Intended for healthcare professionals


What should I do if I feel my working environment in unsafe?

BMJ 2018; 360 doi: (Published 16 January 2018) Cite this as: BMJ 2018;360:k168
  1. Abi Rimmer
  1. The BMJ


During times of increased pressures, Abi Rimmer asks what doctor should do if they have safety concerns.

“Always act professionally”

Marika Davies, senior medicolegal adviser at Medical Protection, says, “If you’re worried that patient safety or care may be compromised you should raise your concerns by following your workplace policy and the GMC’s guidance, Raising and Acting on Concerns about Patient Safety.1

“The GMC says that, wherever possible, you should first contact your manager or an appropriate officer at the organisation you work for—such as the consultant, or clinical or medical director. If you’re a doctor in training, the GMC suggests talking with a named person in the deanery.

“Put your concerns in writing, clearly and objectively setting out the reasons and the potential impact on patient safety, with examples. It may be helpful to enlist the support of colleagues and act as a group—this can give more weight to the concerns you are raising.

“Keep a record of any correspondence or discussions you have had about the problems and the steps you’ve taken to remedy matters. If an adverse incident does happen, it can be useful to show that you took action. Your workplace procedures for reporting adverse incidents and near misses should also be followed.

“If those who are responsible do not take proper action, consider reporting the matter further up the line of management, in line with your workplace policy.

“When raising concerns, it is essential to act professionally and in line with GMC guidance. Be aware that correspondence, including emails or social media postings, may be seen by others. Also remember that your actions must be, and be seen to be, in the best interest of patients at all times.”

“Don’t discount your own health and wellbeing”

Charlie Massey, chief executive of the GMC, says, “I know how hard doctors, and all healthcare professionals, are working to provide good care in very difficult circumstances this winter. Knowing that this season would be challenging, the service has worked hard to prepare, but difficult decisions have had to be made—including cancelling routine surgery—and clearly this will be distressing for many patients.

“If a doctor believes their work environment is unsafe or that they are unable to maintain standards of care, we urge them to flag their concerns. We expect those responsible for running the services to listen, consider and act on those concerns.

“We understand that it’s not always easy, but it must be done. Doctors who need advice have a number of options. They may reach out to a senior member of staff, a medical defence body, their royal college, or the BMA. We also have a confidential hotline for doctors who feel they can’t report their concern at a local level.

“It is a doctor’s duty to put their patients first but they mustn’t discount their own health and wellbeing. We know teams are under immense pressure and this increases the risk of ill health. We hope doctors will do all they can to look after their own health during these pressured times. If you have concerns about the health of a colleague encourage them to seek help if it’s needed.”

“Be measured and objective”

Edward Farnan, a medico-legal advisor for the Medical Defence Union, says, “If you feel that patient safety, dignity, or comfort may be seriously compromised then you have an ethical duty to take action. The GMC advises that ‘if patients are at risk because of inadequate premises, equipment, or other resources, policies, or systems, you should put the matter right, if possible. You must raise your concern in line with our guidance and your workplace policy. You should also make a record of the steps you have taken.’

“The GMC’s Raising and Acting on Concerns About Patient Safety emphasises that the duty to raise concerns applies to all doctors, and that you can justify raising a concern in a measured and objective way in the absence of proof ‘if you do so honestly, on the basis of reasonable belief, and through appropriate channels.’

“It is usually appropriate to first raise your concerns within your own organisation, perhaps with your consultant, or the clinical or medical director, or a practice partner. If you feel that this is not the most appropriate way, or if this does not resolve matters, then it may be necessary to raise your concern externally, for example with the relevant regulatory body.

“It’s also worth discussing your concerns with a medico-legal expert at your medical defence organisation, who can advise you on what steps to take.”


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