The importance of raising concerns

importance of raising concerns

MDU medico-legal adviser Dr Sally Old looks at the importance of raising concerns and gives guidance and advice on doctors' options for action.

Safeguarding patient safety is one of the main reasons for raising a concern in the workplace. When standards of care or behaviour fall below acceptable standards, doctors have an ethical duty to speak up. GMC guidance in Good medical practice (2013) emphasises that doctors 'must take prompt action if (they) think patient safety, dignity or comfort is or may be seriously compromised'.

Niall Dickson, chief executive of the GMC, told the MDU, "Doctors have a significant and wide set of responsibilities, including raising concerns. Doctors must not accept the unacceptable."

Since 2012, the GMC National Training Survey has specifically asked doctors in training if they have a concern about patient safety in their workplace. In 2013 11% of trainees who responded said that they had raised a concern and that it had been addressed, but a further 5% reported unresolved concerns. Doctors near the start of their training were more likely to raise concerns, with 8.7% of F1 doctors reporting issues compared to 2.8% of those in ST8. The GMC also comments that doctors who are working in a specialty that is not their ultimate career choice (which is common for relatively junior doctors on rotations) may bring a 'fresh pair of eyes' to a situation. (See the article by the GMC's Chair Professor Sir Peter Rubin).

In a recent survey of 470 MDU members, more than half of respondents thought that doctors are more willing to raise concerns nowadays than five years ago. Over 50% had raised concerns themselves, although 40% of these reported that the matter was not dealt with to their satisfaction. They were either ignored or told nothing could be done. Only 16% had encountered barriers to reporting concerns.

Raising a concern effectively, without attracting professional or personal repercussions, requires a measured approach and adherence to GMC guidance and your employer's protocols. The MDU receives around 30 calls a week from doctors of all grades seeking help with issues of concern. We guide them through the steps towards raising their concern.

Our experience is that when doctors follow their trust policy and discuss their misgivings with colleagues, they often achieve the patient safety outcome they want. For example, an HCA confided in an F2 MDU member that she believed she had seen another F2 doctor asking a patient out on a date. Our member spoke to a ward nurse who said that the female patient had told her she felt uncomfortable around the other F2. The member broached the subject discreetly with the other F2, who hotly denied that any inappropriate conversation with a patient had ever taken place. The member let the matter drop.

In a recent survey of 470 MDU members, more than half of respondents thought that doctors are more willing to raise concerns nowadays than five years ago.

When he himself witnessed the other F2 speaking to a female patient inappropriately, the MDU member rang us for advice. The MDU adviser reminded him of his ethical duty to protect patients, explaining that the seriousness of this case required him to take action. The adviser suggested he should speak to the HCA and nurse and that they should together report their concerns to senior managers.

The team raised the concern with the trust, presenting written evidence of specific instances, and asking the trust to investigate. The trust dealt with the matter directly with the F2 and informed the team of the outcome.

Compare this with the case of a surgical registrar who judged a colleague's mortality rate to be too high. He reported his unfounded suspicions to the police, without involving his colleagues or employer. There was a complaint to the GMC and the registrar was judged to have brought the profession into disrepute at a fitness to practise hearing.

It's important to distinguish between a genuine patient safety concern and a personal or professional grievance. Members often call to discuss an issue which seems to be a personal issue – for example, that they have been asked to cover an additional clinic when they are already working at capacity. On the surface, this appears to be a straightforward human resources issue. But the effect on the doctor (overwork, tiredness) could have an impact on patients, potentially compromising their safety, and therefore should be raised as a concern.

All healthcare professionals should feel able to raise concerns, but what do you do if your workplace culture discourages you from speaking up? What if your concern is ignored or you find yourself at the heart of a bitter internal row? Niall Dickson says "Even senior staff can feel intimidated and uncertain about raising concerns when the culture is hostile. It can be more difficult still for doctors in training, or those who have limited experience of work."

However, he is "reasonably hopeful" that openness will become the norm. "Mid Staffs was a wake-up call for the profession, and a tipping point for people leading organisations to recognise that the way things were done in the past – that is, protecting the organisation and colleagues at all costs – must be changed."

There is also the possibility that others may raise concerns about your own practice. Mr Dickson advises "It is right and proper for patient safety that an investigation takes place. But being investigated locally or by the GMC is not easy. Our advice is to be straightforward, open and honest, and reflect on lessons learnt from the concern raised."

Sources of advice

  • MDU advisory helpline 0800 716 646
  • GMC helpline 0161 923 6399
  • Public Concern at Work 020 7404 6609

MDU advice on raising concerns

  • Before raising your concern, find out what your employer's policy is and follow it. Most trust policies require you to raise the concern officially with them first.
  • You may only speak about your concern to anyone other than your employer under specific circumstances – namely, that you have done all you can to resolve a situation but without success, patient safety is still seriously compromised and you do not breach confidentiality. Please call us for advice before doing so.
  • Canvassing your colleagues' views can help verify whether your observations are justified or unfounded.
  • If there really is a problem, the most powerful way of putting it right is to act as a team. It may be possible to tackle the issue in the context of a critical incident discussion within the team, in the first instance.
  • If a team approach is not appropriate, or fails, the concern should be raised with the trust.
  • Compile your evidence in writing and be specific, citing examples of what you have observed. Information may be anonymised if necessary.
  • Focus on how patient safety is affected.
  • The GMC advises keeping a record of the steps you have taken.
  • Finally, be clear about the outcome you expect from the trust.

This article originally appeared in the printed edition of wardround April 2014 entitled "raising concerns".

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This page was correct at publication on . 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.