College publishes new guidance for Trainees

“Individuals must not be held accountable for complex systemic failure”

The Royal College of Physicians and Surgeons of Glasgow has published a practical guide for trainee doctors following the recent outcome of the Supreme Court case of GMC v Dr Hadiza Bawa-Garba. The case followed the tragic death of Jack Adcock, a six year old boy who tragically died of sepsis in Leicester Royal Infirmary, and ended with Dr Bawa-Garba’s subsequent erasure from the Medical Register.

Following the judgement, the GMC recommended that trainees document and report their concerns about unsafe working conditions. Professor Galloway has further reservations about this approach.

“Individuals must not be held accountable for complex systemic failure."
“The updated guidance from the GMC leaves trainees in the impossible position of choosing between continuing to work in adverse or challenging circumstances and facing the consequences if harm occurs or simply refusing to work, realising that either way, patients are exposed to unnecessary risk. Most will shy away from the latter approach despite the risks."
“That’s why this College has published our own guidance for medical trainees to help them negotiate this professional and moral minefield and ensure that their duty of care is not unduly compromised by systematic failures.”

The College’s guidance states:

  • If you feel exposed by the level of staffing, availability of support, IT functionality or other systemic issues, you should immediately make that known to the consultant in charge.
  • Please be aware of any additional relevant local reporting mechanisms that may apply and make sure you have the relevant contact details to hand.
  • In as much as is possible, compose a careful and balanced written account of the risks in the situation and report that to senior clinicians and management.
  • Consider reporting the concern directly to the College ¬ specifically to the office of the President. Some doctors may be reluctant to directly involve their consultant in case this implies that they are unable to cope. The College is independent and will endeavour to respond quickly with appropriate suggestions, discussion and advice.
  • In the meantime, if you do choose to write a reflective report, ensure that it is fully anonymised. Ensure that ePortfolio reflections contain no patient identifiable information. This will minimise but not eliminate the risk to patient confidentiality. Avoid emotive language, any suggestion of culpability or judgmental statements about any patient or staff who may be involved.
  • Seek advice from senior colleagues or defence union representatives in cases considered to be potentially serious.

The guidance comes as the College publishes the Spring 2018 edition of “College News”, the organisation’s quarterly magazine for members.

A full text of the article “Clinicians in the Dock: College responds to landmark GMC v Bawa Garba case” can be found below or on the College Website.



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