The College of Optometrists

Raising concerns

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Key points

  • You should raise concerns about patient care and safety, including any practitioner’s fitness to practise.
  • Raising a concern is also known as whistleblowing.
  • In some circumstances you are protected in law when you raise a concern.
  • You should act quickly.
  • You should keep a record of any concerns.
  • You must protect patient confidentiality.
  • You should record adverse incidents centrally, for example in your practice’s system or in the practice Accident Book.
  • You should report near misses involving NHS-funded patients in England and Wales to the National Reporting and Learning System and to the equivalent bodies in the other UK countries.

Principles of raising concerns

You should raise concerns about patient care and safety if you think patients are at risk of malpractice.136 This is sometimes referred to as whistleblowing.137  In this guidance we use the term ‘raising concerns’.
In certain circumstances, you are protected in law from harassment or bullying when you raise a concern. This is known as ‘protected disclosure’.138 139

Practitioner responsibilities

You must act quickly to protect patients from risks posed by colleagues. The safety of patients must come first. If you have serious concerns about any practitioner’s fitness to practise you should raise this with them first if you feel able to. If necessary you should escalate your concerns to an appropriate person. This could be the colleague’s line manager, employer, or person in a Primary Care Organisation or hospital. If you remain concerned you should consult the relevant professional, representative or regulatory body.
Raising a concern is different from making a complaint. If you make a complaint, you might be asked for evidence to prove your case. When you raise a concern, you should not be expected to prove the issue you are concerned about. If you are not sure whether you should act, ask yourself:
  1. what might the outcome be in the short or longer term if I do not raise my concern? And,
  2. how could I justify why I did not raise the concern?

See section on Working with colleagues

Examples of what you should report include:
  1. very poor treatment
  2. failure to gain patient consent to treatment
  3. cross-infection problems, for example use of dirty equipment
  4. sexual assault or abuse. See section on Maintaining boundaries
  5. practising under the influence of drink or drugs
  6. fraud or theft, or
  7. inadequate malpractice insurance.
You should:
  1. act quickly, and
  2. keep a record of the concerns you have raised, or actions you have taken.
You must protect patient confidentiality. See section on Confidentiality.

Adverse incidents and near misses

An adverse incident is where harm has occurred and a near miss is where harm could have occurred.
If an adverse incident occurs you should take the following steps; this is what is meant by duty of candour:
  1. apologise to the patient
  2. explain what has happened, and
  3. explain any remedial action.
If necessary, you should also:
  1. investigate the adverse incident
  2. take the appropriate action, and
  3. keep a written record.
You should record any adverse incident somewhere central to the practice, for example in your practice’s system or in the practice Accident Book. This applies even if it was not due to any fault of the practice or practitioner.
If a near miss occurs, you should learn from it and you should reassure the patient if you think it caused them concern.
You should report any near misses or adverse clinical incidents involving patients receiving NHS-funded care:
  1. in England and Wales to the National Reporting and Learning System (NRLS). This does not collect any patient or practitioner identifiable information140 
  2. in Scotland to your local health board, and
  3. in Northern Ireland to the Northern Ireland Adverse Incident Centre.141 
If the adverse incident was due to a drug or medical device you should report this to the Medicines and Healthcare Products Regulatory Agency, as appropriate.142 134 See sections on Infection control and Use and supply of drugs or medicines in optometric practice.
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