Medical Defence Union (MDU) medico-legal adviser Dr Kathryn Leask explains the steps practice managers need to take when raising concerns about a colleague whose health may be affecting their work.
In the MDU’s experience having concerns about a colleague’s health or performance can put practice managers in a difficult position. While you may be concerned for the colleague’s wellbeing you also have an obligation to ensure their situation does not impact on patient safety.
However, it is important to tackle concerns early so that measures can be put in place to protect patients.
How common are health issues?
A Royal Medical Benevolent Fund survey of over 1,300 hospital doctors and GPs found that 82% of doctors knew of other doctors suffering from mental health issues such as depression and anxiety.
Despite their need for help and support, 84% were unlikely to reach out due to fear of discrimination or stigma from colleagues, or were inhibited by their ‘high achieving’ personality traits (66%).
The doctors responding to the survey cited patient caseloads, increased scrutiny – such as from the CQC and the revalidation process – and long working hours as significant factors.
How to recognise a colleague who is unwell
It is therefore not uncommon for practice managers to find themselves in a position where they have concerns about a clinical colleague.
Your suspicions may be aroused when a doctor or nurse starts to get an increasing number of patient complaints or when reception staff, patients or carers make passing comments about the doctor’s attitude or appearance.
You may have noticed that your colleague’s behaviour is out of character or that they look unwell and may be taking more sick leave than usual. There may be problems with their timekeeping and general reliability.
Referral letters, test results and other paperwork might be piling up, not being dealt with in a timely manner. All of these are tell-tale signs of a colleague who may be struggling due to problems with their physical or mental health, which could be putting them and their patients at risk of harm.
Your obligations to raise concerns
In its Good Medical Practice guidance, the GMC makes it clear that if a doctor has concerns that a colleague might be putting patients’ safety, dignity or comfort at risk, and may not be fit to practice, they must take action promptly (paragraph 25c).
The GMC says that doctors must ask for advice from a colleague, their defence body, or the GMC. If they are still concerned, they need to report their concerns in line with GMC guidance and their workplace policy, making a record of the steps they have taken.
In addition, Nursing and Midwifery Council guidance states that nurses and midwives who are concerned about the level of care people are receiving should ‘raise and, if necessary, escalate (take further action on) any concerns you may have about patient or public safety’ using ‘the channels available to you in line with our guidance and your local working practices.’
Practice managers and non-clinical staff should be aware of their workplace policy and know how to escalate concerns, for example raising them with a senior colleague in the first instance.
It is important for practice staff to feel they are able to raise concerns in a confidential way and for any concerns to be dealt with appropriately.
It may be difficult for more junior members of staff to raise concerns about a senior colleague, particularly, for example, a senior partner. However, staff should be supported in making genuine concerns known to the appropriate person, in accordance with the practice policy.
Support for colleagues who are ill
When a concern is raised with a colleague, they need to be dealt with sensitively and in a supportive way. Encourage the colleague to seek independent support from their GP or an occupational health doctor and, if necessary, take sick leave – both for their own benefit and for that of benefit patients.
If the colleague is a GP or nurse, it will be important to establish whether there has been any risk to patient safety, which may involve reviewing notes about and results for patients they have recently seen, and recalling patients where necessary.
Generally, where concerns have been raised about a colleague’s conduct, performance or health, you should consider whether these can be dealt with internally at practice level, or should be referred to NHS England or your local health board.
If neither of these options are appropriate, do not result in a satisfactory outcome, or if there is an immediate and serious risk to patients, then as a last resort, you may need to refer the matter to the GMC (raising and acting on concerns about patient safety: paragraphs 13 and 16).
It’s important to get advice from your medical defence organisation if you are considering referring a colleague to the GMC or if you have any queries about raising concerns.