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.
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.
There is one incident where a patient was admitted with acute abdominal pain 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 went into Diabetic Ketoacidosis after not being prescribed the right doses of his diabetic.
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 are completed, but do not led to any formal investigation or review of services.
What the doctor did
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 scheduled for 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 Inspectorate 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.