr Quinn witnesses an angry outburst in the practice waiting area and is concerned that Dr McCready doesn't appreciate the seriousness of the situation.

      Dr Quinn talks to Dr Ellis, the senior GP partner, about her concerns. He understands the urgency of the situation and meets with Dr McCready to try to identify the reasons behind his aggressive behaviour. From the discussion, it emerges that Dr McCready's long term relationship has recently ended. And he is in the middle of distressing court proceedings about access to his children. He admits he is angry and not coping with the stress and feels exhausted. He is given special leave with immediate effect to deal with his family situation. And he agrees to talk to the Doctor's Support Line about getting help to develop other coping mechanisms for managing stress.

      Dr McCready agrees that he will return to GP practice only when he feels ready and able to effectively carry out his duties. As additional support, Dr Ellis arranges an Occupational Health appointment for Dr McCready.

      The practice manager sends letters of apology to the individual patients who had previously complained, reassuring them that their concerns had been taken on board, and steps were being taken to ensure a better service in future.

      These case studies and photos are entirely fictional and for illustration purposes only.

      Case study 9

      Can you raise your concern with a named person in your deanery? (Raising Concerns para 16c)

      Doctors treating a patient

      Dr Miller is a specialty trainee in her first year working at a tertiary referral hospital. She is concerned about the ratio of trainee doctors to clinical supervisors in both inpatient and outpatient care. Overall, the services within the hospital are stretched. She feels that patient care is suffering where they are being seen by trainee doctors working without appropriate clinical supervision. Most recently on her ward, a 37 year old patient, Mr George, had been admitted with acute urinary retention due to an increase in the size of his prostate. He needed a catheter inserted. However the trainee doctor managing his care did not know the specialist technique for inserting it. He could not proceed without supervision from an experienced colleague who was unavailable, attending to patients on another ward. The resulting delay caused Mr George, and his family, a lot of distress as he was in considerable pain. Mr George had decided to make a formal complaint.

      Dr Miller discusses with her colleagues the fact that trainees are filling gaps in the rota in place of more senior doctors. A number of the trainees complain that, they feel uncomfortable assessing and treating patients with multiple co-morbidities, without appropriate input from clinical supervisors. They are primarily concerned about the risk to patient safety and the quality of care, although they also feel that the time they spend filling gaps in the rota means they have less time available for formal training.

      There has been no response so far from the hospital management about the incident reports. Despite the trainees raising their concerns with their educational supervisors within the hospital and in hospital departmental meetings, action on staff shortages is not being given priority. It seems that the restructure of the acute admissions unit is taking priority, in terms of staffing and other resources. The trainees decide to approach the Medical Director, Dr Clark, about their concerns with the rotas. Although he is sympathetic, he implies that his hands are currently tied given the demands of the restructure. The trainees feel that their concerns are not being taken seriously enough and tell Dr Clark they plan to contact the Deanery for advice.

      The trainees collectively write a letter to their postgraduate Dean outlining their concerns. A follow-up Deanery visit confirms the service and training issues. The postgraduate Dean discusses the issues with Dr Clark who agrees to reassign the rotas and make arrangements for closer clinical supervision as a matter of priority. The postgraduate Dean kept the GMC informed of the situation and they monitor the progress made until satisfied that patient safety is no longer at risk.

      These case studies and photos are entirely fictional and for illustration purposes only.

      Key points

      Download key points (pdf)

      The GMC regulates the medical profession with the aim of protecting patient safety. We do so against standards which we set. In both Good Medical Practice and our explanatory guidance we set out what is expected of doctors and their duties.

      The GMC regulates the medical profession with the aim of protecting patient safety. We do so against standards which we set. In both Good Medical Practice and our explanatory guidance we set out what is expected of doctors and their duties.

      All doctors have a duty to act when they believe patients’ safety is at risk, or that patients’ care or dignity is being compromised (Raising concerns paragraphs 1-3 and 7 and Good Medical Practice paragraphs 24,25).

      Make sure that you understand:

      Advice and support

      It is important that you seek advice and support if you are not sure whether, or how to raise a concern (Raising concerns paragraph 18). There are many sources of help:

      • contact your educational supervisor or manager
      • your medical defence body, Royal College or professional association (such as the BMA)
      • the appropriate regulator. (Raising and acting on concerns about patient safety)
      • the NHS Whistleblowing helpline (doesn't operate in Scotland or Wales) or Public Concern at work
      • the GMC Confidential Helpline (0161 923 6399)

      Contact details are available in the “other useful contacts” information popup. (Raising and acting on concerns about patient safety)

      Final things to remember

      • Keep a record of your concerns and the actions you have taken to resolve them (Raising concerns paragraph 15)
      • Remember that 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 (Raising concerns paragraph 10c)

      The legal protections:

      The Public Interest Disclosure Act provides legal protection against victimisation or dismissal for individuals who reveal information to raise genuine concerns and expose malpractice in the workplace.

      A summary of the protections available to whistleblowers under the Act are available from the Advisory, Conciliation and Arbitrations Services (ACAS) and Directgov - public services all in one place.

      Additional advice

      If you are considering making a concern public, you should get advice from your medical defence body, your royal college or a professional association such at the British Medical Association. You can also seek advice from:

      Public Concern at Work, which is a charity providing free, confidential legal advice to people who are concerned about wrongdoing at work and are not sure whether, or how to raise concerns. You can call Public Concern at Work on 0207 404 6609

      The NHS Whistleblowing helpline, which provides confidential and independent advice for people to raise concerns about the NHS. You can call the helpline on 08000 724 725

      The Advisory, Conciliation and Arbitration Service (ACAS), which provides advice to employers and employees involved in employment disputes or seeking information on employment rights and rules. You can call ACAS on 08457 47 47 47

      The legal protections:

      The Public Interest Disclosure Act provides legal protection against victimisation or dismissal for individuals who reveal information to raise genuine concerns and expose malpractice in the workplace.

      A summary of the protections available to whistleblowers under the Act are available from the Advisory, Conciliation and Arbitrations Services (ACAS) and Directgov - public services all in one place.

      Additional advice

      If you are considering making a concern public, you should get advice from your medical defence body, your royal college or a professional association such at the British Medical Association. You can also seek advice from:

      Public Concern at Work, which is a charity providing free, confidential legal advice to people who are concerned about wrongdoing at work and are not sure whether, or how to raise concerns. You can call Public Concern at Work on 0207 404 6609

      The NHS Whistleblowing helpline, which provides confidential and independent advice for people to raise concerns about the NHS. You can call the helpline on 08000 724 725

      The Advisory, Conciliation and Arbitration Service (ACAS), which provides advice to employers and employees involved in employment disputes or seeking information on employment rights and rules. You can call ACAS on 08457 47 47 47

      Raising a concern with a regulator

      You should contact one of the below regulatory bodies or another body with authority to investigate your concern in the following circumstances:
      • a. If you cannot raise the issue with the responsible person or body locally because you believe them to be part of the problem.
      • b. If you have raised your concern through local channels but are not satisfied that the responsible person or body has taken adequate action.
      • c. If there is an immediate serious risk to patients, and a regulator or other external body has responsibility to act or intervene.
      Health professions regulators Who do they cover?
      General Chiropractic Council Chiropractors
      General Dental Council Dentists, dental nurses, dental technicians, dental hygienists, dental therapists and orthodontic therapists
      General Medical Council Doctors
      General Optical Council Optometrists, dispensing opticians, student opticians and optical businesses
      General Osteopathic Council Osteopaths
      General Pharmaceutical Council Pharmacists, pharmacy technicians and pharmacy premises in England, Scotland and Wales
      Health Professions Council 15 separate healthcare professions including podiatrists, physiotherapists and others
      Nursing and Midwifery Council Nurses and midwives
      Pharmaceutical Society of Northern Ireland Pharmacists in Northern Ireland
      Other regulatory and investigatory bodies What do they cover?
      Care Quality Commission Health and social care services in England
      Council for Healthcare Regulator Excellence The nine health professions regulators
      Monitor NHS foundation trusts
      NHS Commissioning Board Special Health Authority Patient safety in England and Wales
      Northern Ireland  
      Regulation and Quality Improvement Authority in Northern Ireland Health and social care services in Northern Ireland
      Scotland  
      The Care Inspectorate Social care and social work services in Scotland
      Healthcare Improvement Scotland Healthcare services in Scotland
      Implementing & Reviewing Whistleblowing Arrangements in NHS Scotland PIN (Partnership Information Network) Policy Healthcare services in Scotland
      Wales  
      Healthcare Inspectorate Wales Healthcare services in Wales
      Advice and help  
      Public Concern at Work Provides free, confidential legal advice
      NHS Whistleblowing Helpline 08000 724 725 Offering confidential and independent advice.
      The GMC Confidential Helpline 0161 923 6399 Offering confidential advice

      Useful contacts

      Advice and help

      Phone: 0161 923 6399

      Website: www.pcaw.co.uk
      Phone: 020 7404 6609

      Website: www.bma.org.uk
      Phone: 020 7387 4499

      Website: www.the-mdu.com
      Phone: 0844 420 2020

      Regulatory/investigatory bodies

      Website: www.gcc-uk.org
      Phone: 020 7713 5155

      Website: www.gdc-uk.org
      Phone: 020 7887 3800

      Website: www.gmc-uk.org
      Phone: 0161 923 6602

      Website: www.optical.org
      Phone: 020 7580 3898

      Website: www.osteopathy.org.uk
      Phone: 020 7357 6655

      Website: www.hpc-uk.org
      Phone: 020 7582 0866

      Website: www.nmc-uk.org
      Phone: 020 7637 7181

      Other regulatory and investigatory bodies

      Website: www.monitor-nhsft.gov.uk
      Phone: 020 7340 2400

      Northern Ireland
      Scotland

      Website: www.scswis.com
      Phone: 0845 600 9527

      Wales

      Website: www.hiw.org.uk
      Phone: 029 2092 8850

      Raising and acting on concerns about patient safety

      Steps to raise a concern

      12. 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.

      13. 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.

      View guidance

      blah blah blah believe patients’ safety is at risk, or that patients’ care or dignity is being compromised ( Raising concerns paragraphs 1-3 and 7; and Good Medical Practice paragraphs 6 and 43-45)

      Raising and acting on concerns about patient safety

      Raising and acting on concerns about patient safety

      Steps to raise a concern

      11. You must follow the procedure where you work for reporting near misses and incidents. This is because routinely identifying incidents or near misses at an early stage, can allow issues to be tackled, problems to be put right and lessons to be learnt.

      Raising and acting on concerns about patient safety

      Raising and acting on concerns about patient safety

      1. All doctors have a duty to act when they believe patients’ safety is at risk, or that patients’ care or dignity is being compromised.

      2. Good Medical Practice says that the safety of patients must come first at all times. If you believe 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 raise your concern with the organisation you have a contract with or which employs you. You must also protect patients from risk of harm posed by another colleague’s conduct, performance or health by taking appropriate steps immediately so that the concerns are investigated and patients are protected where necessary.

      3. This guidance sets out our expectation that all doctors will, whatever their role, take appropriate action to raise and act on concerns about patient care, dignity and safety.

      Raising and acting on concerns about patient safety

      Steps to raise a concern

      12. 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.

      13. 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.

      Raising and acting on concerns about patient safety

      Raising a concern with a regulator

      16. You should contact a regulatory body such as the General Medical Council (GMC) (For more information, see how we respond to concerns) or another body with authority to investigate the issue (such as those listed in the ‘Useful contacts’ section of this website) in the following circumstances.

      • a) If you cannot raise the issue with the responsible person or body locally because you believe them to be part of the problem.
      • b) If you have raised your concern through local channels but are not satisfied that the responsible person or body has taken adequate action.
      • c) If there is an immediate serious risk to patients, and a regulator or other external body has responsibility to act or intervene.

      Raising and acting on concerns about patient safety

      Raising a concern with a regulator

      16. You should contact a regulatory body such as the General Medical Council (GMC) (For more information, see how we respond to concerns) or another body with authority to investigate the issue (such as those listed in the ‘Useful contacts’ section of this website) in the following circumstances.

      • a) If you cannot raise the issue with the responsible person or body locally because you believe them to be part of the problem.
      • b) If you have raised your concern through local channels but are not satisfied that the responsible person or body has taken adequate action.
      • c) 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

      17. You can consider making your concerns public if you:

      • a) 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
      • b) have good reason to believe that patients are still at risk of harm, and
      • c) do not breach patient confidentiality.

      But, you should get advice (see paragraph 18) before making a decision of this kind.

      Raising and acting on concerns about patient safety

      Raising a concern with a regulator

      16. You should contact a regulatory body such as the General Medical Council (GMC) (for more information, see how we respond to concerns) or another body with authority to investigate the issue (such as those listed in the ‘Useful contacts’ section of this website) in the following circumstances.

      • a) If you cannot raise the issue with the responsible person or body locally because you believe them to be part of the problem.
      • b) If you have raised your concern through local channels but are not satisfied that the responsible person or body has taken adequate action.
      • c) 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

      17. You can consider making your concerns public if you:

      • a) 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
      • b) have good reason to believe that patients are still at risk of harm, and
      • c) do not breach patient confidentiality.

      But, you should get advice (see paragraph 18) before making a decision of this kind.