The General Medical Council (GMC) has published its annual report on whistleblowing disclosures.

In 18/19, the GMC received 35 whistleblowing disclosures – an increase on the previous year when 23 concerns were raised.

Of the disclosures the majority, 33, were made to the GMC’s Fitness to Practise teams.

• 13 were concluded after an initial assessment being carried out.
• 15 developed into preliminary or full investigations.
• Four were not progressed due to insufficient information and no further information being provided.
• One was closed as the information was already under investigation.

Doctors in the UK are required to take prompt and appropriate action to raise and act on concerns about patient care, safety and dignity. This is a complex topic, and unfortunately many doctors feel unsure how to correctly balance the requirements of patient safety, public interest, responsibilities to colleagues and duties to employers.

Patients can be at risk in a number of different ways – including:

• basic care – patient health care needs not being met
• inadequate premises – including equipment, or other policies, resources or systems
• colleagues – fitness to practise, conduct or health

The GMC recognise that in a number of situations you may be reluctant to ‘blow the whistle’ – for example because you fear that:

• nothing will be done
• raising your concern may cause problems for colleagues, or impact working relationships
• raising your concern may have a negative effect on your career, or result in a complaint

In order to provide encouragement to you in those situations, the GMC points out that:

“…your duty to patients has priority over personal and professional considerations, whistleblowers enjoy legal protection against victimisation or dismissal if you act before proof and are mistaken, the GMC will not hold it against you.”

You may be able to whistleblow anonymously, but this is not always viable. Depending on the situation, it may be relatively easy for eg a colleague to work out who a complaint came from:

“The tribunal determined that when faced with a complaint … you would have investigated the cases sufficiently to determine who the most likely whistle-blower was. [You] had several locum GPs and trainees working at the Practice who you also believed could be responsible for submitting the complaint. However, you stated that you were eventually able to determine who the whistle-blower was, as Dr B was the GP to see all six patients after yourself.”

And the GMC also concedes that:

• anonymous complaints can be less effective
• if not anonymous, the GMC may have to reveal your identity to help resolve the concern

As a whistleblower, you do have a protected legal status under the Public Interest Disclosure Act 1998 – you should not be treated unfairly or lose your job because you ‘blow the whistle’.

However the law only protects you under certain circumstances – firstly, you have to be a worker (eg employee, trainee, agency worker, or a member of a Limited Liability Partnership).

Secondly, it only counts as whistleblowing if you report:

• a criminal offence
• a threat to someone’s health and safety
• risk or actual damage to the environment
• a miscarriage of justice
• the company is breaking the law
• you believe someone is covering up wrongdoing

The common element here is public interest – the act that you are reporting must have consequences for others – so whistleblowing explicitly does not cover personal grievances, eg bullying, harassment or discrimination.

As you would expect, the GMC is a Prescribed Body for the purposes of raising concerns about registration and fitness to practice of doctors on the GMC register, as well as about their other relevant statutory functions (medical education and standards of medical professionalism).

Whistleblowing is defined by the GMC as “where an employee, former employee or member of an organisation raises concerns to people who have the power and presumed willingness to take corrective action”.

In their full guidance, ‘Raising and Acting on Concerns about Patient Safety’, the GMC describe circumstances where you should contact them (or another appropriate authority):

• 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.

And since the responsibility to whistleblow is both complex and important, the GMC also recommends taking advice from:

• a senior member of staff or other impartial colleague
• the GMC’s Confidential Helpline (0161 923 6399)
• your medical defence body, your royal college or a professional association such as the British Medical Association (BMA)
• the appropriate regulatory body listed at the end of this guidance if your concern relates to a colleague in another profession, or other relevant systems regulators if your concern relates to systems or organisations rather than individuals
• 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.

If you are a doctor with a management role, you will also have the added responsibility of creating a culture in which staff can raise concerns appropriately – including the options of either trying to put the matter right, handling the concern locally, or referring serious or repeated incidents either to senior management or the relevant Prescribed Person or Body.

Recognising that this can be another challenging area of practice, the GMC has created a decision making tool– to guide you if you have concerns about patient safety.