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Early in the morning of 21st October 1805, at the start of the Battle of Trafalgar, Admiral Nelson sent a signal out to all his fleet saying "England expects that every man will do his duty". The rallying call is said to have been the main factor in a historic win against the odds.
The new GDC Standards include a call to dentists to ‘do their duty’ when it comes to being aware of any failings in the standards and skills of fellow professionals. It begins with “Patients expect: That the dental team will act promptly to protect their safety if there are concerns about the health, performance or behaviour of a dental professional or the environment where treatment is provided”. The common term for this action is ‘whistleblowing’, an act that some people see as unpalatable. The responsibility is causing a good deal of conflict and passionate discussion amongst the profession, with some people recognising the need to protect patients from poor care and others seeing this, to quote Kevin Lewis, as an “unedifying spectacle that belittles the profession”.
So, should we or shouldn’t we? The GDC is strongly of the opinion that we should. This tenet is expanded at considerable length in the new standards, with the next paragraph saying:
“You must raise any concern that patients might be at risk due to:
- the health, behaviour or professional performance of a colleague;
- any aspect of the environment where treatment is provided; or
- someone asking you to do something that you think conflicts with your duties to put patients interests first and act to protect them. You must raise a concern even if you are not in a position to control or influence your working environment. Your duty to raise concerns overrides any personal and professional loyalties or concerns you might have (for example, seeming disloyal or being treated differently by your colleagues or managers)”.
There is no ambiguity in this guidance. You must raise concerns even if you think it is not in your best interests. Your registration is dependant on you policing the standard of care of those other professionals with whom you come into contact. The GDC actually says this. Now, this doesn’t mean you become pedantic about every little mistake, we all have ‘off-days’. However, it does mean if you have consistent worries about someone with whom you work or have other professional contact with, perhaps as a referring dentist.
OK, but what does ‘act’ mean?
Well, the GDC says that you must act quickly, in order to tackle poor practice before there is a serious risk to patient safety. It also says that you must act even if you are not sure whether the issue that worries you amounts to a concern that you should raise. If in doubt, you must raise your concern. This brings us to the issue of Whistleblowing Policies. The QCS policy and procedure covers this and you should not have to prove your concern for it to be
investigated. If the investigation shows that there was no problem, the fact that you raised the concern should not be held against you as long as you were justified in raising the concern.
Where possible, you should raise concerns first with your employer or manager. However it may not always be appropriate or possible to raise concerns with them, particularly if they are the source of your concern. If it is not appropriate to raise your concern with them, or if they fail to act on your concern, you must raise your concerns with your local Commissioner
of Health or with the appropriate body:
- Care Quality Commission
- Healthcare Inspectorate Wales
- Regulation and Quality Improvement Authority
- Healthcare Improvement Scotland.
You can also get advice from your defence organisation or professional association. If all this fails, then approach the GDC directly.
Even after Clinical Governance was introduced as a way of tackling poor practice within healthcare, there has been a reluctance to speak out in the presence of increased risk to patients through clinical ineptitude and poor management. This has recently been illustrated by the Mid-Staffordshire Hospital developments where it is maintained that many patient died unnecessarily through poor care. Eventually, this was brought to light through a whistleblowing process. Even then, the whistleblowers concerned have had to fight to continue the raising of standards to a safe level. Changes in law and the in the NHS constitution are required (and are ongoing) in order to protect people who highlight poor care.
How does this make you feel?
This particular requirement in dentistry is making some people feel awkward and worried as they do not feel able to raise concerns or feel that it is not fair that this responsibility is being transferred to us. On the other hand, it should make us feel empowered to act in the interests of both the profession and the patient in helping to raise and maintain standards.
There is a concern that this is an open window for grudges to be settled and mischief to be made. We can never escape the sort of people who might take advantage of this as a way of dealing with their own inadequacies; they are present in any profession. On balance, I feel that this is a higher responsibility that we should all embrace and act upon responsibly when, or if, the need arises. Hopefully, that won’t be very often.
Dr John Shapter – QCS Expert Dental Contributor