The GMC’s new guidance documents give clarification on a doctor’s duties and address concerns over acting on issues of patient safety. Lisa Jones explains.

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In August 2011 a joint investigation by the Bureau of Investigative Journalism and Channel 4 news revealed that at least 170 doctors in England and Wales had agreed a severance agreement with their employing trust. Of these agreements:

  • 90 per cent contained confidentiality clauses
  • Of the 64 redacted contracts provided, 55 contained gagging clauses
  • Three contained a specific clause that the doctor should not take their concerns to the General Medical Council.

In January 2012 the General Medical Council published two new guidance documents, both of which will come into effect this week. The new guidance documents focus on the issues of raising concerns and secondly on leadership and management for doctors.

The first publication Raising and acting on concerns about patient safety replaces Raising concerns about patient safety (2006).

The duty of doctors to report concerns is not a new one. Good Medical Practice (GMP), the core guidance published by the GMC, states:

“If you have good reason to think that patient safety is or may be seriously compromised by inadequate premises, equipment, or other resources policies or systems, you should put the matter right if that is possible. In all other cases you should draw the matter to the attention of your employing or contracting body. If they do not take adequate action, you should take independent advice on how to take the matter further. You must record your concerns and the steps you have taken to try and resolve them.”

Whistleblowers are afforded full protection from raising concerns under the Public Interest Disclosure Act (1999). However, in theory, many doctors still remain concerned about raising concerns about colleagues or systems at their place of work.

These concerns include jeopardising both their long-term employment prospects and ongoing relationships with colleagues.

The new guidance attempts to address these concerns in two parts, the first part providing advice on raising a concern and the second part dealing with acting on concerns that have been raised with the doctor directly.

Part one is relevant to all doctors and sets out the duty to raise concerns when they believe that patient safety or care is being compromised.

A new addition to the guidance, which would appear to be as a direct response to recent press coverage regarding ”gagging clauses” can be found in paragraph eight. This clearly states that a doctor must not enter into a contract which seeks to prevent them from raising concerns about patient safety. These contracts would be considered to be void.

To assist doctors on how to raise concerns it attempts to set out the steps that a doctor must follow, identifies when they should raise a concern with the GMC and when they should make their concern public.

The guidance encourages doctors to raise concerns at a local level in the first instance and then to escalate their concerns accordingly if they have still not been resolved.

Doctors should only raise matters with the GMC in the following circumstances:

  1. If the issue cannot be raised locally as you believe them to be part of the problem
  2. If you remain unsatisfied that the responsible person or body has taken adequate action
  3. If there is an immediate, serious risk to patients

When considering whether to make a concern public, a doctor must seek advice before making this decision. The guidance suggests that this advice should be sought from professional organisations such as the GMC, British Medical Association, their medical defence organisation and Public Concern At Work.

Part two of the guidance provides advice to doctors who have concerns raised with them and, in particular, sets out advice to doctors who have a management role or responsibility.

These responsibilities include ensuring that there are systems and policies in place to ensure that concerns can be raised and that incidents, complaints and concerns can be investigated promptly and fully. It explains that staff should be encouraged to raise concerns, and that those that do are protected from unfair criticism or action.

Part two ties in with the second document published by the GMC Leadership and Management for all doctors, which replaces Management for Doctors.

This guidance makes clear the responsibilities that doctors have in respect of the management and leadership of their staff and the health services provided. It sets out a doctor’s duties in respect of the following areas:

  • Employment issues
  • Teaching and training
  • Planning, using and managing resources
  • Raising and acting on concerns
  • Helping to develop and improve services

It also clearly sets out the duties that the GMC considers applies to all doctors in comparison to those doctors who are considered to have “extra responsibilities”.

What is evident is that the duties of a doctor extend far wider than those which relate to being a good clinician. This is especially the case for doctors who have extra managerial responsibilities. Registered doctors will face criticism from the GMC if they are unable to demonstrate their effectiveness as both a clinician and a manager.

In fact, neither of the new guidance documents published by the GMC set out what could be considered to be “new” duties and responsibilities on registered doctors. However, the new guidance is clearer on precisely what a doctor’s duties are in respect of these important areas. Failure to comply with these duties may lead to action being taken against a doctor’s registration.