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Medicolegal Issues - How to... blow the whistle

Flagging up a colleague's problems is never easy, but must be done if patients are at risk, says Jennifer Taylor.

At some point in your career, you may work with a GP who has a mental health problem or an addiction, or who is incompetent. Blowing the whistle is never easy, but if your colleague is putting patients at risk, you have a duty to do something about it.

WHEN TO BLOW THE WHISTLE

The GMC's guidance, Good Medical Practice, clearly states that if a colleague's conduct, health or performance is of sufficient concern that they might be a risk to patients, you have an ethical imperative to do something about it.

'It can be an area of concern to doctors because, as individuals, they find it difficult to raise concerns about a colleague's performance,' says Dr Michael Devlin, a medicolegal adviser at the Medical Defence Union (MDU). 'But the GMC guidance is so clear... we can reassure doctors that it's the right thing to do.'

SPEAK TO YOUR COLLEAGUE

If possible, speak to your colleague about your concerns. He or she may have a health problem that you were unaware of, or may be having difficulties at home.

The GP may volunteer to remove him or herself from work and seek help.

If you are absolutely satisfied that the GP will not be putting any patients at risk by, for example, doing locum work elsewhere, then you do not have to take the complaint further. But in many cases it will be appropriate to use formal procedures.

HOW TO BLOW THE WHISTLE

Contact the nominated individual within the PCT who has a duty to receive this information. At this point, you should identify the GP and explain your concerns.

'If time is of the essence, many organisations are happy to have the initial contact by phone,' says Dr Devlin.

Follow up your call with a letter. The matter is now essentially left in the PCT's hands.

WHEN TO APPROACH THE GMC

In some cases you may wish to contact the GMC directly, for example if there are very serious concerns that a GP is harming patients and that practising for even a few more days would be a risk. The GMC has powers to suspend a GP's registration or put conditions on their registration, pending further investigation.

Another case for approaching the GMC would be for a conduct issue where a patient has made an allegation of sexual assault but has not reported it to the police.

COMPILING EVIDENCE

If you contact the GMC they will ask for information to help begin an investigation. This will include the GP's full name or surname and initials, their GMC registration number, and their home or practice address.

You will also need to give a full account of events or incidents that concern you, with dates and details if possible. Copies of relevant papers or other evidence, and any action taken such as speaking to the GP concerned, should also be supplied.

Patient consent will be required if your report includes information that will identify them. If they refuse, the GMC may allow disclosure if it is in the public interest or for the protection of other patients.

LEGAL CONSIDERATIONS

There are two main legal issues to consider. Firstly, in very extreme examples, if you fail to whistleblow you could find yourself in front of the GMC for serious professional misconduct.

Secondly, at the other end of the scale, you need to be sure there are genuine causes for concern. As Lynne Abbess, a partner at medical specialist solicitors Hempsons, explains: 'If you are making false allegations, you could find yourself having to defend an allegation of defamation.'

HOW TO HELP A COLLEAGUE WITH A PROBLEM

When a colleague is unwell and it is impairing their work, try to talk to them first. If that is not possible, confirm your fears are valid by speaking to a trusted peer or ringing the Sick Doctors' Trust, your medical defence organisation or the BMA Doctors for Doctors service.

Then approach the GP, or ask the GP's relative or friend to speak to them, to let them know you are concerned and suggest several routes for getting help.

'Very few people can deal with a mental health problem or an addiction by themselves,' says Dr Alasdair Young, vice-chairman of the Sick Doctors' Trust.

Alcoholics Anonymous and Narcotics Anonymous are good options, as are the nearly 20 British Doctors' and Dentists' Groups across the country, where GPs will not encounter any of their patients. Local health services are another possibility.

'The important thing is to give as many options as possible,' says Dr Young.

GPs who need detox are also likely to need residential treatment, and they cannot return to work until they are clean and sober. The Sick Doctors' Trust can advise on locations and funding.

USEFUL CONTACTS
The Sick Doctors' Trust 0870 444 5163 (24 hours) Medical and Dental
Defence Union of Scotland (0141) 228 1208
Medical Defence Union 0800 716 646
Medical Protection Society 0845 605 4000
The BMA Doctors for Doctors service (020) 7383 6739

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