Confidential disclosure/Whistleblowing

Correct as of October 2011

Concerns about colleagues

One of the most difficult situations faced by any clinician is when you are concerned that a colleague’s behaviour, health or professional performance may be placing patients at risk.

Deciding what to do in such circumstances is always uncomfortable. However, the General Medical Council (GMC) has given clear advice in Good Medical Practice (2006). The relevant advice is found under the heading “Working with colleagues”, and especially paragraphs 43–45.

This makes it clear that the safety of patients must come first at all times. This means that a doctor who has concerns that a colleague may not be fit to practise must take appropriate action. They should explain their concerns promptly, clearly and honestly to an appropriate person from the contracting or employing body. Any specific local procedures should be followed, and concerns should usually be documented in writing. In such circumstances you should seek advice from MPS about how to raise such concerns, to ensure that your position is protected.

Where there are no appropriate local procedures, or they have not resolved the problems, the GMC goes on to advise that if there are still concerns about patient safety, the relevant regulatory body should be informed (for example the GMC for doctors, the Nursing and Midwifery Council for Nurses and midwives, and so on). In such circumstances you should seek advice from MPS as to how to take the matter further. You should ensure you have made a record of your concerns and the steps you have taken to try to remedy matters.

Concerns about resources and procedures

Ensure you have recorded your concerns, as well as the steps you have taken to try to remedy matters

Sometimes you may be concerned that patient safety is (or may be) seriously compromised by issues unrelated to the performance or conduct of colleagues. For example, you may have such concerns about inadequate premises, equipment or other resources, or about the systems, policies or protocols you are asked to work to. In such circumstances, the GMC again advises that you are under an obligation to take appropriate action.

Paragraph 6 of the Good Medical Practice guidelines says that you should draw the matter to the attention of your employing or contracting body. If this does not result in appropriate action being taken to remedy the situation you should contact MPS for advice on how to take the matter further. You should ensure you have recorded your concerns, as well as the steps you have taken to try to remedy matters.

Doctors working in management

If you are in a management position within an organisation, then you may have other responsibilities. The GMC has produced specific guidance in such circumstances – see Management for Doctors, published in February 2006, which is available at the GMC website.

This guidance contains further advice for doctors in such positions who might find themselves concerned about patient safety (whether due to the actions of colleagues or not). In particular, the advice makes it clear that there must be adequate procedures in place for identifying, raising and dealing with potential risks to patients, staff and the wider community and that staff are aware of these policies. The GMC also advises that where you have good grounds to believe that patients or the health of the wider community might be at risk of serious harm, you must take appropriate steps (in line with the advice in Good Medical Practice).

There is a duty to ensure that staff members who raise concerns are protected from unwarranted criticism or actions.

Making a concern public

If you have done all you can by raising the concerns within the contracting or employing body or organisation and the regulatory body, but you believe that the risk to patient safety remains, the GMC advises that you may consider making your concerns public (so long as patient confidentiality is protected at all times). In such circumstances you should ensure your concerns, and the steps you have taken, have been properly documented.

Trying to decide whether an issue should be made public is difficult, and can be very stressful. If you are contemplating such a step, always ensure that you take appropriate advice, and contact MPS before raising any such matter publicly to ensure that your position is protected at all times.

NHS guidance and legal issues

You should also be familiar with the Health Service Circular dealing with the Public Interest Disclosure Act 1998 which sets out the rights and obligations in relation to whistleblowing and the protection afforded to workers and employees in such situations, and whistleblowing in the NHS.

Further information

GMC – Good Medical Practice, 2006
GMC – Management for Doctors, 2006
OPSI – Public Interest Disclosure Act 1998
PCAW – Public Concern at Work Scotland.