We hear far too many cases where those working in the NHS suffer retaliation or victimisation for having raised a whistleblowing concern. Here at Public Concern at Work (PCaW), the whistleblowing charity, this is an all too familiar story. Where it’s possible for the victimisation to lead to a career ending hearing about the whistleblower’s fitness to practise, this can be particularly damaging.
We hear far too many cases where those working in the NHS suffer retaliation or victimisation for having raised a whistleblowing concern.
We therefore welcome the GMC’s new approach to fitness to practise referrals which are designed to try and address this issue. In particular the aim is to change the way the GMC responds to fitness to practise referrals from organisations in the health sector and to reduce the impact of referrals on doctors in certain circumstances.
The aim is to change the way the GMC responds to fitness to practise referrals from organisations in the health sector.
A study published in the BMJ last year found doctors to be at an increased risk of anxiety, depression and thoughts of self-harm when their clinical practice is under investigation.
Checking the fairness of referrals from organisations
The key change to this process requires organisations to answer a series of questions which will check whether a whistleblowing concern has been raised by the doctor being referred, whether that issue has been investigated and whether the doctor knows about the referral. The organisation must also confirm that the information provided in the referral form is fair and accurate (a so-called ‘statement of truth’). Where the referrer confirms that a whistleblowing concern has been raised by the doctor being referred, the GMC will carry out preliminary checks before deciding to open an investigation.
This change in process provides an additional layer of protection to whistleblowers as it will likely reduce the risk of retaliatory referrals. Requiring, in effect, a statement of truth from the referring organisation will mean that such referrals are more considered and are sense checked before being passed to the GMC.
Speeding up the process for one-off clinical mistakes
The GMC is also piloting a more streamlined approach to certain types of fitness to practise complaints. Where a doctor has erred from accepted practice in one sole incident, and the doctor understands and admits their error, except in a small number of the most serious cases, the GMC will be unlikely to find they are an ongoing risk to patient safety. The GMC believes such instances may account for between 15% and 20% of fitness to practise referrals and hopes to identify and resolve such instances quickly.
Doctors who admit their error will not be subject to the normal, sometimes lengthy, fitness to practise investigations that can stop them from doing their job.
This seems a sensible approach for two reasons. Firstly, doctors who admit their error will not be subject to the normal, sometimes lengthy, fitness to practise investigations that can stop them from doing their job. It is obviously important that doctors whose clinical practice poses a risk are kept away from patients.
But, where a doctor has made one lapse in judgment and understands and atones for that error, it is not in the public interest to remove them from practice, increasing the strain on colleagues and the system as a whole. The new process will also save the GMC from committing resources to unnecessary investigations.
Having a quick and constructive process whereby lessons are learned without disciplinary action may help to normalise the process of whistleblowing.
Secondly, seeing that fitness to practise referrals do not always result in a protracted and accusatory process may lessen staff’s anxieties around raising concerns. Having a quick and constructive process whereby lessons are learned without disciplinary action may help to normalise the process of whistleblowing, so problems can be addressed and resolved with greater efficiency.
The introduction of these changes is also, to some extent, an acknowledgement that there has been a problem with malicious referrals to the GMC. Sir Anthony Hooper’s review of GMC cases involving whistleblowers recommended certain steps should be taken to ensure fitness to practise referrals were not being used to victimise whistleblowers. These pilot schemes by the GMC are intended to meet Sir Anthony’s recommendations.
There is no quick fix to change attitudes towards whistleblowing but the GMC’s proposals, as well as efforts from other organisations, will hopefully start the much needed cultural change in the NHS.
The GMC also encourages whistleblowers by offering guidance and tools on how to raise concerns when patient safety is at risk and provides a confidential helpline (0161 923 6399), which supports those with concerns about clinical practice. Of course, the PCaW advice line is also a good place to go for advice about a whistleblowing concern.
As ever, there is no quick fix to change attitudes towards whistleblowing but the GMC’s proposals, as well as efforts from other organisations, such as the appointment of a National Guardian for whistleblowing and the setting up of a network of local Freedom to Speak UP Guardians across the NHS in England, will hopefully start the much needed cultural change in the NHS.
Cathy James OBE is Chief Executive of Public Concern at Work (PCaW). PCaW, the whistleblowing charity, runs a confidential advice line for workers who witness wrongdoing or malpractice in the work place. Since being established in 1993, the charity has advised over 21,000 whistleblowers. PCaW also works with organisations and campaigns on public policy to encourage workplace whistleblowing. For further information, please visit pcaw.org.uk.
The GMC’s Anna Rowland talks about new proposals aimed at easing the pressure on vulnerable doctors subject to a GMC investigation
Prof Terence Stephenson, Chair of the GMC, shares his personal reflections on whistleblowing and the everyday challenges of raising and acting on concerns
Prof Louis Appleby blogs about his recent work to identify what changes could be made to help make GMC processes more compassionate