Raising Concerns and Whistleblowing

One of the most consistently tested themes in SJT is the duty to raise concerns about unsafe practice, unprofessional behaviour, or risks to patient safety. This lesson provides a comprehensive guide to when, how, and to whom you should raise concerns — and what to do when the system does not respond.

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The Duty to Raise Concerns

Raising concerns is not optional. It is a professional obligation established by the GMC, the NHS Constitution, and employment law.

GMC Good Medical Practice, paragraph 25: "You must take prompt action if you think that patient safety, dignity, or comfort is being compromised."

Why This Duty Exists

Reason	Explanation
Patient safety	Unreported concerns can lead to preventable harm
System learning	Healthcare systems cannot improve without knowing where problems exist
Professional accountability	Everyone in the system shares responsibility for safety
Public trust	The public trusts that healthcare professionals will speak up about problems

What Happens When Concerns Are Not Raised

The consequences of silence can be catastrophic. Major NHS scandals — Mid Staffordshire, Morecambe Bay, Gosport — all involved situations where staff were aware of problems but did not raise them effectively. These failures led to hundreds of preventable deaths.

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What Concerns Should Be Raised

Category 1: Patient Safety Concerns (Immediate Priority)

Concern	Example
Clinical errors	Wrong medication, wrong patient, wrong procedure
Impaired colleagues	A colleague who appears to be under the influence of alcohol or drugs
Deteriorating patients	A patient whose condition is worsening but who has not been reviewed
Equipment failure	Faulty equipment that could compromise care
Infection control breaches	Failure to follow hand hygiene or sterile technique
Staffing shortages that compromise care	Dangerously low staffing levels

Category 2: Professional Conduct Concerns

Concern	Example
Dishonesty or fraud	Falsifying records, claiming for work not done
Bullying or harassment	Persistent mistreatment of colleagues
Discrimination	Treating patients or colleagues differently based on protected characteristics
Confidentiality breaches	Sharing patient information inappropriately
Boundary violations	Inappropriate relationships with patients

Category 3: System and Process Concerns

Concern	Example
Inadequate policies	Protocols that do not adequately protect patients
Poor working conditions	Environments that compromise care quality
Inadequate training	Staff performing tasks they have not been trained for
Resource misuse	Wasteful use of NHS resources

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The Duty of Candour

The duty of candour is closely related to raising concerns. It is a legal requirement (under Regulation 20 of the Health and Social Care Act 2008) that healthcare providers must be open and transparent with patients when things go wrong.

What the Duty of Candour Requires

Requirement	Detail
Notify the patient (or their representative) as soon as reasonably practicable after a safety incident	Do not wait for the patient to complain
Apologise	Sincerely — and know that an apology is not an admission of legal liability
Provide a truthful account	Explain what happened, based on the facts known at the time
Explain what will be done	Describe the steps being taken to investigate and prevent recurrence
Provide support	Offer emotional and practical support, including information about how to raise a complaint

SJT Application

Scenario: You are a medical student who accidentally knocks a patient's water jug onto the floor, spilling water near medical equipment. No damage or harm occurs.

Action	Rating	Why
Clean up immediately, check the equipment is undamaged, and inform a staff member about what happened	Very appropriate	Honest, responsible, and ensures safety is not compromised
Clean up and say nothing because no harm was done	Inappropriate, but not awful	Dishonest by omission; misses an opportunity to ensure equipment safety
Leave the spillage for someone else to deal with	Very inappropriate	Creates a safety hazard and shows no accountability

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The Escalation Pathway

Step 1: Direct Conversation

Where safe and appropriate, raise the concern directly with the person involved first.

When this is appropriate	When this is NOT appropriate
A colleague forgot to wash their hands	A colleague appears to be intoxicated
A team member made an unintentional error	You suspect deliberate fraud or cover-up
A minor miscommunication occurred	The person is senior and you fear retaliation
A process was not followed correctly	Patient safety is at immediate, serious risk

Step 2: Immediate Supervisor

If the direct approach is not appropriate, has not worked, or the concern is more serious, raise it with your immediate supervisor (e.g., clinical tutor, registrar, ward manager).

Step 3: Senior Management

If your supervisor does not act, or if they are part of the problem, escalate to senior management (e.g., clinical director, medical director, head of department).