This is particularly relevant given the pressure on general practice is at an all time high and especially important when you have a concern about patient safety.
Londonwide LMCs have developed a wealth of resources to assist GPs with the challenges of professional life, which can be accessed via our GP Professional Support Network, including on its resources page.
Remember that GPs may be reluctant to seek help
GPs have particular barriers to seeking and asking for help but like everyone else they will suffer from stress, mental health issues and chronic disease.
GPs will often fail to seek help as a result of personal, attitudinal or professional and cultural barriers.
It is well documented that GPs often deny or minimise medical problems, particularly emotional or psychological distress as there remains a culture of viewing their own illness as a sign of personal weakness.
What questions may arise?
If you do have concerns about the health, wellbeing, performance and/or conduct of a colleague, several reasonable questions may arise, which include:
- Should I do anything at all?
- If I should do something –
- What should I do?
- When should I do it?
- Who can I ask for help?
- What are the implications of taking action (or indeed not doing so) –
- ..for you?
- ..for the GP in question?
- ..for the practice?
- ..for patients?
- ..for the profession?
All the above questions may be compounded if there is a power imbalance in play (for example – a newly appointed salaried GP who has concerns about the senior partner) and/or if you have had a longstanding professional relationship with the GP in question.
Better to do Something about nothing that nothing about something
Try to take off your GP hat and (if it is appropriate to do so) speak to them in person with a genuine expression of concern, kindness and compassion – as a friend.
Questions/approaches that may help are:
- Are you ok?
- You don’t seem yourself.
- Do you want to talk?
Please don’t let embarrassment stop you exploring these potentially lifesaving questions.
Remember, your colleague may need urgent help and assessment: Staying safe from suicidal thoughts.
The signs may be subtle and misleading (in that they may represent an underlying problem or may be amenable to reasonable explanation)
In some circumstances it may be obvious that action is required (for example – a GP who arrives at work intoxicated), however usually the signs are more subtle, for example –
- A passing comment from a patient that a GP was slightly inattentive during a consultation – whilst this could be an indication of a health issue, it could be that the GP was perceived to be inattentive because they were making comprehensive notes during the consultation.
- A GP who is slightly behind in dealing with their investigation results – whilst this could be a cause for concern, it could simply be that the GP is catching-up after a period of annual leave.
- A GP who makes an unusual a management decision – whilst this could be a cause for a concern it is possible that the decision was made on the basis that the patient declined to accept some of the orthodox options (albeit if this was the case, it should have been documented within the records).
- A GP who is curt with a colleague – whilst it is advisable to be courteous to our colleagues at all times, we all have our bad days – this could be an isolated incident and there may be some context about which you are not aware.
It might well be that there are a number of subtle signs which may build a picture of concern.
What are my professional obligations?
The GMC have produced some helpful guidance: Raising and acting on concerns about patient safety.
- The key principles of the guidance are set out below:
- You must take prompt action if you think patient safety, dignity or comfort is being compromised.
- You must encourage and support a culture in which staff can raise concerns openly and safely.
- You have a duty to put patients’ interests first and act to protect them, which overrides personal and professional loyalties.
- The law provides legal protection against victimisation or dismissal for individuals who reveal information to raise genuine concerns and expose malpractice in the workplace.
- You do not need to wait for proof – you will be able to justify raising a concern if you do so honestly, on the basis of reasonable belief and through appropriate channels, even if you are mistaken.
- You must follow the relevant procedure, which usually involves trying to resolve the matter at a practice level in the first instance if it is appropriate to do so (please refer to the next bullet point).
- You should escalate your concerns to NHS England and/or the GMC in the following circumstances:
- If the person to whom you would raise the concerns are the subject of the concerns and/or part of the problem.
- If you have raised your concerns at a practice level but are not satisfied that adequate action has been taken.
- If there is an immediate serious risk to patients that engages the responsibility of NHS England and/or the GMC to act or intervene.
Who can I approach for help for help?
Whilst (depending on the circumstances) it may be reasonable to speak directly with the colleague about whom you have concerns or a colleague at the practice, our GP Support Team will be able to provide you independent and confidential advice tailored to the particular circumstances.
The GP Support Team can be contacted via the GP Professional Support Network at Londonwide LMCs or via GPSupport@lmc.org.uk.
The GP Support Team would also be able to offer and guidance to the GP who is the subject of the concerns (this would be provide by a different member of the GP Support Team who provided you with the advice about the obligation to raise the concerns).
Other organisations that may be able to offer advice in these circumstances are:
- Your medical defence organisation (or equivalent).
- BMA Concern about a Colleague
- BMA wellbeing Support Services counselling and peer support services
Raising concerns about the health, performance and conduct of a colleague (that impact patient on patient safety, dignity or comfort) can be one of the most challenging things that you may have to face in your professional life, given the impact on the GP in question and your personal/professional relationship.
You should have a low threshold for seeking independent, professional and confidential advice tailored to the circumstances and such advice can be provided by our GP Support Team.