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GPs buried under trusts' workload dump

Answering trainee doctors' medicolegal queries

Dr Ellie Mein, Medical Defence Union

With the new cohort of trainee doctors starting, Dr Ellie Mein, medicolegal adviser at the Medical Defence Union (MDU) answers some common medicolegal questions from foundation doctors.

Raising concerns in the workplace

If you’re concerned that a colleague’s health may be posing a threat to patient safety, the GMC’s guidance states that all doctors have a duty to raise concerns where they believe that patient safety or care is being compromised. For example, you may be concerned that a colleague is coming to work under the influence of drugs or alcohol. Raising concerns would also be in your colleague’s interests as they can then be offered treatment and support.

The MDU can provide you with specific support, but consider taking the following steps:

  • Consider approaching the colleague directly to discuss your concerns, encouraging them to leave work and to talk to their supervisor and/or GP
  • Make it clear to your unwell colleague that you will take action if they continue to work while clearly unfit to do so
  • If you don’t feel able to approach your colleague directly or have had tried to do so unsuccessfully, for example because the person did not take such discussions seriously, reacted angrily or refused to accept help, follow your hospital’s established procedures for raising concerns. This would usually require concerns to be raised in writing but in acute situations, it’s better to speak to the designated person in the relevant department straightaway
  • The GMC expects doctors to keep a record of their concerns and the steps they have taken to resolve them
  • In the unlikely event that no action is taken and the doctor remains a serious threat to patients, you should escalate your concerns. This would mean contacting a more senior manager within the trust, a postgraduate dean at your local education and training board or the GMC

Having acted on concerns, avoid any departmental gossip about the unwell colleague: they are entitled to the same degree of sensitivity and confidentiality about their health as any other patient.

Further advice on raising concerns can be found here.

Working in an understaffed department

The GMC advises that if doctors consider their working conditions unsafe, they should try to work with colleagues to establish a way to provide the safest care possible to patients. If you have such concerns raise these directly with a senior colleague or ask someone else to on your behalf.

Doctors should be aware of who to contact when they have concerns and how to do so. Keep a written record of what action has been taken. If you raise concerns by phone, follow this up with an email referring to the conversation, so both parties have a record of what was discussed and agreed.

The guidance highlights that employers are responsible for ensuring that working environments are safe and that the appropriate supervision and support are provided.

In summary, when doctors feel that staffing arrangements pose a patient safety issue they are advised to follow the GMC’s guidance Raising and acting on concerns, keep a record of the steps they have taken and be able to justify their actions if necessary.

Private work and prescriptions

When thinking about taking on private medical services, bear in mind that if you’re an FY1 doctor, you only have provisional GMC registration which means you’re not permitted to undertake any kind of service post, other than an approved UK FY1 programme.

FY2 doctors are fully registered with the GMC. However, there are still barriers to them providing private services as they are still required to practice in an Approved Practice Setting (APS). 

The GMC are clear that if you’re working under APS restrictions, you’re not limited to only working within their designated body. You can work in other organisations provided you remain connected with the designated body. Locum work, however, can only be undertaken if the locum agency is also a designated body.

The GMC stipulates that doctors who are on a UK training programme and who wish to practise outside of their substantive employment must make their educational supervisor aware of such work. You would also need to comply with any reporting requirement set by your training body or Responsible Officer (RO).

FY2 doctors can write private prescriptions while under APS restrictions subject to compliance with appropriate GMC guidance. FY1 doctors cannot write private prescriptions.

However, as we explain below, it will rarely be appropriate for foundation doctors to write a private prescription for a relative, friend or acquaintance. Wherever possible, you must also avoid self-prescribing.

Reflections

Formal reflective writing is an increasingly important part of medical training and ongoing development. However, following the Dr Hadiza Bawa-Garba case, it’s understandably also a cause for concern among many doctors. We get enquiries about how to frame reflective documents given the potential for them to later be used against doctors.

Pulse recently covered the short guide, called The Reflective Practitioner, that was produced on this topic by various medical organisation and confirms that the GMC won’t ask a doctor to disclose reflective notes to assist in their investigations unless the doctor wants to disclose the note in order to demonstrate insight. However, they explain that these notes can still be required by a court. As such, reflective notes ‘should focus on the learning rather than a full discussion of the case or situation. Factual details should be recorded elsewhere.’

The joint guidance is clear that if you are asked by courts to disclose part of your learning portfolio then you should seek advice from your ‘employer, legal adviser, medical defence organisation or professional association.’ If you have any concerns about such requests then please contact us for advice.

Dr Ellie Mein is medicolegal adviser at the MDU 

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Readers' comments (9)

  • Cobblers

    I have read and reread this and it makes me very uncomfortable. This is a FY1, a Houseplant, a gopher, a dogsbody and the lowest of the low on the medical scale. No doubt this advice is the council of perfection and medico-legally sound BUT my head is screaming that if the FY1 has noted the problem then others more senior will have too. Why are the seniors not dobbing this person in? Probably because they know that by adopting the three wise monkeys’ approach (see no evil, speak no evil, hear no evil) that they can keep their heads down and avoid the inevitable shit storm that will happen to whistleblowers. A FY1, or probably anyone, who acts like is suggested by bypassing lower managers and going up the feeding chain to achieve action will get action, against themselves, and find further progress along their career path is quietly blocked.

    A cynical approach and, no doubt, some (hello GMC?) may feel that such thoughts heretical and actionable but I am long retired and happily stick deux digits up to the GMC. I am a pragmatist and suggest that doing your own job as well as you can and avoid being a proud upstanding nail (whistleblower) in the NHS as you’ll only get hammered.

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  • Well said Cobblers. Gives a nice balanced realistic view.

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  • Having stuck my head above the parapets on a few occasions in the past I completely agree with Cobblers. Unless you are pretty sure of a nailed on post in GP you should keep your head right down while working in hospitals. Whistleblowing sucks in the NHS. I was told by three people that they would ‘end by career’ when I raised legitimate concerns as a junior doctor. luckily I was never planning the sort of ‘career’ that they meant as was heading for the sinking prison hulk of primary care.

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  • Never whistleblow. You have nothing to gain and everything to lose. Managers are there for a reason, to manage such situations, not your job.

    Best thing someone ever told me - there are no medals for bravery in NHS - this applies to everything whistleblowing, going the extra mile for a patient or colleague, taking risks I,e not refer etc.

    Look after yourself and your family

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  • Poor Ellie probably spent a long time writing her article. Totally agree with the wise comments of the readers.

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  • If you’re concerned that THE SYSTEM may be posing a threat to patient safety, the GMC’s PRACTICAL VIEW (BAWA-GARBA) IS TO BLAME THE doctors CAUSE WE (GMC) DON'T HAVE THE BALLS TO CHALLENGE THIS.

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  • Moral of the story is only to reflect on those issues in the system that could be improved and not the individual-self in reflective processes as if a court asks for it you have no protection. What the GMC expects these days has been undermined by its actions and hence practitioners are right to be guarded.

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  • I agree fully with all responses. The piece above is the hymn-sheet and the NHS is the space with appalling acoustics.

    The advice is ostensibly sound but when "your unwell colleague" takes time off and the understaffed rota is stretched further, the likelihood of more "colleagues" needing drink/drugs to cope gets bigger.And the whistle-blowers own work schedule gets rougher. Worth it for the greater good?

    Reminds me of the Cold War and The Domino Effect theory.

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  • To put it simply the GMC is trying to paint a pretty picture of "all is well" to the general public to the expense of doctors lives like that of Dr BG

    Solution?: Leave the NHS

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