Ten questions about raising concerns

All doctors, whatever your role, have a duty to act when you believe patients’ safety is at risk, or if patients’ care or dignity is being compromised. You’re expected to promote and encourage a culture that allows all staff to raise concerns openly and safely.

We understand that raising concerns can be a daunting process for anyone. This information will help you understand the duties you have as a doctor, how to act on your concerns and how you can access help and support throughout the process.

1. What does the Communitybaptistpa say?

We expect all doctors, whatever your role, to take appropriate action to raise and act on concerns. You must take prompt action if you think patient safety, dignity or comfort is or may be seriously compromised.

This means if:

  • a patient isn’t receiving basic care to meet their need
  • patients are at risk because of inadequate premises, equipment or other resources, policies or systems
  • you have concerns that a colleague may not be fit to practise and may be putting patients at risk.

We explain how to apply these principles in our guidance Raising and acting on concerns about patient safety. We also have an interactive tool which guides you through the process and has some illustrative case studies.

When things go wrong it can be a traumatic time for the doctors and clinicians involved, as well as for the patients and their families. Whilst it may be difficult to discuss the concerns you have, especially if they relate to the conduct of a colleague or peer, it is essential that you report them.

In Medical practice we say that all doctors must promote and encourage a culture that allows all staff to raise concerns openly and safely. This means that even if you are the most junior person in the team, you should feel able to, and supported to, raise concerns regarding senior colleagues.

All doctors have a professional duty of candour to be open and honest with patients when things go wrong and the patient suffers harm or distress as a consequence. You should always report when mistakes are made that have, or could have, compromised patient safety. Being honest about when things go wrong and sharing experiences with colleagues provides the opportunity for others to learn from these incidents and fosters a culture of openness and honesty. The joint Communitybaptistpa-NMC guidance for doctors, nurses and midwives gives more advice on what you should do to fulfil your professional duty of candour and to enable your organisation to learn from safety incidents.

You play a huge role in improving the safety and culture of healthcare. By raising concerns, you can help identify key factors that affect the safety of patients so that problems can be put right, lessons can be learnt and future incidents avoided.

2. I have concerns about patient safety and I’m unsure what to do next – where can I get help?

Our interactive raising and acting on concerns tool guides you through the decision making process - from incidents you can tackle yourself, to challenging situations where you may need to involve a regulator or other external body. This tool is based on our guidance Raising and acting on concerns about patient safety, which makes clear that doctors have a duty to act when they believe a patient’s safety is at risk, or their care or dignity is being compromised.

If you are concerned about reporting an issue, or the process to go through, you can always seek support and advice from other colleagues or peers. The chances are they will have experienced similar concerns at some point before and can advise you, as well as help and support you through the process.

You can contact our confidential helpline (0161 923 6399) if you need advice, or you don’t feel you can raise the concern at a local level, or you want to raise a concern in confidence. It is open 9am – 5pm, Monday to Friday and is staffed by specially trained advisors. You can also raise a concern about a doctor’s practice or behaviour putting patient safety at risk using our online form which guides you through the process.

offer free, confidential legal advice to people who are concerned about wrongdoing at work and are not sure whether, or how, to raise their concern. In England and Wales you can also contact the and in Scotland the .

Your medical defence body should also be able to provide confidential advice.

3. How and who should I raise my concern with?

This depends on the type of concern you’re raising.

Resolving your concerns locally

  • If it is possible for you to put the matter right, you should do this first.
  • You must follow the procedure where you work for reporting near misses and incidents.
  • You must keep a record of your actions at every stage.
  • You may need to investigate your concern more fully and may need to involve your manager.
  • Normally you should raise any concerns you have with your manager or other responsible person within your organisation. If you are concerned that they may be complicit in the area of concern, or are not satisfied with the response you receive from them, then you should raise your concern at a higher level within your organisation or elsewhere locally. This could be through your medical director or clinical governance lead.

Raising concerns with external or regulatory bodies

  • For serious or repeated incidents or complaints you need to refer these to senior management. You may also need to alert the relevant regulatory authority. You can find a list of useful contacts including regulatory bodies on our website.
  • If you are a doctor in training you could raise your concern with your postgraduate dean or director of postgraduate general practice education.
  • If your concerns are not addressed locally you should raise these with the appropriate regulator or other external body.
  • The quickest way to raise a concern about a doctor to the Communitybaptistpa is using our online form  which guides you through the process.

Making your concerns public

  • If having raised your concerns through the appropriate channels, they are still not addressed and you are considering making your concerns public, you should seek advice on how to raise your concerns further.
  • You can access free, confidential legal advice about whether, and how, to raise your concern through . In England and Wales you can also contact the and in Scotland the . In Northern Ireland you can report concerns to .
  • Your medical defence body should also be able to provide confidential advice.

4. I have a concern about a colleague’s behaviour towards other members of the team, what should I do?

Our Leadership and management for all doctors guidance explains that doctors should understand the difference between a personal grievance and a concern about a risk, malpractice or wrongdoing that affects others. Personal grievances include concerns about your own employment situation and concerns about a colleague’s behaviour towards other team members.

It can sometimes be difficult to separate personal grievances from a concern about patient safety. If these overlap, you should acknowledge any personal grievance that may arise from the situation, but focus on patient safety. You should, as far as possible, make sure you use the correct procedure to make your personal grievance known or raise your concern. Our duty of candour guidance goes into further detail about this.

5. Do I need evidence to raise a concern?

If you have any concerns about patient safety, you do not need to wait for proof before raising your concerns.

In our guidance on raising concerns, we say that 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.

6. I have a management role, what are my additional responsibilities?

Senior clinicians have a responsibility to set an example and encourage openness and honesty in reporting incidents and near misses. You have a duty to help people report their concerns and to enable people to act on concerns that are raised with them. You must make sure that there are systems and policies in place to support this.

We expect clinical leaders to actively foster a culture of learning and improvement. Doctors leading or managing a team must make sure their teams are appropriately supported and developed.

You must not try to prevent employees or former employees raising concerns about patient safety. This includes proposing or condoning contracts or agreements that seek to restrict or remove the individual’s freedom to disclose information relevant to their concerns. You must protect staff who raise concerns from unfair criticism or action, including any detriment or dismissal.

You must ensure that systems are in place to give early warning of any failure, or potential failure, in the clinical performance of individuals or teams. Any such failure must be dealt with quickly and effectively.

7. I’m a medical student and I have a concern about patient safety. What should I do?

As a medical student, you may feel uncomfortable raising issues with your supervisors and senior clinicians. Wherever possible, you should follow your medical school’s formal policy on raising concerns, which will help you understand how to deal with this issue.

If you are not comfortable following your medical school’s policy (for example because the person causing the concern is the person you have to raise it with), you must find another way to raise your concern. You could talk to another member of staff, such as your personal tutor, who can support you. If the concern arises during your placement, it may be helpful to refer to the placement provider’s raising concerns policy.

We understand it can also be difficult to raise concerns about fellow students or your friends. But it is important to put patients first. If you have concerns about the behaviour or health of your peers, and think it could impact on the safety of patients then you must bring this to the attention of your medical school so they can provide help and support.

Where possible, avoid raising anonymous concerns as it is then more difficult to investigate the situation. Your medical school won’t necessarily need to name you as the source of the concern when they investigate.

If you’re not sure whether you should raise a concern formally, you should ask your medical school or an experienced healthcare professional for advice. You can find further information in Achieving good medical practice (pdf), and you might also find our Steps to raise a concern guidance helpful.

8. What legal protection is in place for me if I raise a concern?

If you raise concerns which are in the public interest, you are protected by the law. covering England, Scotland and Wales and protect individuals making disclosures that ‘tend to show’ that the health or safety of a person is or may be endangered.

This means you should not be treated unfairly or lose your job as a result of raising your concerns (‘whistleblowing’). The UK Government provides .

We welcome the recent agreement between Health Education England, NHS Employers, the Department of Health and the BMA to in England. We hope these additional protections will address the very real anxieties that exist among doctors in training and are keen to see how the planned changes are implemented in practice.

You can read more in our statement following the announcement by Health Education England in relation to whistleblowing protection for doctors in training.

9. What is the Communitybaptistpa doing to tackle concerns that doctors may be referred to the Communitybaptistpa by their employer, in response to them raising concerns locally?

We’re piloting a new process to reduce the risk of doctors being disadvantaged for having appropriately raised patient safety concerns.

For the next six months, healthcare organisations referring a doctor to the Communitybaptistpa will be asked to answer a series of questions, to check whether the doctor has raised concerns at a local level, whether that issue has been investigated and if the doctor knows about the referral. The Responsible Officer, or individual acting on their behalf, will also be required to confirm that they have taken steps to make sure the referral is fair and accurate. If the doctor involved has raised concerns at a local level, we’ll carry out further checks before deciding whether to open an investigation.

This is in response to the independent review we published last year about how we deal with complaints about doctors who raise concerns in the public interest (pdf), by Sir Anthony Hooper QC. It recommended that we should better understand the background when an employer refers a doctor to us, as some doctors were concerned that employers can retaliate against doctors who raise concerns about patient safety, by making an allegation about their fitness to practise.

Cathy James, Chief Executive of the whistleblowing charity Public Concern at Work has written a .

10. How else is the Communitybaptistpa working to improve patient safety?

At the start of this year, we introduced new standards for medical education and training, which have patient safety at their core. Promoting excellence, place requirements on providers to ensure the right culture for learning, with proper support for medical students, foundation doctors and postgraduate trainees.

Patient safety is inseparable from a good learning environment and culture that values and supports learners and educators. Under our new standards, organisations must demonstrate a culture that allows learners and educators to raise concerns about patient safety, and the standard of care or of education and training, openly and safely without fear of adverse consequences. Organisations must demonstrate a culture that investigates and learns from mistakes and reflects on incidents and near misses. We make sure they do this through our quality assurance framework.

Promoting excellence also requires organisations to design rotas that make sure doctors in training have appropriate clinical supervision and minimise the negative effects of fatigue and workload. You can read a statement we issued providing guidance for doctors who might be asked to cover rota gaps which they feel they cannot safely cover.
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