Blow the whistle and sound the alarm

Niall Dickson, GMC’s chief executive, talks about the importance of speaking up when patient safety is at risk.

What struck me most about the findings of the Francis Report was not what doctors did do, but what they didn’t do. Their failure to cross over the ward when they saw neglect. Their failure to take or share the blame. Most of all, their failure to sound the alarm when they knew that, even when patients’ lives weren’t at risk, their comfort and dignity were being compromised.

Part of the issue at Stafford was that doctors were discouraged, either actively or by the prevailing culture, from coming forward. I acknowledge that raising concerns about patient safety or ‘speaking up’ can be a daunting prospect even for a self confident professional. Sometimes there may be doubt as to how serious the issue really is, sometimes fear of the personal consequences of seeming to criticise colleagues or superiors and sometimes what may seem unacceptable seems acceptable to everyone else. But, of course, the risks to patients of failing to act should always outweigh these concerns. And it’s one of the reasons why for the first time we’ve made explicit in the new version of Good medical practice that doctors have a duty to immediately tell a colleague or manager who is in a position to act straight away.

image of doctors in discussion

Our guidance demands that doctors take prompt action if they think that patient safety is or may be seriously compromised. That means if they have doubts about a colleague’s conduct, skills or knowledge they need to do something and report it. If they think patients are at risk because of inadequate premises, equipment or other resources, or policies or systems, they need to speak up and act swiftly to put it right.

And for the first time – following on from the first Francis inquiry – we’re also clear about doctors’ responsibilities when patients’ basic care needs – their comfort and dignity – are not being met. Basic care is not the sole responsibility of nurses and managers – doctors have responsibility for whole patient care – they must take the lead on this.

Raising concerns

So where should a doctor take his or her concern? If possible the first choice should be local, so that action can be taken quickly to remedy the situation. Often this will mean raising the matter with the consultant or clinical manager responsible for that patient or department but for whatever reason – if the doctor does not feel comfortable or able to raise it within the organisation, there are a variety of different organisations, including the GMC who can provide support and advice. Some doctors will choose to go to their college, the BMA or medical defence organisation, while others can contact our confidential helpline on 0161 923 6399. We also have a decision-making tool that helps doctors map out their options when they have a concern about patient safety. On top of this, we are happy to talk through any issues, advise on how to take forward concerns in line with our guidance and, if appropriate, open up an investigation. We have issued new guidance both on how to raise a concern and for those in leadership positions, how to respond when concerns are raised.

In the long term, this is about empowerment – doctors and other health professionals have to feel they can act to protect patients without fear of it harming them or their careers. It is, of course, a duty as well – with the powers and privilege of medical practice comes responsibilities and this is one of the most crucial. As Dame Janet Smith said in her report of the Shipman enquiry: ‘The greatest patient safety device is the eyes and ears of fellow professionals’.

The initial response to our helpline is encouraging – since it opened in December last year we have received 392 calls. And these have led us to open more than 20 serious investigations. We have also seen doctors in training willing to raise concerns about patient safety in our annual survey – last year more than 2000 of them raised patient safety concerns about where they were working, all of which were followed up.

In the long term though this has to be about creating a culture within every healthcare organisation where staff feel able to challenge and discuss, where learning from experience and mistakes is actively encouraged, and where hierarchies are never allowed to stand in the way of patient safety. That is a challenge both for the local leadership of every organisation and for the leadership of medicine and it is why in the latest edition of Good medical practice we now require doctors to promote and encourage a culture that allows staff to raise concerns openly and safely.

A reluctance to come forward may seem out of kilter in the age of Twitter and Facebook but we need to accept that there is still a long way to go to achieve the open and transparent system of healthcare to which we should all aspire.

Further information

Read Good medical practice
Read Raising and acting on concerns about patient safety

Join our Twitter chat

In that spirit, we’ll be hosting a discussion on Twitter on Friday 21 June between 12noon and 1pm to explore more about what barriers doctors are facing in terms of raising concerns, and how – or indeed if – they’re managing to overcome them.

The hashtag for the Twitter chat will be #GMCchat. You can follow us on Twitter at @gmcuk.

Good medical practice has patient safety at its heart, so do speak up – it is in all our interests that you do.

9 responses to “Blow the whistle and sound the alarm

  1. Highlighting this issue at the highest level is an encouraging start. Indeed many doctors have remained silent despite witnessing appalling standards of care. However, it is also the case that many have raised concerns but have been ignored or worse been given marching orders.
    It is nevertheless humbling to note that medical directors, clinical directors and other doctors in various managerial positions have chosen on many occasions to endorse decisions that have directly or indirectly resulted in poor standards of care and therefore the medical profession especially those in influential positions in health care organisations and colleges will have to accept some share of the responsibility.

    The GMC also may have inadvertently in fact increased the reluctance of doctors to raise issues. By in most cases announcing that the medical director shall be the responsible officer for revalidation, will mean that those who seek to differ or may disagree with operational or organisational decisions shall always have the implicit if not explicit threat of losing their licence to practice. It is hoped that the GMC shall be able to look into this rule that may in fact have the opposite effect rendering revalidation as a tool that medical directors shall be able to use as a threat to bring clinicians to heel.

    • You raise some interesting points. As doctors, responsible officers must follow our professional standards like every other medical professional. Our leadership and management guidance says doctors who are in leadership positions ‘must be honest and objective and keep to the principles of equality and diversity when appraising or assessing colleagues’ performance’.

      The Department of Health also gives guidance for responsible officers that lays out a clear code of conduct: ‘It is important that the evaluation of a doctor’s fitness to practise is fair, honest and evidence based if it is to provide the assurances that patients and doctors require from the system’. Their guidance also includes what to do when there are concerns about responsible officers making recommendations free from conflict of interest or appearance of bias. – GMC Media Team

    • FI your comment hits the nail on the head in my situation the objects of the whistling were the Hospital Manager and Medical Director! The result they have gone with large payoffs, my revalidation has been put off for 6 months and I have had to find another job, patient care has been compromised but the hospital will survive due to the effort of an extremely depleted and demoralised team. Vested interests and profit seem to be what matters.

  2. Ok, blow the whistle when you work for an independant organisation (one of the biggest in the UK) and expect to be attacked, discriminated, against and abused without support or protection. I, for one, am only here to work for my patients, but now realise that the profession is as professions are – a conspiracy against the laity (a reference to George Bernard Shaw ‘The Doctor’s Dilemma’). The reality is that we are being screwed again in the current political and economic situation.

  3. Sir,
    My name is Dr Amer M A Shata. My GMC Reference Number: 4455893
    It is very interesting to receive this “Blow the whistle and sound the alarm”. And from who? from the GMC website
    This is not the first or even the hundred times that I have accused and pointed to the GMC in writing that : “the GMC is misleading the public, misguiding the doctors”.
    Years ago, I reported to GMC gross negligence, ignorance and crimes. I paid heavy price because the GMC chose to cover up the negligence and to take advantage of me as junior doctor of foreign name (at then time). The Fitness to Practice Directorate is still playing the game..the game of “GMC can not go back to investigate incidents that happened more than 5 years ago”. But cases were reported to GMC in the appropriate time and it was the GMC’s choice to cover up crimes.
    Had the GMC recated earlier, had the GMC NOT been covering up the crimes earlier, this following case would have never happened years later by the same doctor and in the same hospital. How can a medical case reach as far the European Court of Human Rights while the GMC is still deaf blind and more.
    Please click on the links below to find more about the scandal:

    Damages awarded to parents in care case
    http://justiceforfamilies.freeforums.org/damages-awarded-to-parents-in-care-case-t1608.html#p10557

    http://www.bailii.org/cgi-bin/markup.cgi?doc=/eu/cases/ECHR/2008/950.html&query=AK+and+RK&method=boolean
    http://news.bbc.co.uk/1/hi/england/manc … 642434.stm

  4. I blew a relatively small whistle at a previous trust and was, I believe, disciplined because of that. Meanwhile no-one was held accountable for the serious issues I raised. It is my sincere belief that, mainly as a result of this, attempts were made to effectively “manage me out”. The, then, medical director was cruical to those attempts. At one point I feared about revalidation but “got out” before it became a live issue.
    My main point is that GMC has placed Responsible officers (In the vast majority of trusts the Medical Director) at the centre of the revalidation strategy and has thus handed those individuals a large amount of potential power. Medical Directors are appointed by Trust Boards / executives who are normally anxious to “bury bad news” and, no matter what is said in public, do not wish to encourage whistle-blowing. If you (the GMC) concentrate the power to revalidate in the hands of individuals beholden to trust boards then, I would strongly argue you discourage rather than encourage active whistle-blowing.
    Emma’s reply to FI on the website misses the practicalities of the situation and is a triumph of distant idealistic naivity over a pragmatic understanding of the day to day problems of frontline clinicians. The GMCs actions would appear to me to be at odds with their stated intent.
    My second point is the apparent failure of the GMC and others to take appropriate action when concerns are raised / proved. In the BMJ 2012 (BMJ 2012;345;e5191) there was a clear accusation that the GMC had allowed approx 100 doctors who were convicted of accessing child pornography to remain on the medical register. On searching I can find no public rebuttal of this and must, therefore assume it is true. I have raised concerns with MONITOR about actions of a trust which the current goverment is considering making illegal and the result when fed back to me was that they had actually increased the trust’s governance rating to the maximum allowable. The rather (admittedly) cynical point I am making is that the NHS and it’s patients have been failed repeadly by its regulators (which are wider than merely the GMC). What reassurances can you give that, when important issues are raised they will be taken seriously and acted upon properly? Please don’t expect individuals to metaphorically put their necks on the line if the wider establishment (including the GMC) doesn’t / won’t act in an appropiate way when those concerns are raised.

  5. Pingback: Case 5: raising concerns | Question of the week at UCL Medical School·

  6. It is good to hear that the GMC is working for greater openness in health care, it benefits everyone.
    I wonder: do the first points of contact at the GMC have the right level of knowledge to understand more nuanced issues?
    How might a concerned doctor raise the alarm at a higher level if the first response seems not to have fully grasped the seriousness of the situation?

    • It is absolutely right that callers have to have access to helpful trained staff from the first call. We have worked with Public Concern at Work to develop our Confidential Helpline Service. Where necessary, calls are referred to Fitness to Practise. We would encourage anyone who has concerns about the way their call has been dealt or handled to speak to a manager in our Contact Centre. – GMC Media Team

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