Raising and acting on concerns about patient safety
Part 1: Raising a concern
Duty to raise concerns
All doctors have a duty to raise concerns where they believe that patient safety or care is being compromised by the practice of colleagues or the systems, policies and procedures in the organisations in which they work. They must also encourage and support a culture in which staff can raise concerns openly and safely.
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. Contracts or agreements are void if they intend to stop an employee from making a protected disclosure.3
Overcoming obstacles to reporting
You may be reluctant to report a concern for a number of reasons. For example, 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.
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.4
- 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.
Steps to raise a concern
You must follow the procedure where you work for reporting adverse incidents and near misses. This is because routinely identifying adverse incidents or near misses at an early stage, can allow issues to be tackled, problems to be put right and lessons to be learnt.
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.
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.
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.
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
You should contact a regulatory body such as the General Medical Council (GMC)5 or another 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 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
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 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 (see paragraph 18 below) before making a decision of this kind.
Help and advice
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
- the GMC’s Confidential Helpline6
- your medical defence body, your royal college or a professional association such as the British Medical Association (BMA)
- the appropriate regulatory body listed at the end of this guidance if your concern relates to a colleague in another profession, or other relevant systems regulators 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 concern.