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Crisis of confidence

Junior doctors have urged hospitals to develop a ‘culture of openness’ after colleagues spoke of reluctance to raise concerns for fear of negative consequences.

The call comes from BMA junior doctors committee chair Jeeves Wijesuriya after the issue was raised by the guardian of safe working at Homerton University Hospital last month.

Emergency medicine consultant David Wilson said in a report to the board that the 225 exception reports raised by junior doctors in 2017-18 suggested an ‘underreporting’ of concerns.

‘It was of significant concern that at the most recent JDF [junior doctors forum] a number of trainees voiced reluctance to exception report fearing potential negative consequences from their supervising consultants,’ the report stated.

It said he was satisfied with the ‘overall safety of junior doctors’ working patterns’ but that the safety of patients and staff would be put at risk if doctors felt unable to speak out.

He called for further action to bring about ‘an open exception reporting culture’ at the trust.

Dr Wijesuriya said workplaces had to develop cultures of openness and honesty around staff raising concerns for working environments to be improved.

‘Raising these issues at trust board level, as the guardian has done in this case, is precisely what the guardian should be doing so trusts are made aware and asked to act,’ he said.

‘We know that there will be times in every trust in which doctors will be concerned about something and wish to raise their concerns,’ he added. ‘Exception reporting, which allows concerns to be reported in real time, plays a crucial role, but its success depends upon doctors having the confidence to use it, safe in the knowledge that they will not face personal repercussions.’

The association, along with NHS Employers, the GMC, the Care Quality Commission, Health Education England and others, are working with NHS Improvement to standardise the collection and reporting of exception report data.

The group’s remit may also extend to addressing cultural issues impacting exception reporting and to developing guidance to support safe working guardians in their role.

BMA armed forces committee chair Glynn Evans, who is guardian of safe working hours at London North West Healthcare NHS Trust, said consultants should work ‘in tandem’ with junior colleagues.

‘Many doctors see and welcome the important benefits to patient and staff care provided by exception reporting, although, occasionally, more traditional attitudes to working practice can conflict with this,’ he added. ‘Consultants must seek to work in tandem with their junior colleagues in ensuring that the reporting of concerns can take place effectively and in a supportive and non-judgemental environment.’

Read the BMA’s guidance on exception reporting

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