Raising concerns amidst COVID-19

HEALTHCARE services are facing increasing pressure to cope with demand caused by the coronavirus outbreak – and some NHS staff are already working at capacity. Practising in this type of environment and treating patients under new protocols means that you may have concerns about the risks to patients, colleagues and yourself.

In times of crisis, the care of your patient must remain your first concern. However, significant extra demands can lead to fatigue, lapses in concentration, heightened stress levels, and suboptimal decision-making and team communication, all of which can impact on patient safety.

Common concerns include individuals being asked to carry out duties they may not have the necessary skills or knowledge to undertake, unclear or absent emergency planning and poor infection control.

Clinicians will have understandable concerns about whether to speak up or simply carry on trying to provide appropriate care until these problems are resolved. GMC guidance is very clear that:

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

This applies even in this challenging time and you can access the specific guidance here.

Doctors should always consider whether they can resolve a concern themselves, or at least offer practical suggestions to resolve the matter. You should try to familiarise yourself with local policies in relation to raising concerns and follow these. If you are not sure how to raise concerns, seek advice from a senior colleague and/or MDDUS.

Raising concerns without delay is particularly important in fast-moving situations such as the current crisis. If you have a concern regarding patient safety, you must act on this immediately by informing your clinical team lead, line manager or head of department, in line with local policies. If you don’t feel comfortable raising a concern with a particular individual (perhaps because they may be part of the problem), speak to someone else within your organisation. Be specific about the risks or potential risks you have encountered or foresee.

You should keep a record of any concerns raised. This does not mean you have to put those concerns in writing, but it is best practice to do so in order to demonstrate the steps you have taken.

All doctors have a responsibility to act on concerns raised to them but those with management or leadership roles have greater responsibilities. Should you submit a concern having followed your organisation’s policy/procedures and receive no response or an unsatisfactory or inadequate response, you should consider escalating your concern to the next appropriate level depending on the nature, seriousness and urgency of your concern. In a hospital setting, you may need to contact the clinical director or medical director. You should escalate the matter as far as necessary to achieve a proportionate response; ultimately this may involve alerting an external organisation, such as the GMC.

A recent article in the Guardian featured reports that some hospitals and NHS bodies are warning doctors and nurses not to air concerns on social media over shortages of personal protective equipment. The Doctors’ Association UK said it had evidence that some staff were reprimanded by managers or threatened with disciplinary action after posting comments online. MDDUS would urge clinicians to proceed with caution before posting to social media and to ensure they have followed all appropriate channels for escalating concerns. Be sure to comply with GMC guidance Doctors’ use of social media. It would also be advisable to contact your medical defence organisation before taking action.

If a concern is reported to you, inform your colleague as to what steps you will take to address that concern. You do not have to provide full details but they should receive some formal feedback – otherwise your colleague may feel they have a professional responsibility to escalate the matter further.

Raising concerns is an area that causes members much stress and worry. Remember that you will be able to justify raising a concern if you do so honestly, on the basis of reasonable belief and through appropriate channels.

ACTION POINTS

• Make yourself aware of specific GMC guidance on raising and acting on concerns.
• Don’t ignore an issue in the hope it will disappear or won’t be a problem; take action promptly.
• Follow your organisation’s policy on raising concerns, focus on the specific risks you have identified within your communication, and document any action and responses.
• Escalate your concerns if the issue is still unresolved.
• Take advice from MDDUS at an early stage of the process.

Kay Louise Grant is a risk adviser at MDDUS