With the appointment of a National Guardian and Freedom to Speak Up Guardians in NHS trusts in 2016, there has been an increased focus on NHS staff raising concerns about patient safety.
The MDU opens over a hundred case files each year to support members who are unsure how to raise concerns and advises many more members on our advice line. In many cases, concerns relate to quality of care or resource issues, but what happens when a doctor is concerned about the health or performance of a colleague?
Duty to act
Where a colleague’s poor performance could compromise patient safety, GPs have a duty to act. This may be the result of an underlying health issue but research has shown that doctors are often reluctant to ask colleagues for support if they are suffering from health problems.
A Royal Medical Benevolent Fund survey of over 1,300 hospital doctors and GPs and found that 82% of doctors knew of other doctors suffering from mental health issues such as depression and anxiety. https://www.gponline.com/four-five-doctors-know-colleagues-facing-depression-anxiety/article/1388342 Despite their need for help and support, 84% were unlikely to reach out due to fear of discrimination or stigma from colleagues, or were inhibited by their ‘high achieving’ personality traits (66%).
The doctors responding to the survey cited patient caseloads, increased scrutiny (such as by the CQC and revalidation process) and long working hours as significant factors.
The GMC makes it clear in Good Medical Practice, that if a doctor has concerns that a colleague might be putting patients’ safety, dignity or comfort at risk, and may not be fit to practice, they must take action promptly.1
The GMC says that you must ask for advice from a colleague, your defence body, or the GMC. If you are still concerned, you must report your concerns in line with GMC guidance and your workplace policy, making a record of the steps you have taken.
What to do if you have concerns
Doctors referred 752 of their colleagues to the GMC in 2015; 31% of these concerns were investigated by the GMC. Between 2011 and 2015, 1,151 doctors referred colleagues to the GMC, with the concerns relating to health in 11% of cases, performance in 34%, criminality in 3%, and probity concerns in 27% cases.2
Where you have concerns about a colleague’s conduct, performance or health, the GMC says you should consider whether these can be dealt with internally at practice level, or should be referred to NHS England or your local health board.
If neither of these options are appropriate, or do not result in a satisfactory outcome, or if there is an immediate serious risk to patients, then as a last resort, you may need to refer the matter to the GMC. 3
The following anonymised scenario is based on queries raised by MDU members.
A salaried GP contacted the MDU advice line explaining that he had concerns about the senior partner at the practice. A patient had attended with a chronic cough, explaining they had seen the senior partner five months earlier, who had sent them for a chest X-ray, and prescribed inhalers for a trial period.
The patient hadn’t noticed any significant improvement with the inhalers, and had recently noticed some blood in his sputum. The salaried GP checked the X-ray report, which described a suspicious lesion in the lung and the radiologist had recommended a two-week referral. There was no evidence in the notes to suggest the report had been actioned.
The salaried GP explained there had been a couple of other cases of abnormal blood results, that had been marked as no action necessary by the senior partner, although no harm had come to either patient.
The salaried GP was reluctant to raise these concerns directly with the senior partner, as he was worried it would adversely affect their working relationship, and he was unsure whether these isolated incidents were serious enough to cause concerns about the senior partner’s fitness to practice.
The MDU adviser suggested that the GP first speak to his colleagues in confidence, to see whether anyone else had similar concerns, and how best to deal with them. The adviser suggested that all such incidents be logged as significant events, and investigated according to practice policy.
Three weeks later the GP contacted the MDU again. He explained that he had spoken to his colleagues, some of whom had similar concerns. In addition, the senior partner had been verbally abusive to the practice manager and four patients had made complaints in the last few months about the senior partner’s attitude.
Everyone felt this behaviour was out of character, and they were concerned about the senior partner’s health. One of the partners spoke to the senior partner in confidence about their concerns, and suggested she take some sick leave and see her GP. The senior partner refused, denying any health issue.
The salaried GP wondered whether to now involve the GMC.
The MDU adviser explained that this was one option, but that it might be more appropriate to first discuss the problem with the local area team responsible officer. The adviser suggested that the matter be discussed at a minuted practice meeting and the decision to refer documented.
This referral would almost certainly result in an investigation under the NHS Performer’s List Regulations, and therefore the practice should compile a document detailing the specific concerns so that they could be investigated, and the senior partner’s practice restricted if appropriate.
- Good Medical Practice paragraph 25c
- SoMEP 2016, GMC
- Raising and acting on concerns about patient safety (GMC) paragraphs 13 and 16.