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GPs are to receive guidance on how to help a staff member concerned about a development at work and how to report it

If one of your staff felt something was going wrong in your practice, how sure are you that they would be confident enough to discuss it with you? Would they feel they were taking up your valuable time, or that it wasn't their place to raise the issue? And if they did bring a concern to you, how would you react?

Letting staff know how to raise concerns is a vital part of ensuring the safety of your patients. NHS Employers and the organisation Public Concern at Work are publishing new guidance for GPs on how to introduce a whistleblowing policy and how to involve staff so that they know what to do if they have any concerns. There is a guidance pack that includes a draft policy, case studies and a poster reminding staff there is a safe alternative to silence. This pack is being sent to GPs.

The first step is to set aside time with your staff to discuss whistleblowing in a team meeting. There's no point having a policy if your staff don't understand what it means to them in their daily lives.

The meeting will give you a chance to identify risks; discuss the value of an open and accountable workplace; make staff comfortable and confident to raise a concern about patient safety or other risks; commit to dealing with concerns fairly and professionally and protecting staff who raise a genuine concern; and understanding the importance of a safety valve when the usual channels of communication do not work.

Before the meeting, you should contact your PCT to tell them who will be responsible for handling whistleblowing in your practice, find out who the PCT contact is and how concerns raised outside the practice will be handled.

At the meeting, you could use the case studies that follow to start the discussion among staff members. Ask your staff to think about what went wrong in each case. Why did it go wrong? What could or should have been done differently? Would a whistle-blowing policy have been a help?

The discussion could then move on to wider issues:

·Do your staff think their colleagues would speak up if concerned about something going wrong in the practice?

·Why could it be important to speak up early even if wrong?

·Why might someone initially want to speak in private about a concern?

·What difficulties can arise for the practice or for staff when a concern is not raised openly?

·Why should staff be told they can contact the PCT?

·Should you tell staff they can seek independent confidential advice?

·Where should a staff poster be displayed?

The next stage is to agree your whistleblowing policy. Tailor it to your practice and make sure employment contracts do not send a contrary message. Ask a few members of staff doing different types of work to check the

policy for clarity. Add the correct PCT contact details on the poster. Agree the final whistleblowing policy at the next team meeting.

Display your staff poster prominently. Make sure you inform your PCT of your practice's approach to whistleblowing and/or provide a copy of your policy. Make whistleblowing part of induction and ensure new staff see the poster.

Finally, make sure you revisit your whistleblowing arrangements at intervals.

Practical tips on responding to a concern

·Thank the staff member for telling you, even if the concern proves to be mistaken

·Respect and heed legitimate staff concerns about their own position or career

·Remember there are two sides to every story

·Determine whether there are grounds for concern and if necessary investigate as soon as possible

·Always remember you may have to explain how you handled the concern

·Feed back any outcome and/or remedial action you propose to take to the whistleblower

·Consider reporting to your PCT the outcome of any genuine concern where malpractice or a serious safety risk was identified and addressed

Case study one

Irene took a part-time job as a receptionist at a practice when her children began school. Irene had worked for three months when she overheard a female patient telling another receptionist that she did not want to see Dr Lewis ­ one of the male GPs ­ again. The receptionist said: 'Well, it's not the first time.'

When Irene mentioned this to one of the practice nurses, the nurse told her to ignore her colleague. She thought little more about it until the following week when she took a call from another female patient who refused an appointment with Dr Lewis.

Irene had read a story in the press about a doctor abusing female patients and felt she ought to do something.

When Irene saw a poster in the surgery about Public Concern at Work, she called to ask whether she should tell the GMC or the PCT. Public Concern at Work advised that she have a quiet word with the practice manager first, explaining that with little evidence she may have got things out of perspective.

A couple of days later Irene called Public Concern at Work to say she had talked to the practice manager, who had thanked her for coming to see him.

He assured her there had been no complaints against Dr Lewis, though there were some people who found his sense of humour a little bizarre.

However, he said he would make a note

of the issue and keep an eye on things, and

if Irene had any future concerns to let him know as soon as possible.

Case study two

Sarah was a care assistant in a small, private nursing home and had worked for years on the dementia ward with Joan, a senior nurse. Sarah considered Joan to be a friend.

A month previously, Sarah had noticed that Joan had begun to treat everyone in an off-hand way. Sarah began to worry about the effect on residents.

Sarah heard Joan shout at the residents and then found out she was sedating a particularly difficult resident without a prescription from a GP.

Sarah tried to speak to Joan, but her response was that the doctor would prescribe it soon anyway and that she was just giving everyone a bit of peace.

One night when a resident got out of bed shouting, Sarah saw Joan put her hands briefly around the woman's neck before pushing her back to her room. Sarah then heard screams coming from behind the door.

The following day a locum GP was visiting the home and Sarah mentioned that she was worried that a colleague was being rough with residents. The GP said Sarah should report it and told her she could get advice from Public Concern at Work. Sarah rang and Public Concern at Work talked her through her options.

At first, Sarah said she did not trust the new manager but was worried about what would happen if she went outside the home to the care inspectors. Sarah then said she thought the manager would take issues of care seriously and Public Concern at Work suggested Sarah ask to meet him to explain her concerns.

The next day Sarah spoke to the manager and he began an immediate investigation.

Though initially denying a problem, other staff began to describe incidents that Sarah knew nothing about and Joan was suspended. The police were called in and 10 months later Joan was convicted and jailed for two years.

Gordon Fleck is a senior business manager at NHS Employers with responsibility for safer recruitment issues, including whistleblowing

Anna Myers works at Public Concern at Work

Adapted from Whistleblowing for a Healthy Practice by NHS Employers and Public Concern at Work. The pack is now available on the website of NHS Employers, the employers organisation for the NHS in England, at www.nhsemployers.org/ EmploymentPractice/whistleblowing.asp Copies will also be sent by post to all PCTs and GP practices in England.

Contacts:

Public Concern at Work is a charity that can provide free, independent, confidential advice

at any stage about whistleblowing on

0207 404 6609

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