What to do about Trainee patient or personal safety concerns

If you are a Trainee…

Step 1.     

Decide whether this is an “immediate concern” (see definition below) or “non-immediate” concern.

  • Discuss it with your Clinical or Educational Supervisor (CS or ES).
  • Submit a clinical incident/critical event form.

Step 2.     

If still concerned, or unable to discuss with your CS, discuss with the Head of Department, Senior Partner or Training Programme Director.

Step 3.     

If still concerned, or unable to discuss with your CS or Training Programme Director or HoD/SP, follow the Trust’s or Practice’s whistleblowing procedure.

Timescales as below

If you are a Clinical or Educational Supervisor, or a Training Programme Director, and your Trainee has notified you of a concern…

Step 1.     

Decide whether this is an “immediate” or “non-immediate” concern (see definition below).

  • If it is either of these, go to Step 2.
  • If you feel it is not a significant concern, explain why to the Trainee.

Step 2.     

Can you resolve the problem yourself? If not, discuss with the Head of Department or Senior Partner. You may wish to bring it to their attention anyway. Check that the issue been logged as a clinical incident/critical event.

Step 3.     

If this is not possible or doesn’t result in resolution, discuss with your Medical Director, Training Programme Director or (if you are the TPD) with the Director or Head of your School.

Step 4.     

If this Step 3 is not possible or doesn’t result in resolution, follow the Trust’s or Practice’s whistleblowing procedure.

Timescales as below

What counts as an “immediate concern”?

An “immediate concern” signifies a clear, immediate and continuing danger or hazard to patient or personal safety from the Trainee’s point of view. It describes actual harm, near misses or continuing inadequate supervision, and is a first person account, not hearsay, and specifies a location i.e. a ward or department in an identifiable hospital or other setting, and provides a clear description of the problem giving rise to the risk.

Timescales

Trainees and Faculty need to follow this timescale for all concerns:

  • individuals need to decide whether the concerns are
    • “immediate” (see definition above),
    • “non-immediate”, or
    • “not a significant personal or patient safety concern”;
    • If an “immediate” concern, raise it with the next person/organization within two working days (two weeks for non-immediate concerns);
    • If there is not a satisfactory response within two weeks (four weeks for non-immediate concerns) take the concern to the next level
    • Faculty need to respond to concerns raised within two weeks (four weeks for non-immediate concerns)

Trainees and Faculty must keep a written record of the concern raised and action taken.

The GMC Training Survey has questions pertaining to patient safety. This survey runs annually and is usually open for a six week window. The preferred approach for raising personal or patient safety concerns should be through existing local processes.

Why are there so many possible steps?

Most concerns should be resolved at local level. However, the Trainee’s Clinical Supervisor may have multiple roles (e.g. may also be the Trainee’s Educational Supervisor or Head of Department or Training Programme Director), the Trainee may feel too vulnerable to take action locally, or action through local processes may be ineffective. We therefore give a variety of possible courses of action.