The safety, dignity and care of patients must come first, and you must act quickly to protect patients from risks posed by colleagues and premises, equipment or other resources, policies or health systems/services which fail to meet minimum standards. If you have serious concerns about any practitioner’s fitness to practise, you should raise this with them first if you feel able to and, if not, with an appropriate person in your organisation.

If necessary. you should escalate your concerns to an appropriate person.²¹⁹ 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?

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 timeline 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’.^{220, 221} 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.²²²

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.