Professional duty to report concerns

53. We accept this recommendation. A review of professional codes is under way. 54. Dr Kirkup found that many staff did not raise any concerns about standards of care in the maternity units across Morecambe Bay, but perhaps even more troubling is that where concerns were raised there was no evidence that they were properly addressed or followed up. 55. The Professional codes of conduct for both the General Medical Council13 and the Nursing and Midwifery Council14 require registrants to raise concerns and take action where patient safety is at risk. 56. In addition, Professor Sir Bruce Keogh has been asked to review the professional codes of practice of doctors, nurses and midwives and to ensure that the right incentives are in place to prevent people from covering up, instead of reporting and learning from mistakes. This work is being conducted in collaboration with key stakeholders, including the Professional Standards Authority, the General Medical Council, the Nursing and Midwifery Council and Health Education England. The final report is expected later this year.

In March 2015, the former Secretary of State for Health asked Sir Bruce Keogh to review the professional codes of doctors and nurses, and to ensure that the right incentives are in place to prevent health care professionals from covering up mistakes. On 16 July 2015, Sir Bruce confirmed that the professional codes of conduct for doctors (Good Medical Practice) and nurses (The Code) are both fit for purpose.

The GMC and NMC developed joint guidance on the professional duty of candour in 2015 (updated in 2019) which makes clear that healthcare professionals must be open and honest with their colleagues, employers and regulators, raising concerns where appropriate and taking part in reviews and investigations when requested. It also states that professionals must support and encourage each other to be open and honest, and not stop someone from raising concerns. The GMC developed a ‘Speaking Up Hub’ for doctors. This contains advice and tools to help doctors follow GMC guidance and be more confident in raising concerns effectively, and case studies showing the positive impact of raising concerns on patient safety.

The GMC updated Good Medical Practice guidance in January 2024. The guidance states that doctors must raise concerns promptly and includes a duty which says that doctors in management roles must encourage and support their colleagues to raise concerns. All professional regulators are overseen by the Professional Standards Authority for health and social care. The Professional Standards Authority annually reviews each professional regulator’s performance against the following four core functions: Guidance and standards, Education and training, registration, and fitness to practice.

Department of Health response (July 2015):

“We accept this recommendation. A review of professional codes is under way … Professor Sir Bruce Keogh has been asked to review the professional codes.” (p. 78)

Whilst there is information online which shows that Sir Bruce Keogh sent a letter to the Secretary of State updating on his review, a complete report of his assessment of the professional codes could not be found.

The Department of Health also mentioned that there is existing guidance for both the General Medical Council and the Nursing and Midwifery Council to require registrants to raise concerns and act where patient safety is at risk.