21st November 2016

We hear far too many cases where those working in the NHS suffer retaliation or victimisation for having raised a whistleblowing concern. Here at PCaW, the whistleblowing charity, this is an all too familiar story, but where the victimisation extends to the potential for a career ending hearing with questions about the whistleblower’s fitness to practise, this can be particularly damaging.

We therefore welcome the GMC’s new approach to Fitness to Practise referrals which are designed to try and address this issue. In particular the aim is to change way the GMC responds to fitness to practise referrals from organisations in the health sector and to reduce the impact of referrals on doctors in some circumstances. A study published in the BMJ last year found doctors to be at an increased risk of anxiety, depression and thoughts of self-harm when their clinical practise is under investigation.

The key change to this process involves a requirement that organisations complete a form in which they answer a series of questions which will check whether a whistleblowing concern has been raised by the doctor being referred, whether that issue has been investigated and whether the doctor knows about the referral. The organisation is also required to confirm that the information provided in the referral reform is fair and accurate (a so called ‘statement of truth’). Where the referrer confirms that a whistleblowing concern has been raised by the doctor being referred, the GMC will carry out preliminary checks before deciding to open an investigation.

This change in process provides an additional layer of protection to whistleblowers as it will likely mean that the risk of retaliatory referrals is reduced. Requiring, in effect, a statement of truth from the referring organisation will mean that such referrals are more considered and are sense checked before being passed to the GMC.

The GMC are also piloting a more streamlined approach to certain types of fitness to practise referrals. Where a doctor has erred from accepted practice in one sole incident, and the doctor understands and admits their error, except in a small number of the most serious cases, the GMC will be unlikely to find they are an ongoing risk to patient safety. The GMC believe such instances may account for between 15 and 20% of fitness to practise referrals and hope to identify and resolve such instances quickly.

This seems a sensible approach for two reasons. Firstly, doctors who have admitted their error will not be subject to the normal, sometimes lengthy, fitness to practise investigations that can stop them from doing their job. Whilst it is of obvious importance that doctor’s whose clinical practice poses a risk are kept away from patients, where a doctor has made one lapse of judgment and understands and atones for that error it is not in the public interest to have them removed from practice, increasing the strain on colleagues and the system as a whole. The process will also save the GMC from committing resources to unnecessary investigations.

Secondly, seeing that fitness to practise referrals do not always result in a protracted and accusatory process may lessen staff’s anxieties around raising concerns. Having a quick and constructive process whereby lessons are learned without disciplinary action may help to normalise the process of whistleblowing, so problems can be addressed and resolved with greater efficiency.

The introduction of these changes is also, to some extent, an acknowledgement that there has been a problem with malicious referrals to the GMC. Sir Anthony Hooper’s review of GMC cases involving whistleblowers recommended that steps to be taken to ensure fitness to practise referrals were not being used to victimise whistleblowers and these proposals by the GMC’s are intended to meet Sir Anthony’s recommendations. The GMC also encourage whistleblowers by offering guidance on how to raise concerns when patient safety is at risk and providing a confidential helpline which supports those with concerns about clinical practice. Of course the PCaW advice line is also a good place to go for advice about a whistleblowing concern.

As ever, there is no quick fix to change attitudes towards whistleblowing but the GMC’s proposals, as well as efforts from other organisations such as the appointment of a National Guardian for whistleblowing and a network of local Freedom to Speak UP Guardians across the NHS in England, will hopefully start the much needed cultural change in the NHS.