REPORTING a colleague who you believe poses a threat to patient safety is never easy for any healthcare professional and it can be a particularly challenging area for trainee doctors. However, you must resist the temptation to simply overlook, or “turn a blind eye” to, issues of concern. By doing so, not only could patient safety be jeopardised, but you yourself could end up in professional difficulty for not having acted to put those issues right.
All doctors, whatever their role, are required to speak up if they believe patient safety or care is being compromised by the practice of colleagues – being a trainee does not excuse you from this responsibility. The General Medical Council recognises there may be reluctance among some medical professionals to do so, perhaps for fear that nothing may be done or that raising your concern may cause problems for colleagues or for your own career prospects.
But that is no excuse for inaction.
In its guidance Raising and acting on concerns about patient safety, the GMC says: “You have a duty to put patients’ interests first and act to protect them, which overrides personal and professional loyalties.”
If you have concerns about a colleague and you do not raise them with the health board/PCT or the GMC and the failing clinician’s fitness to practise is later called into question, then you could also find yourself in professional difficulties.
In recent months there has been an increasing emphasis on the value of “whistleblowing” and a growing number of support structures have been put in place. In early 2012, a free government-funded whistleblowing hotline was launched (08000 724 725) and a national charter, Speaking Up, was published to protect NHS staff who raise concerns. This is in addition to a contractual duty to raise concerns that is being enshrined in the new NHS Constitution.
Announcing the helpline launch, former health secretary Andrew Lansley said it will “play an important role in creating a culture where staff will be able to raise genuine concerns in good faith, without fear of reprisal.” A web-based whistleblowing service is also being developed.
The GMC recently launched a confidential helpline for doctors to raise concerns about patient safety on 0161 923 6399. The regulator also advises doctors against signing contracts that contain so-called “gagging clauses”, stating: “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.”
If you have concerns but are unsure of how to proceed then it is advisable to discuss the issue with a senior colleague or call your medical defence organisation where an adviser can offer guidance and support.
Some legal protection is offered to whistleblowers against victimisation or dismissal in cases where they have revealed information to raise genuine concerns.
The GMC reassures doctors in Raising concerns… that: “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.”
The regulator adds that doctors 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.” It is advisable also to keep a record of your concern and any steps that you have taken to deal with it.
The Public Interest Disclosure Act (1998) (PIDA) was introduced to provide protection for those who honestly raise concerns about wrongdoing or malpractice in the workplace and are victimised and/or dismissed for doing so. Where possible, you should follow your health board/Trust’s whistleblowing policy and drastic measures, such as alerting the media, should only be taken as a last resort.
The British Medical Association has also pledged to support any doctor who raises concerns and has previously called for a “culture change” in the NHS to encourage more doctors to speak out.
If you do have concerns then it is important to act swiftly and not delay raising them by trying to investigate them yourself or because you feel you are not in a position to put the matter right. Ultimately, the decision on whether to speak out will be a matter of individual professional judgement but GMC guidance should be at the forefront of your mind.
Joanne Curran is an associate editor of FYi