Keeping patients safe

Abstract

In July, 2011, the UK's medical regulator, the General Medical Council (GMC), was told by the Commons Health Select Committee to send a “clear signal” to doctors that they were failing in their duties if they did not report concerns about patients' safety. That signal has now come in Raising and acting on concerns about patient safety—new GMC guidance published on Jan 26, which advises doctors about the best ways to alert employers and health-care regulators about poor quality care. The guidance emphasises that doctors have a duty of care to report actions that may endanger patient safety and that responsibility must override personal and professional loyalties. It notes that there is legal protection in the UK against victimisation and dismissal of individuals who expose malpractice and it reassures doctors that firm proof is not needed for a valid concern to be raised. The guidance is not without teeth. It warns doctors that “serious or persistent failure to follow this guidance” will put doctors' registration at risk. Importantly, for the first time in such guidance, the GMC has banned so-called gagging clauses—agreements between doctors and their employers not to speak publicly about poor quality care they may have witnessed. Figures on the extent of gagging clauses are hard to come by, but a 2010 investigation by the UK's Bureau of Investigative Journalism and Channel 4 News found that, over the past decade, 170 doctors had signed a settlement or compromise agreement with their NHS Trust. 55 of 64 settlement contracts obtained during the investigation contained gagging clauses. Such agreements, and the signing of them, are unacceptable practices in medicine. Too few doctors blow the whistle on bad medical practice worldwide, and patients are at risk when good doctors do nothing, or are prevented from acting. Past medical scandals such as those involving Bristol Royal Infirmary, Harold Shipman, and Peter Connelly remind us of the tragic consequences of inaction. The new guidance by the GMC contains important messages that will be relevant to doctors wherever they practice.