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Ian McNeill, Head of the GMC’s Regional Liaison Service, explains how a new information sharing agreement between regulators in England is improving the way we share and act on concerns to protect patients and doctors.

Overstretched. Exhausted. Burnt out.  These are words my team hear every week from doctors about how they feel working in challenging, pressured and often under-staffed care settings.

We speak to around 30,000 doctors on the frontline each year and we know that they and other healthcare professionals are working harder than ever to provide high quality care under very difficult circumstances.

No one should feel like this at work and it’s crucial that staff are empowered to raise concerns. Sadly, we know it takes immense courage to speak up. Those who do deserve assurance that they will be listened to, and where necessary their concerns acted upon. We all need employers and those in authority to listen to doctors and other clinicians, especially those in training, as they move around more and see things with fresh eyes. This applies to regulators too.

Traditionally regulation has been a reactive instrument, responding after things have gone wrong. The GMC has publicly committed to moving away from that model to be a proactive regulator, intervening where risks exist before something goes wrong.

Regulators of all types have an important role to play within their sphere of responsibility – be that for a profession or care provider. But everything is interconnected. A doctor’s ability to provide high quality care may be hampered by poor supervision, equipment, rota gaps or access to training. Therefore, to be truly effective, professional and system regulators need to collaborate even more closely to identify and act on shared concerns, at the earliest opportunity.

This year we’ve taken positive steps to improve the way we work together. As part of that commitment, the GMC has joined eight other healthcare regulators* in England to launch the emerging concerns protocol, a new mechanism for sharing and escalating information. It is our ambition that this will strengthen the way we work together and ensure that risks are acted upon at an early stage and in a more consistent way.

Putting the protocol into action

We’ve already seen the protocol used to a positive effect four times in London and the Midlands.

One of our Regional Liaison Advisers (RLA) became the first to put the system to the test after a senior NHS doctor flagged concerns about poor-quality theatre equipment; surgical packs were missing parts and contained instruments that broke during surgery. And it soon became apparent that this wasn’t just a local issue – the supplier had provided equipment to several other public and private care organisations.

The issue was escalated immediately within the GMC before the protocol was used to trigger one of the new Regulatory Review Panels (RRP) with the CQC, NMC, HEE, NHSI and other partner organisations. We were able to agree a course of action and referral to other non-signatory regulators. Between the CQC and these other organisations, steps to remove these items happened within hours, protecting both patients and staff.

Other situations where the protocol has already been used include a hospital with a lack of senior clinical supervision for trainee doctors out of hours; and concerns about the quality of care provided for patients on a particular treatment pathway in another organisation.

In using this protocol we also hope to alleviate regulatory burden on employers and providers. By identifying shared concerns early these can often be resolved locally, in partnership with those responsible, before a serious issue occurs and more formal (and burdensome) regulatory intervention is required.

Making improvements to improve future care

We’ll continue to track the success of the protocol, to ensure its being used to its full potential.  We are also exploring establishing similar escalation processes, building on protocols already in place (where they exist), with partners in Northern Ireland, Scotland and Wales.

It is vital we keep up the momentum and ensure we do take advantage of these systems as often as possible. We hope this will result in safer working environments, where all healthcare professionals feel supported to provide high quality care to patients. And ultimately, where staff need to raise fewer concerns in future.

If you’d like more information about the emerging concerns protocol or the work of the Regional Liaison Service, email Regional Liaison Service Administrator Grace Cousins: grace.cousins@gmc-uk.org.

The signatories of the protocol are: the Care Quality Commission, General Dental Council, General Pharmaceutical Council, Health and Care Professions Council, Health Education England, Local Government and Social Care Ombudsman, Nursing and Midwifery Council and the Parliamentary and Health Service Ombudsman.