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  • You must raise concerns about patient care and safety, including any practitioner’s fitness to practise.
  • Raising a concern is also known as whistleblowing.
  • In some circumstances you are protected in law when you raise a concern.
  • You should act quickly.
  • You should keep a record of any concerns.
  • You must protect patient confidentiality.
  • You should record adverse incidents centrally, for example in your practice’s system or in the practice Accident Book.
  • You should report near misses involving NHS-funded patients in England and Wales to the National Reporting and Learning System and to the equivalent bodies in the other UK countries, in Scotland to your local health board, and in Northern Ireland to the Northern Ireland Adverse Incident Centre.
This Guidance does not change what you must do under the law.
The safety of patients must come first, and you must act quickly to protect patients from risks posed by colleagues. If you have serious concerns about any practitioner’s fitness to practise, you should raise this with them first if you feel able to. 
If necessary. you should escalate your concerns to an appropriate person.206 This could be the colleague’s line manager, employer, or person in a primary care organisation or hospital. If you remain concerned, you should consult the relevant professional, representative or regulatory body.
Raising a concern is different from making a complaint. If you make a complaint, you might be asked for evidence to prove your case. When you raise a concern, you should not be expected to prove the issue you are concerned about, although you do need to have a reasonable belief that wrongdoing is happening, has taken place in the past, or is likely to happen in the future. If you are not sure whether you should act, ask yourself:
  1. what might the outcome be in the short- or longer-term if I do not raise my concern? 
  2. how could I justify not raising the concern?
See section on Working with colleagues
Examples of what you should report include:
  1. very poor treatment
  2. failure to gain patient consent to treatment
  3. cross-infection problems, for example use of dirty equipment
  4. sexual assault or abuse. See section on Maintaining boundaries
  5. practising under the influence of drink or drugs
  6. fraud or theft
  7. inadequate malpractice insurance.
You should:
  1. act quickly
  2. keep a record of the concerns you have raised, and actions you have taken. The record should be as detailed as possible, and not influenced by your personal feelings or opinions. The record should be verifiable or auditable, and you should keep a time line record of any communications.
You must protect patient confidentiality. See section on Confidentiality.
In certain circumstances, you are protected in law from harassment or bullying when you raise a concern. This is known as ‘protected disclosure’.207, 208 If you are making what you believe to be a protected disclosure, you should make it clear to the person you are making the disclosure to that you believe the disclosure to be protected, and your reasons for this.
In order to receive the protections of the Public Interest Disclosure Act, you must follow your employer’s policy, if it is a reasonable one. If you feel that your employer’s policy is not reasonable, contact your professional or representative body, or you can contact Public Concern at Work.209
You should be able to raise your concern confidentially, so your name is not revealed unless this is required by law. When you raise your concern you need to make it clear if you are doing so confidentially. This is different from raising a concern anonymously, when you refuse to give your name.
An adverse incident is where harm has occurred, and a near miss is where harm could have occurred.
If an adverse incident occurs you should:
  1. apologise to the patient
  2. explain what has happened
  3. explain any remedial action.

    This is what is meant by the duty of candour.
If necessary, you should also:
  1. investigate the adverse incident
  2. take the appropriate action
  3. keep a written record.
You should record any adverse incident somewhere central to the practice, for example in your practice’s system or in the practice Accident Book. This applies even if it was not due to any fault of the practice or practitioner.
If a near miss occurs, you should learn from it and you should reassure the patient if you think it caused them concern.
You should report any near misses or adverse clinical incidents involving patients receiving NHS-funded care:
  1. in England and Wales to the National Reporting and Learning System (NRLS). This does not collect any patient or practitioner identifiable information210 
  2. in Scotland to your local health board211
  3. in Northern Ireland to the Northern Ireland Adverse Incident Centre.212 
If the adverse incident was due to a drug or medical device you should report this to the Medicines and Healthcare Products Regulatory Agency, as appropriate.213, 214 See sections on Infection control and Use and supply of drugs or medicines in optometric practice.
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