Protecting patients, colleagues and others from harm
- You must 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.
- 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.178 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, although you do need to have a reasonable belief that wrongdoing is happening, has taken place in the past, or is likely to happen in the future. If you are not sure whether you should act, ask yourself:
- what might the outcome be in the short- or longer-term if I do not raise my concern? And
- how could I justify why I did not raise the concern?
See section on Working with colleagues.
- Examples of what you should report include:
- very poor treatment
- failure to gain patient consent to treatment
- cross-infection problems, for example use of dirty equipment
- sexual assault or abuse. See section on Maintaining boundaries
- practising under the influence of drink or drugs
- fraud or theft, or
- inadequate malpractice insurance.
- You should:
- act quickly, and
- keep a record of the concerns you have raised, and actions you have taken. The record should be as detailed as possible, and not influenced by personal feelings or opinions.
- You must protect patient confidentiality. See section on Confidentiality.
- In certain circumstances, you are protected in law from harassment or bullying when you raise a concern. This is known as ‘protected disclosure’.179, 180
- In order to receive the protections of the Public Interest Disclosure Act you must follow your employer’s policy, if it is a reasonable one. If you feel that your employer’s policy is not reasonable then please contact your professional or representative body, or you can contact Public Concern at Work.181
- You should be able to raise your concern confidentially, so your name is not revealed unless this is required by law. When you raise your concern you need to make it clear if you are doing so confidentially. This is different from raising a concern anonymously, when you refuse to give your name.
178 General Optical Council (2016) Standards of practice for optometrists and dispensing opticians para 11.3 [Accessed 2 Nov 2017]
179 The Public Interest Disclosure Act 1998
180 The Public Interest Disclosure (Northern Ireland) Order 1998
181 Public Concern at Work [Accessed 2 Nov 2017]
- 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:
- apologise to the patient
- explain what has happened, and
- explain any remedial action.
- If necessary, you should also:
- investigate the adverse incident
- take the appropriate action, and
- 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:
- in England and Wales to the National Reporting and Learning System (NRLS). This does not collect any patient or practitioner identifiable information182
- in Scotland to your local health board, and
- in Northern Ireland to the Northern Ireland Adverse Incident Centre.183
- 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.184, 185 See sections on Infection control and Use and supply of drugs or medicines in optometric practice.
182 National Reporting and Learning System (NRLS) is now the responsibility of NHS England [Accessed 2 Nov 2017]
183 Northern Ireland Adverse Incident Centre (NIAIC). Reporting an adverse incident [Accessed 2 Nov 2017]
184 MHRA Yellow Card Scheme [Accessed 2 Nov 2017]
185 MHRA. Report a problem with a medicine or medical device [Accessed 2 Nov 2017]
Public Health Wales (2013) All Wales Raising Concerns (Whistleblowing) Policy [Accessed 2 Nov 2017]
General Optical Council (2016) Raising concerns with the GOC (whistleblowing) policy [Accessed 2 Nov 2017]
NHS Improvement. Patient safety [Accessed 2 Nov 2017]
NHS Improvement (2016)Freedom to speak up: raising concerns policy for the NHS [Accessed 2 Nov 2017]
Whistleblowing for employees [Accessed 2 Nov 2017]
NHSScotland Confidential Alert Line 0800 008 6112 [Accessed 2 Nov 2017]
Speakup Helpline 08000 724 725 [Accessed 2 Nov 2017]
Public Concern at Work [Accessed 2 Nov 2017]