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How to blow the whistle safely

MDU medicolegal adviser Dr Emma Cuzner offers 10 nuggets of advice on how best to raise concerns over a policy or a colleague’s practice

By Dr Emma Cuzner

MDU medicolegal adviser Dr Emma Cuzner offers 10 nuggets of advice on how best to raise concerns over a policy or a colleague's practice

Many GPs have had occasional nagging doubts that they ought to raise concerns they have about a practice colleague or a local policy. Was that a whiff of alcohol at 10am? Should something be done about the doctor that a patient confided is rude and offhand? Should I co-operate with a policy change that might harm patient care?

The safety of patients must come first and GPs are required by the GMC to protect patients from harm posed by another GP or health professional's conduct, performance or health, or from local policies or a lack of resources that may compromise patient care1.

It can take courage to raise concerns but following these 10 top tips, based on advice the Medical Defence Union gives to members, will help to ensure you take the appropriate steps:

1 You may be reluctant to report concerns about a colleague or about patient safety being compromised. However, the GMC advises that patients' interests must come first and protecting them must override personal and professional loyalties2.

2 Get advice from your medical defence organisation – it can talk you through the steps to take if you need to raise your concerns.

3 Keep a record of your concerns and any steps you have taken to resolve them.

4 Remember that it may be more appropriate to approach your colleague first, setting out your concerns about their behaviour or performance and seeking an explanation.

5 Put your concerns in writing and ask for them to be addressed and for a written reply to confirm that this has been done.

6 If you have concerns about a policy or system that affects other professional colleagues, you could consider joining forces to send a consolidated letter of concern, which may have a greater impact.

7 Consider how you could raise your concerns locally in the first instance – for example, with a senior colleague or with your primary care organisation.

8 If you have raised your concerns locally and feel they are not being addressed or taken seriously and that patients may be harmed as a result, you may need to take further action such as informing the GMC.

9 If you have concerns about a colleague, the GMC says it is important to be ‘clear, honest and objective about the reason'3.

10 You could be criticised if you know of problems and do nothing.

Case study: inebriated GP colleague

A GP had previously smelt alcohol on a colleague's breath and that morning had noticed the doctor's speech was also slurred. She rang her defence organisation to ask what she should do.
She was advised that the care of patients was the principal concern and she had an obligation to take steps to protect them. In this instance, the defence organisation advised the GP to discuss the situation with her colleague as soon as possible. If the colleague was due to be seeing patients that day it was important to act immediately. She was also advised to record in writing her concerns and all the actions taken.
If the colleague denied there was a problem or refused to seek help, the GP was advised she would have an obligation to take the matter further if she still had concerns that his conduct might affect patient safety. This could be to a senior partner in the practice, the LMC or the PCT.
The GP's final recourse, where there are no appropriate local systems or local systems do not resolve the problem and there is a continuing risk to the safety of patients, would be to inform the GMC of her concerns.
The GP rang again later to say that, on confronting her colleague, he at first denied there was a problem. But when presented with the evidence, he admitted he had been drinking rather more lately and agreed to see his own GP to get help. He agreed not to see patients until he was fit to do so.

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