A duty of openness

NEW GMC guidance on Raising and acting on concerns about patient safety comes into effect next month. Much of the press coverage to do with the announcement – perhaps unsurprisingly – has focused on the duty of individual doctors to act when they believe patient safety might be at risk or that the care or dignity of patients might be compromised. In particular is a warning against signing any employment contract with "gagging clauses" that might prevent a doctor from raising concerns with the regulator.

But if you download the guidance and read on you will find it also concerns doctors with management and clinical governance responsibilities. In particular it states that doctors and, by extension, all healthcare managers "have a duty to help people report their concerns and to enable people to act on concerns that are raised with them". So as a manager you are expected to foster an atmosphere of openness even if that means facing criticism for your own decisions and leadership.

Among 'must do' items in the GMC guidance is a responsibility to ensure there are proper systems and policies in place that allow staff to raise concerns and have them investigated "promptly and fully". Nothing must be done to prevent employees from raising concerns about patient safety (including "gagging clauses" in contracts). Indeed, management must ensure that staff "understand their duty to be open and honest about incidents or complaints with both patients and managers". Staff who raise concerns must be protected from "unfair criticism or action, including any detriment or dismissal".

The General Dental Council has similar guidance for dental professionals with management responsibilities. In an advice sheet published in 2010 (Raising and escalating concerns) the GDC states: "It is in an employer’s interest to promote a culture where staff can raise concerns safely and therefore prevent further problems."

It adds: "An increasing number of employers have a whistleblowing policy in place which outlines the procedure for raising concerns, and identifies who individuals can raise their concern with."

Dentists and DCPs in management positions are expected to:

• ensure that systems are in place through which colleagues can confidently raise concerns
• ensure that concerns raised are taken seriously
• maintain confidentiality if and where appropriate
• investigate properly and make an objective assessment of the concern
• keep the employee who raised the concern advised of progress
• ensure that action to resolve a concern is taken and monitored
• follow local authority safeguarding policy and that of the organisation.

For guidance in establishing appropriate systems and policies, managers in England can to refer to Speak up for a Healthy NHS: How to implement and review whistleblowing arrangements in your organisation.

In Scotland you should consult NHS Scotland, Implementing & Reviewing Whistleblowing Arrangements in NHSScotland PIN Policy (May 2011).

ACTION: Doctors and dentists with wider management and clinical governance responsibilities must ensure there are systems and policies in place that allow staff to raise concerns and to have them investigated "promptly and fully" without fear of recrimination or reprisal.