Fitness to practise reforms: a step towards better protection for whistleblowers in the NHS

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.

Organisation referral process

What happens when an organisation refers a doctor to the GMC?

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

Related posts

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

6 responses to “Fitness to practise reforms: a step towards better protection for whistleblowers in the NHS

  1. The concept of whistle blowing is very ill defined. Various NHS managers – and this includes clinicians who have taken on a management role – seem excessively concerned to suppress criticism and negative comments about their work. Accusations of ‘behaving unprofessionally’ are regularly used in an attempt to silence criticism and negative comments.

    In my CCG managers are regularly critical of what they characterise as ‘vocal GPs’, and often seek to isolate them by various means, and thus ignore the factual basis that underlies their criticisms. In contrast they are much more tolerant of poor performance from CCG managers or Trust managers, whatever impact this may be having on patient care. To some extent I believe these attitudes are driven by the central leadership of the NHS; I suspect also that CCG chairs in particular are indoctrinated on appointment in a manner that seems to impair their ability to deal constructively with negative comments.

    I don’t believe my CCG is any worse than average for England in this regard.

    If this proposal is to achieve a positive contribution then I think it will be necessary to widen the concept of ‘whistle blowing ‘ to include any kind of negative comment made by the individual. It would be necessary to check the information provided by the referring organisation against the information provided by the doctor concerned.

    I hope this is clear. I would be happy to discuss further if that would be helpful.

    • Dear Dr Kelpie,

      Thank you for your feedback on this new approach. During the pilot, we are defining patient safety concerns as concerns about danger, illegality or anything else that poses a risk to patients, that is in the public interest and has been raised with an appropriate body (for example, the doctor’s employer). This is intended to capture the spirit of Sir Robert Francis’ definition of whistleblowing, which Sir Anthony Hooper refers to on page 2 of his report. The purpose of the pilot is to make sure that the approach is working as an effective safeguard and strikes the right balance between effective patient protection and reducing the impact of a referral on doctors.

      In relation to your second comment, the overall aim of the referral form and declaration is to help prevent referrals coming to us which are not fair and accurate. Referrers will need to take reasonable steps to make sure that any referral they make is fair and accurate and we will ask them to confirm this. However, if there is evidence that a referral involves dishonesty or an attempt to mislead, the referrers own registration would be at risk. This isn’t a change to our current processes and guidance – Good medical practice is clear that doctors ‘must be honest and trustworthy when writing reports, and when completing or signing forms, reports and other documents’. But, where there has been dishonesty, the form (and the declaration contained in it) will assist us to prove such misconduct.

      We hope this information is helpful.

      Kind regards,
      GMC social media team

  2. This is in addition to my earlier comment regarding whistle blowing and victimisation.
    A further measure which I think the GMC should add is that where doctors with managerial responsibility are suspected of being complicit in victimisation then they should be subject to investigation, and if appropriate disciplinary action by the GMC.
    At present it is just too easy for those in management positions (whatever their job title) to abuse referral to the GMC as one of their repertoire of bullying tactics.
    Disciplinary action for managers is clearly not something we have credible mechanisms for at the moment. For doctors however the GMC does have mechanisms. Doctors with management roles should not be able to escape these when their conduct requires them.

    Best wishes

    Tony Kelpie

  3. Letter sent 21July 2016 to Cathy James Chief Executive of Public Concern at Work:

    “To Cathy James Chief Executive Public Concern at Work, 21 July 2016

    Dear Cathy,

    GMC’s implementation of Sir Anthony Hooper’s recommendations

    I write in response to your blog of 20 July, posted by GMC on this matter. In this blog you welcome GMC’s new approach to referrals of whistleblower doctors to GMC, which as you are aware have sometimes been vexatious in a nature and a form of punishment for raising concerns.

    https://gmcuk.wordpress.com/2016/07/19/fitness-to-practise-reforms-a-step-towards-better-protection-for-whistleblowers-in-the-nhs/

    In short, Sir Anthony’s key recommendations were that referring bodies should declare whether a doctor being referred to the GMC has previously raised concerns, that the referrer should make a statement of truth about their referral and that referrals should be made by a registered doctor, to provide increased accountability and to enable improper referrals to be dealt with under professional processes.

    I do not know if you had sight of the pilot referral form that GMC has agreed with Responsible Officers – attached – before writing your blog, but I do not think that the form meets Sir Anthony’s requirements:

    1. The GMC’s pilot referral form asks only if the referred doctor has raised patient safety related concerns, which is a restrictive focus.

    Sir Anthony in fact recommended a question about whether a referred doctor had raised concerns about “patient safety or the integrity of the system”, without requiring the latter to relate to patient safety.

    2. The GMC’s pilot referral form permits referrals to be signed by parties other than registered doctors.

    This undermines the principle of greater professional accountability for the probity of referrals, which Sir Anthony recommended.

    I also attach the relevant excerpts from the form.

    I would be grateful to hear from you if Public Concern at Work will now address these issues with GMC and also whether these omissions by GMC will now be reflected in your blog.

    Many thanks and best wishes,

    Dr Minh Alexander”

    • Dear Dr Alexander,

      Many thanks for your feedback on this new approach. During the pilot, we are defining patient safety concerns as concerns about danger, illegality or anything else that poses a risk to patients, that is in the public interest and has been raised with an appropriate body (for example, the doctor’s employer). This is intended to capture the spirit of Sir Robert Francis’ definition of whistleblowing, which Sir Anthony Hooper refers to on page 2 of his report.

      In relation to your second point, the declaration in the form should be signed by the Responsible Officer (or with their knowledge), their delegate or any other appropriate member of staff from the organisation (for example, the medical director). This was extended beyond Responsible Officers because, in light of the variety of structures within which Responsible Officers work, with some overseeing systems in large bodies with responsibility for a large number of doctors, requiring them to sign forms individually is impractical. However, our guidance makes it clear that overall responsibility for the content of the form remains with the Responsible Officer.

      There is further information on this in the our accompanying guidance [PDF] (page 4 – ‘you may choose to delegate the administration of the referral, but you remain accountable for the referral’) and our action plan [PDF].

      The purpose of the pilot is to make sure that the approach is working as an effective safeguard and strikes the right balance between effective patient protection and reducing the impact of a referral on doctors.

      We hope this information is helpful.

      Kind regards,
      GMC social media team

  4. What saddens me is all leaders who have commented in this article or the blogs are White. They are all nice people and doing great job. Buthe why can’t GMC make sure they follow true inclusion and diversity and appoint BME senior leaders, make sure there are honest comments and blogs on this subject by some good BME leaders who are the real experts? Charity begins at home and GMC as a regulator must always lead from the front and lead by example. Sad reality is every Institution in NHS has either No BME in senior leadership position or some BME who admires their White leaders are appointed. This creates a dangerous uni-cultural leadership.

    Multi-cultural UK a haa uni-cultural leadership and no wonder country is divided. Regulators must lead by example and lead from the front and all leaders must be value based who create a value based culture and accountability

    Brexit is simply a wake up call for all of us. Country can not continue to sleep walk when thousands of patients are dying and many BME staff are suffering

    GMC is just a tip of the iceberg and has come a long-way but if anyone thinks these reforms will protect patients then you are letting patients, staff and NHS down and yourselves down as one day we all will be patients of NHS.

Leave a comment

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out / Change )

Twitter picture

You are commenting using your Twitter account. Log Out / Change )

Facebook photo

You are commenting using your Facebook account. Log Out / Change )

Google+ photo

You are commenting using your Google+ account. Log Out / Change )

Connecting to %s