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This ethical hub topic shows ways in which our professional standards can be applied in this area of care and signposts to relevant resources. It does not set new professional standards and is not intended to replace the formal guidance. Page last reviewed: 30 January 2024.
This page answers questions from doctors about how to apply our guidance in times of high service demand.
To see the ethical principles this advice is based on, you can read our professional standards.
Whenever a concern is raised about a doctor, we will always consider the individual circumstances and take any relevant factors known to us into account. Such factors include the context the doctor was working in including wider system or environmental pressures beyond the doctor’s control such as staffing levels. We will also consider any relevant protocols or guidance from their employer.
We encourage local investigation and resolution of concerns in the first instance. This includes asking responsible officers (ROs) to take the context a doctor was working in, including system factors and any workforce or training issues, into account in any local process and when considering making a referral to the GMC. To support this, we’ve made changes to the referral form completed by ROs to include additional questions about how employers have considered systemic issues, the support they’ve provided locally, and the impartial checks that have been made to make sure the referral is fair and meets our threshold. We also advise ROs to discuss any potential referral with their GMC Employer Liaison Adviser to check the threshold is met.
If you believe patients are being put at risk due to inadequate staffing or other service pressures, we expect you to take prompt action and follow our guidance on Raising and acting on concerns about patient safety.
Our guidance says that you must be competent in all aspects of your work and recognise and work within the limits of your competence (Good medical practice, paragraphs 1-2)
If you’re asked to work beyond the limits of your competence or capability, your employer should provide appropriate induction training and clinical supervision before this work takes place.
Supervision should be from an appropriately experienced medical professional who is competent to make decisions within the relevant specialty or healthcare setting about treatment or discharge of patients.
In an emergency, you should provide the safest care you can. When deciding the safest and best thing to do in this situation, we advise the following:
If you think that patients are being exposed to risk, you should tell a senior colleague or manager and work with colleagues to find the best possible solution in the circumstances. You will need to make sure you record any concerns about working outside of your competence, the steps you have taken to raise concerns and the impact on patient safety.
We know that telling patients they can’t access treatment due to decisions not in your control, can impact on the way patients respond to you.
Be open and honest with your patient and follow the principles of good practice on communicating with patients, set out in Decision making and consent.
However, if you feel that patient safety or care is being compromised by this decision criteria or policy, you have duty to raise concerns, in line with our guidance on Raising concerns.
We would also encourage you to get support from your leadership team and colleagues, as these conversations and decisions can be difficult and have an impact on your own health and wellbeing. There are also resources that you can access for support.
Nothing in the guidance should be taken to imply that doctors must always step in to manage service provision issues which are the responsibility of their employer. Nor does it oblige them to take on an unreasonable workload to the detriment of their own health and wellbeing.
The important thing for doctors when asked to cover unexpected absences is to respond responsibly and reasonably to the situation they face, using their professional judgement to assess any risks and the options available to deliver the best possible care for people in the circumstances.
The BMA set out in its guidance on the European Working time Directive that doctors in training can be asked to cover unexpected absences but they aren’t obliged to do this. They are also clear that doctors in training are not expected to cover longer term rota gaps and they set out how the directive applies to consultants and SAS doctors.
There is nothing in our guidance that prevents you from exercising your rights to campaign or protest on issues that matter to you.
However, in doing so, you must take account of the principles in our guidance, including patient confidentiality, and the importance of upholding the public’s confidence in the profession. We have a resource to help you apply our social media guidance in practice, developed with input from medical professionals.
There are some factors which lie outside our remit as a regulator, including contractual and employment matters. However, we continue to do everything we can to speak up about the pressures doctors are facing. This has included:
We share our data with broad range of organisations. This includes employers, the leaders of the four UK health services and the UK government. We do this to highlight the challenges doctors are experiencing, help influence change and pinpoint how to make the most out of the existing and future workforce.
Our annual national training survey (NTS) of all trainees and trainers across the UK, helps us understand more about their training and workplace experiences. If concerns about the quality of training, doctors’ workloads or wellbeing and workplace cultures are raised through the survey, we work with employers and education bodies to identify how we can resolve the issues.
In response to the 2023 NTS results, we shared our concerns directly with employers, government officials and education bodies. We called for supportive training environments to be prioritised, including the importance of tackling discrimination experienced by trainees.
Our Outreach teams across the UK also support doctors directly, by running training sessions on how to apply our professional standards to the environments they’re working in. They also work closely with employers to help develop more supportive, inclusive working cultures.
Steps such as staying hydrated, well-fed and getting the rest you need can help, but we know this isn’t always possible. You can also access support through this list of organisations and resources we have created.
If you feel your performance or judgement is compromised due to the environment you’re working in, you should raise this with your employer, clinical supervisor or educational supervisor, in line with our raising concerns guidance. They should then take the steps to put the matter right for patient safety and for you.
In our Leadership and management guidance we say that doctors with extra responsibilities must promote the health and wellbeing of staff they manage. We also say that they should be prepared to discuss constructively and sympathetically any work problems that the people they manage may have (Leadership and management 73 & 75).
Regularly check in with your team members to see how they’re feeling and let them know they have your support. Carrying out regular team debriefs and setting up a buddy system if you’re on shifts can help provide a wellbeing safety net and help people to keep an eye on each other.
For long shifts, consider scheduling check-in meetings across the working day. Remember that some colleagues will feel more comfortable sharing concerns in smaller groups, whereas others will be happy to share their experience in larger meetings.
Be proactive in asking colleagues whether they feel safe to travel home after a shift – this includes both day and night working. Consider building this question into daily routines such as handover conversations. If you think a colleague is too tired to drive home after a shift, make sure you discuss your concerns with them before they leave. There may be an alternative, safer way for them to travel or on-site accommodation available. The BMA has produced guidance on how to manage risks associated with fatigue.
If you feel that the request to cancel leave will impact patient safety and your health and wellbeing, we encourage you to raise this with your employer, speak to your guardian of safe working or equivalent, and speak to your defence body. This would be in line with paragraph 75 of Good medical practice, which says that you must act promptly if you think that patient safety or dignity is, or may be, seriously compromised.
The BMA have created resources about safe working in primary and secondary care. This includes information on what employers can do to design safe rotas. You can find this in the useful links section.
Our Leadership and management guidance says that doctors in leadership positions must promote the health and wellbeing of staff they manage. It emphasises working collaboratively across the multi-disciplinary team, demonstrating respect and kindness, and stressing the importance of clear communication. Leadership needs to encourage kindness, civility and collaboration.
Our report, Caring for doctors, Caring for patients on pages 16 -18 sets out steps six urgent steps needed to minimise workplace stress and ensure wellbeing and motivation at work. These include:
It's important to create a culture in your workplace where all staff feel safe and supported to raise any concerns.
If you are in a leadership position, you should make sure there is a system in place for raising concerns. This system should be open, transparent, and fair. If a colleague raises a concern with you, you should act on this concern by following guidance in Raising and acting on concerns. This includes logging what has been raised and letting your colleague know what actions have been taken in response. Our Speaking up hub has more information on how you can support colleagues in raising concerns.
Doctors are entitled to hold and express personal views. They also have an overriding duty to patients, and to uphold the public’s confidence in the profession. It's vital that doctors raise any concerns that may adversely affect patient safety and/or their own wellbeing, but it’s also important that these are raised via the appropriate channels.
Doctors should continue to follow our guidance on Raising and acting on concerns, Confidentiality and Using social media as a medical professional. You can also direct colleagues to our ethical hub, where we give practical advice about using social media.
We advise those who are faced with these decisions to:
In our Leadership and management guidance we say when making these decisions, you must consider your primary duty for the care and safety of patients. You must take account of any local and national policies that set out agreed criteria for access to particular treatments and allocating resources, and make sure that these policies are available to clinical staff.
If you are concerned about how management decisions might conflict with your primary duty to patients, you must take steps to manage or deal with any conflict. This could include, asking for colleagues’ advice, declaring the conflict to your board or other decision-making body or asking for advice from external professional or regulatory bodies, including defence organisations, if necessary.
You may also find it helpful to look at the useful links section for resources on prioritisation.
You must be supervised to be safe and act within your competence at all times. This includes any periods of pressure experienced by the service you are learning in.
You should stop work immediately if, at any time, you’re concerned about your level of supervision, or you’re being expected to work beyond your level of competency.
You should speak to your named clinical supervisor and medical school about these concerns. Medical schools are responsible for making sure medical students have an alternative named clinical supervisor if the planned supervisor is not available.
We work with doctors, patients, and other stakeholders to support good, safe patient care across the UK.
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