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Patient safety - When GPs need to blow the whistle

Raising a concern about a colleague can be hard, but it is necessary if patients are at risk.

Raising concerns about a colleague is one of the most difficult things a GP may ever have to do.

Yet in certain circumstances, acting as a whistleblower is not only the right thing to do but also a professional requirement as outlined in new guidance from the GMC, which came into effect on 12 March.

For the first time the GMC has sent a leaflet on its new guidance, Raising and acting on concerns about patient safety, to every doctor in the UK.

The guidance states that doctors must not sign contracts containing so-called 'gagging clauses' that would prevent them from raising concerns with professional regulators, such as the GMC, and systems regulators, such as the Care Quality Commission (CQC).

It also provides advice on when doctors should raise concerns and how to go about approaching a regulator.

How to raise concerns
  • Ensure your concerns are objective and reasonable.
  • Seek advice from others, such as colleagues in the practice, the LMC or your defence body, before doing anything.
  • Follow the procedures for raising concerns within your practice and PCO before contacting the GMC.
  • Document your concerns, your actions and the outcome.
  • New GMC guidance www.gmc-uk.org/guidance/ethical_guidance/raisingconcerns.asp came into effect on 12 March.
  • The CQC has also recently issued new guidance on whistleblowing, which sets out the rules around having a whistleblowing policy. GP practices will not be covered by this guidance until CQC registration for general practice begins in April 2013.
  • Other sources of advice include helplines run by Public Concern at Work, 020 7404 6609, and the DH, 08000 724 725.

Change in attitude
Niall Dickson, chief executive of the GMC, hopes the guidance will underline to doctors their duty to raise concerns and send a message to the health service that doctor whistleblowers must be supported.

He says: 'There are circumstances where doctors do find it difficult to speak out, but over the past 20 years I think there has been a sea change and doctors are more willing to raise concerns.'

Lynne Abbess, a partner with specialist medical solicitors Hempsons and a member of the Ask the Experts panel for GP, also believes the tide has turned as far as whistleblowing is concerned. 'There is now a far more overwhelming duty to whistleblow than to keep quiet,' she says.

Ms Abbess highlights one case she has come across recently where a GP was advised by his medical defence body to whistleblow on a fellow GP he was treating as a patient because of concerns about fitness to practise. The medical defence body said the GP's duty to whistleblow overrode his duty of confidentiality.

In all cases, Ms Abbess says, GPs must ensure their concerns are rational and legitimate and not, for example, the result of a partnership falling out or dispute.

Even so, reporting that a fellow GP has addiction problems or is practising bad medicine is far from easy, as Dr Stephanie Bown, director of policy, communications and marketing at the Medical Protection Society, acknowledges.

'This may be a colleague you interact with on a daily basis, you may know each other's families and there may be an overlap of personal and professional relationships,' she says.

Seek advice first
Dr Bown's advice is to be objective about your concerns and to discuss it with other colleagues in the practice or someone else before acting. 'Having an external trusted route such as the LMC can be absolutely invaluable,' she says.

Dr Bown adds that it may be possible to initially raise concerns directly with the person involved and says that in all cases GPs should document their concerns, the action they take and the response to that action.

Dr Richard Vautrey, GPC deputy chairman, says LMCs can be an excellent source of advice. If the problem cannot be resolved internally your primary care organisation's (PCO's) medical director or clinical governance lead is likely to be the next port of call. Dr Vautrey says it is unclear who will take on this role in the new NHS in England, but suggests it may be covered by local offices of the NHS Commissioning Board.

He adds: 'I hope that will mean better standardisation and consistency of approach. In some areas you find PCTs and LMCs that work extremely well together but that is not always the case and that impacts on the way these issues are dealt with.'

Whistleblowing does not just apply to concerns about individuals. GPs may be worried about the quality of care at an organisation or service.

Healthcare reforms could create another area of concern, for example if GPs believe contracts are being placed without due process. Dr Bown says if there is a suspicion of contracts being set for personal financial advantage it will not be something GPs can just 'shrug off'.

Mr Dickson says conflicts of interests are taken seriously by the GMC. 'There is always a danger in a system where money is getting tight but the duties of doctors are clear and it is imperative to follow the procedure for raising concerns if patient safety is at risk,' he says.

Protection for whistleblowers
Andrew Firman, a partner with London-based lawyers Carter Camerons, says GPs have protection under the Public Interest Disclosure at Work Act 1998, which would cover both salaried GPs and partners employed under PCT contracts. He adds: 'If individuals are discriminated against as a result of raising a concern they can bring a claim in an employment tribunal.'

However Cathy James, chief executive of the whistleblowing charity Public Concern at Work (PCAW), says there are loopholes in this law and the charity is lobbying the DH for these to be addressed.

Until recently PCAW ran the DH's helpline for whistleblowers and took 20,000 calls from those with concerns, including many GPs. The contract for that helpline has gone to Mencap but PCAW continues to run its own helpline.

Ms James says most doctors understand the need to protect patients and the importance of speaking up.

Dr Bown adds: 'We only have to remember the words of Lord Kennedy after the Bristol heart case. He said, "The scandal wasn't that no-one knew, it was that everyone knew".'

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