The GMC’s Director of Education and Standards, Dr Colin Melville, addresses some of the concerns raised following the ruling in the Dr Bawa-Garba case this week.

I know that many doctors are feeling anxious after the outcome of this week’s High Court appeal. I acknowledge the strength of feeling and I recognise the concerns.

I am hugely grateful for your ongoing contribution to our health services and for your commitment and dedication to put patients first in times of pressure. We know that any doctor, no matter how experienced, can make a mistake, particularly when working under pressure. What’s important is how you respond. I wanted to provide some advice to try and allay some of the fears I’m hearing from doctors.

Will the GMC take action against me if I refuse to work in unsafe conditions?

If you are following all our guidance – on the duty of candour and raising concerns – and keeping a record of your decisions and actions, you have nothing to fear. Of course we need to look at complaints raised with us but we take action against doctors only where serious and persistent breaches of our guidance put patients at risk or harm the public’s trust in the profession.

What do you expect of doctors in leadership roles, if doctors are reporting concerns about their working environment?

It’s really important that all doctors feel supported in being able to speak up and raise concerns. We’re clear that doctors in positions of leadership: responsible for clinical governance or with wider managerial responsibilities have a duty to help others report their concerns and to enable people to act on concerns that are raised with them. They must make sure there are mechanisms in place to allow concerns to be raised, that employees aren’t prevented from doing so, and that staff that raise a concern are protected from unfair criticism or action.

How do I raise concerns about my training and working environment?

It’s crucial that doctors in training make their concerns known so that they can be addressed. If you have concerns about your training environment you must use exception reporting in England to flag concerns. If your working environment is unsafe or you’re unable to maintain standards of care, you must raise concerns, either through your supervisor, your defence organisation or via our confidential helpline.

I know it’s not always easy to raise an issue, but please make sure you do. Our guidance on Raising and acting on concerns about patient safety sets out the steps to take.

After I have raised concerns about my working environment, do I continue to work? Who is responsible if something goes wrong?

You need to consider the risks to patients from any refusal to cover a shift, and wherever possible, work collaboratively with colleagues to find a solution. If you feel under pressure to cover a rota gap, please carefully consider your own health and welfare and the impact on your practice if you are exhausted.

As doctors, we are accountable for our professional practice and must be prepared to explain and justify decisions and actions, so it is important to keep a record of how you have handled your safety concerns.

I recognise the current pressures you are under, and the anxiety that this issue has generated. I hope that this advice helps to allay some of those concerns.