Management of Issues of Concern

A concern regarding the provision of education and training may be raised by anyone related with the quality of junior doctor training via a number of routes:

  • Contract visiting
  • Levels 2, 3 or 4 of the Risk Management process
  • Quality Panels
  • Directly with anyone in the Quality Team (please see contacts on this website)

Trainees Raising Concerns

  • Immediate patient safety concerns should be reported via the appropriate local Trust/GP/Public Health reporting systems
  • Urgent concerns relating to the safety of patients or trainees or the quality of training should be raised with a trainee's Clinical Supervisor/Educational Supervisor/Training Programme Director/Foundation Programme Director/Head of School (as appropriate)
  • Anonymous or attributed concerns can also be raised by trainees to the following email address: and will be addressed by the Quality Team.

Every year trainees also have the opportunity to raise concerns via the GMC National Training Survey and via Quality Panel reporting systems but serious concerns which require immediate attention should not wait for these routine quality processes to occur.


The Risk Management Process

Level 1 – Enquiry

Concerns will be made by the Quality Team to the relevant Training Programme Director, Head of School or Director of Medical Education, with a view to understanding the nature of the concern. This will usually occur when the Quality Register is periodically sent to stakeholders for comment.

If the concern is deemed to be low risk, have been appropriately investigated and there is an action plan in place, details will be logged on the Quality Register and monitored until there is evidence that the issue is resolved.

The issue will be marked green on the quality register.

However, if further investigation elicits evidence of a higher level concern, the issue will need to be escalated to Stage 2.

Level 2 – School Visit

If the stage 1 enquiry identifies the need for further action, the Programme/School will initiate an investigation, which may include:

  • A meeting between the Head of School, Training Programme Director/Foundation Programme Director with the Director of Medical Education and relevant staff, depending on the area of concern.
  • Triangulation of evidence will be used to validate the concern e.g. GMC surveys, Quality Panels and the Quality Register etc.
  • It is crucial that an action plan is created and entered onto the Quality Register for monitoring purposes and the issue will be marked Amber. Please contact the Quality Team to obtain the Report pro forma.

If the School Visit elicits evidence of higher level concerns, or the School is unable to resolve the process and requires further support, the issue will need to be escalated to Stage 3.

Level 3 – Severn PGME Triggered Visit

There will be a visiting team and a host team. The composition of the teams will depend on the issue, but may comprise:

  • The Visiting Team
    • Chair (Associate Dean for Quality)
    • Deputy Postgraduate Dean
    • Quality Team
    • Head of School
    • Lay representative
  • Host team
    • Trust Chief Executive
    • Medical Director
    • Clinical Director
    • Director of Medical Education
    • Specialty Tutors
    • Educational Supervisors
    • Trainees

The meeting will review evidence and elicit additional information in order for the Quality Team to produce:

  • A report of the meeting.
  • Action plans with agreed timescales and assigned responsibilities.
  • Progress will be monitored by the Quality Register and the issue will be marked Red.

If the Triggered Visit or other information elicits evidence of higher level concerns, or the stakeholders are unable to resolve the process and require further support, the issue will need to be escalated to Stage 4.

Level 4 – GMC Enhanced Monitoring

Where Severn Postgraduate Medical Education requires support to help with serious issues concerning training, these will be entered into GMC Enhanced Monitoring. The Issue will be marked Red* on the Quality Register. The GMC will be involved with supporting an action plan and relevant activities to improve the quality of training.

The GMC Enhanced Monitoring process will be followed.

In the case of serious educational failure, Severn PGME reserves the right to withdraw training recognition from either the Programme or a site.