Doctors have an ethical duty to raise a concern.
A measured approach is advisable.
Follow GMC guidance and your employer's protocol.
Seek help from the MDU.

General principles

Doctors have an ethical duty to speak out when standards of care or behaviour fall below acceptable standards.

The GMC's core guidance, 'Good medical practice' (2024), states that you must take prompt action if you think patient safety or dignity is, or may be, seriously compromised (paragraph 75).

The GMC expects doctors to act to make sure that patients whose basic care needs are not being met, are cared for as soon as possible (for example, by asking an appropriate colleague to attend to the patient straight away).

If you’re concerned that, "patients are at risk because of inadequate premises, equipment or other resources, policies of systems", you should, "first protect patients and put the matter right if that’s possible" (paragraph 75) You must then raise your concern in line with your workplace policy, and keep in mind the GMC’s separate guidance on 'Raising and acting on concerns about patient safety' (2012).

You must also act on concerns that a colleague may not be fit to practise and may be putting patients at risk. Take advice and consider if you need to make a formal report.

Your concern doesn't have to be proven, but it must be honestly held and you must be clear, honest and objective in raising it. Your duty to put patients' interests first and act to protect them overrides personal and professional loyalties, but it's important to distinguish between a genuine concern and a personal or professional grievance.

Raising a concern effectively

This requires a measured approach, as well as adherence to GMC guidance and your employer's protocols. Refer to the GMC's guidance, 'Raising and acting on concerns about patient safety' (2012).

Wherever possible, you should first raise your concern within your organisation.

Arrangements vary around the UK. In the NHS in England, the National Guardian’s Office leads a network of Freedom to Speak Up Guardians. In Scotland, procedures for raising concerns in the NHS are set out in the National Whistleblowing Standards and concerns can be escalated to the Independent National Whistleblowing Officer.

You should contact a regulatory body if:

you cannot raise the issue locally because you believe the local responsible person or body is part of the problem
you have raised concerns locally but are not satisfied that the response has been adequate
there is an immediate serious risk to patients, and a regulator or other external body has responsibility to act or intervene.

Call the MDU for advice before talking to anyone outside your organisation.

Before raising your concern

In urgent cases where you believe that patients are or may be at risk of death or serious harm, you should report your concerns immediately.

In less urgent cases, the below steps are helpful to consider before raising a concern.

Find out your employer's local policy and follow it.
Canvass your colleagues' views – this may verify if your observations are justified or not.
Act as a team – together you may be able to tackle the issue within the team (perhaps in the context of a critical incident discussion).
If this approach fails, or is not appropriate, raise your concern with your employer.
Compile evidence in writing, citing specific examples.
Focus on how patient safety is affected.
Be clear about the outcome you expect from your employer.
Keep a record of the steps you have taken.

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