Case study - Safe working concerns

...Dr S is an ST3 and claims that trainees in her department are being "coerced" into working beyond their rostered hours...

  • Date: 28 October 2020


Dr S is an ST3 in anaesthetics and contacts MDDUS to ask advice on her working hours. She claims that trainees in her department are constantly “coerced” into working beyond their rostered hours in contravention of the European Working Time Directive (EWTD) and their NHS contract.

Dr S says that there is an expectation that to be a fully trained clinician requires extra professional duties. She has no wish to alienate consultants in the department and thereby risk future employment prospects. However, she worries over her personal liability should an adverse incident occur while on-call and fatigued, having worked beyond her rota. Does she have a duty to report her concerns to the hospital administration or the regulator?


An MDDUS adviser contacts Dr S pointing out that MDDUS is only able to assist with clinical matters arising out of the care of individual patients. Contractual or employment matters, such as working excessive hours, would be a matter for the BMA or similar professional body.

However, the adviser does highlight that Dr S would have an ethical obligation to ensure that patient safety is not compromised by her own health or by organisational risks. He draws her attention in particular to General Medical Council (GMC) guidance Raising and acting on concerns about patient safety, which states: “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”.

The GMC guidance further states that: “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”. The MDDUS adviser suggests to Ms S that it may be helpful to raise such concerns in conjunction with her colleagues rather than individually.

GMC guidance also recognises that healthcare organisations across the UK will have policies in place relating to an organisational duty of candour. The GMC states: “you should comply with any system for reporting adverse incidents that put patient safety at risk within your organisation (see paragraphs 32–33 on the organisational duty of candour). If your organisation does not have such a system in place, you should speak to your manager and – if necessary – raise a concern in line with our guidance”. Should the responsible person or organisation fail to take adequate action then the matter can be escalated to the GMC or another body with authority to investigate the issue.

The MDDUS adviser encourages Dr S to read the relevant GMC guidance carefully and comply with the suggestions. In the event that a GMC matter is raised she will then have written evidence of having identified a potential risk and done her utmost to deal with it.


  • Doctors have an ethical obligation to ensure that patient safety is not compromised by their own health or known organisational risks.
  • Ensure you comply with procedures for reporting adverse incidents or patient safety risks within your organisation.

This page was correct at the time of publication. Any guidance is intended as general guidance for members only. If you are a member and need specific advice relating to your own circumstances, please contact one of our advisers.

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Insight - Secondary is published quarterly and distributed to MDDUS members throughout the UK who work in secondary care. It provides a mix of articles on risk, medico-legal and regulatory matters as well as general features and profiles of interest to our members.
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