How to blow the whistle on hospital care

GPs have a duty to raise concerns with their own employer or with external providers under the GMC Good Medical Practice guidance.

Their overriding ethical responsibility means they have an obligation to take action if they think that patient safety, dignity or comfort has been seriously compromised. GPs should not enter into a contract that prevents or restricts them from raising concerns about patient safety. 

The GMC’s supplementary guidance Raising and acting on concerns about patient safety (2012) explains how to take action and what to do if the concerns are not acted on, or are not acted on properly. Paragraphs 7 and 8 explain the duty to raise concerns as follows:

‘All doctors have a duty to raise concerns where they believe that patient safety or care is being compromised by the practice of colleagues or the systems, policies and procedures in the organisations in which they work. They must also encourage and support a culture in which staff can raise concerns openly and safely.

‘You must not enter into contracts or agreements with your employing or contracting body that seek to prevent you from or restrict you in raising concerns about patient safety. Contracts or agreements are void if they intend to stop an employee from making a protected disclosure.’

Most GPs will have very constructive working relationships with colleagues in secondary care and will be able to resolve any concerns informally in a prompt and satisfactory way.

Where there is a systemic or significant patient safety concern then it is appropriate to go to someone higher up in the organisation who has operational oversight and will be able to delegate responsibility for investigating the concerns to the right person and take the necessary action. 

Where serious patient safety concerns are identified, the stages described below will help ensure that they are raised in a prompt, proportionate way.

Stage 1

1. Report concerns immediately – do not delay as you are not in a position to put the matter right yourself.
2. This may be by telephone initially, but put your concerns in writing to the trust’s medical director or other appropriate officer to ensure that they are accurately summarised and reported
3. Keep a clear record of concerns, the steps you have taken and all correspondence
4. Expect a prompt investigation and a written response from the trust explaining what was found and any action taken to rectify the problem
5. If no response or an unsatisfactory response is received, consider escalating complaint further – see Stage 2.

Stage 2

1. Escalate the complaint within the trust. Contact the trust’s chief executive, including all details and correspondence
2. Also consider informing commissioners. Speak to your CCG board, CSU or NHS England local area team medical director
3. If no response or an unsatisfactory response is received, consider escalating complaint further by raising the matter with the relevant regulator – see Stage 3.

Stage 3

1. If you have not been able to raise the issue locally with the responsible person because they are part of the problem, or where your concerns have been dismissed without good cause and where there remains an immediate and serious risk to patients then your duty is to raise the matter with the regulator (e.g. GMC or CQC) who may have responsibility to act.
2. If you are unsure get advice from your medical defence organisation, BMA/LMC, professional bodies, the NHS Whistleblowing helpline (http://wbhelpline.org.uk/) or Public Concern at Work (a charity that provides free, confidential legal advice)

Stage 4

1. In exceptional circumstances, where the stages above have been followed but you believe that patients remain at risk of harm, you may consider whether to make your concerns public
2. You should get advice from your medical defence organisation or other bodies mentioned in stage 3 before taking such action, and refer to GMC guidance on making concerns public. This guidance says that this is justified provided the concern is formed in good faith and you must be scrupulous in protecting patient confidentiality
3. Don’t disclose confidential information and manage the process carefully. Consider making a single disclosure of essential information to one media organisation you can trust

Dr Michael Devlin is head of advisory services at the Medical Defence Union