Documenting concerns

Staffing issues can make wards and services unsafe for patients.

If you are concerned for patient safety, it is imperative that you:

• document all concerns and actions taken to raise attention to them, with a separate log made for each step of raising and escalating a concern, incident or problem.
• document concerns via your workplace’s incident reporting system and keep your own personal log. This ensures a tangible paper trail and record of steps taken, which is important in demonstrating that responsibility for any impact of short staffing or system pressures on delivery of care rests with the employer and not with you.

Raising concerns

Raising concerns with your employer

All doctors have a duty to raise concerns where they believe that patient safety or care is being compromised by the systems, policies, procedures or resources in the organisations in which they work.

If at any time you feel patient care is being compromised, you must inform your consultant or Clinical Director as a matter of urgency.

Paragraph 25 of Good Medical Practice states:

'25 You must take prompt action if you think that patient safety, dignity or comfort is or may be seriously compromised.

a. If a patient is not receiving basic care to meet their needs, you must immediately tell someone who is in a position to act straight away.

b. If patients are at risk because of inadequate premises, equipment or other resources, policies or systems, you should put the matter right if that is possible. You must raise your concern in line with our guidance and your workplace policy. You should also make a record of the steps you have taken.

c. If you have concerns that a colleague may not be fit to practise and may be putting patients at risk, you must ask for advice from a colleague, your defence body or us. If you are still concerned you must report this, in line with our guidance and your workplace policy, and make a record of the steps you have taken.

• Follow the procedure where you work for reporting concerns.
• If you have reason to believe that patients are, or may be, at risk of death or serious harm for any reason, you should report your concern to the appropriate person or organisation immediately.
• Wherever possible, you should first raise your concern with an appropriate officer of the organisation which employs you – such as the consultant in charge of the team, the clinical or medical director.
• If you are a doctor in training, it may be appropriate to raise your concerns with a named person in the deanery – for example, the postgraduate dean. Be clear, honest and objective about the reason for your concern.
• Acknowledge any personal grievance that may arise from the situation but focus on the issue of patient safety.

Raising concerns with the regulator

You should contact a regulatory body with authority to investigate the issue (such as the CQC in England, the RQIA in Northern Ireland, the HIW in Wales, or the HIS in Scotland – or the GMC if your concern relates to the actions or behaviour of an individual doctor(s) – in the following circumstances:

• If you cannot raise the issue with the responsible person or body locally because you believe them to be part of the problem.
• If you have raised your concern through local channels but are not satisfied that the responsible person or body has taken adequate action.
• If there is an immediate serious risk to patients, and a regulator or other external body has responsibility to act or intervene.

Making a concern public

According to GMC guidance, you can consider making your concerns public if you:

• have done all you can to deal with any concern by raising it within the organisation in which you work and with the appropriate external body, and
• you have good reason to believe that patients are still at risk of harm, and
• you do not breach patient confidentiality.

You should seek thorough and impartial advice before considering making a concern public. You could seek advice from:

• the BMA's advisors
• a senior member of staff or other impartial colleague
• the GMC’s Confidential Helpline
• your medical defence body or your royal college
• Protect (formerly Public Concern at Work) – a charity which provides free, confidential legal advice to people who are concerned about wrongdoing at work and are not sure whether, or how, to raise their concern.