Part 2: Acting on a concern

All doctors have a responsibility to encourage and support a culture in which staff can raise concerns openly and safely.

Concerns about patient safety can come from a number of sources, such as patients’ complaints, colleagues’ concerns, critical incident reports and clinical audit. Concerns may be about inadequate premises, equipment, other resources, policies or systems, or the conduct, health or performance of staff or multidisciplinary teams. If you receive this information, you have a responsibility to act on it promptly and professionally. You can do this by putting the matter right (if that is possible), investigating and dealing with the concern locally, or referring serious or repeated incidents or complaints to senior management or the relevant regulatory authority.

If you are responsible for clinical governance or have wider management responsibilities in your organisation, you have a duty to help people report their concerns and to enable people to act on concerns that are raised with them. 

If you have a management role or responsibility, you must make sure that:

1. there are systems and policies in place to allow concerns to be raised and for incidents, concerns and complaints to be investigated promptly and fully⁶  
2. you do not try to prevent employees or former employees raising concerns about patient safety – for example, you must not propose or condone contracts or agreements that seek to restrict or remove the contractor’s freedom to disclose information relevant to their concerns
3. clinical staff understand their duty to be open and honest about incidents or complaints with both patients and managers
4. all other staff are encouraged to raise concerns they may have about the safety of patients, including any risks that may be posed by colleagues or teams
5. staff who raise a concern are protected from unfair criticism or action, including any detriment or dismissal.

If you are responsible for investigating incidents or complaints, you have a responsibility towards those who raise a concern. You must:

1. protect them from unfair criticism or action, including any detriment or dismissal
2. tell them what action has been or will be taken to prevent a recurrence of the problem (if this applies)
3. outline the process if they are still not satisfied with the response – for example, if complaints are considered within the Local Authority Social Services and National Health Service Complaints (England) Regulations 2009, the process for escalating the concern to the Health Service Ombudsman. 

If you are responsible for investigating incidents or complaints, you should also make sure that:

1. any investigations or resulting actions are carried out in a way which is consistent with the law, including, for example, the Public Interest Disclosure Act 1998⁷⁷⁷ 
2. you have a working knowledge of the relevant law and procedures under which investigations and related proceedings are carried out
3. those being investigated are treated fairly
4. appropriate adverse event and critical incident reports are made within the organisation and to other relevant external bodies
5. recommendations that arise from investigations are put into practice or referred to senior management
6. patients who make a complaint receive a prompt, open, constructive and honest response. 

You must also make sure that patients who suffer harm receive an explanation and, where appropriate, an apology.⁸ 

If you are not sure how to act on a concern, you should get advice from:

1. a more senior member of staff, your organisation’s management team or other impartial colleague
2. your responsible officer or, if you are a responsible officer or medical director, a GMC employer liaison adviser⁹ 
3. your medical defence body, royal college or a professional association such as the BMA
4. the relevant regulatory authorities (such as the Care Quality Commission, the GMC, or other professional regulators)
5. Protect, a whistleblowing charity that advises and supports individuals and encourages safe whistleblowing.