Colleagues, errors and workload

A colleague who is struggling

Respect and compassion for colleagues sit alongside patient safety. The GMC also expects doctors to obtain independent professional advice when health may affect fitness for work.

When comparing options, consider the person, today’s work and any recurring problem separately. A sympathetic conversation, practical redistribution and longer-term support may each address a different need. Check which need each option actually addresses.

Useful questions include: What is unfinished? Who is affected? What can safely wait? Who can agree cover? Does the option provide support, or merely instruct the person to cope?

A colleague who may be impaired

If a colleague appears to be under the influence of alcohol or drugs, or is otherwise unfit to work safely, the immediate priority changes. Patients they would treat are at risk now, so a private conversation about wellbeing cannot be the whole response.

Usual starting point: prevent the colleague from treating patients for now, for example by speaking to them and informing the senior responsible for the shift so that cover is arranged. Treat them with respect and support while doing so. Later steps, such as occupational health or formal processes, are for the appropriate senior, not for you to decide alone.

What could change it: if the evidence is only a rumour, or something that happened off duty with no effect on current work, establishing the facts and seeking advice may be the appropriate next step. The GMC says that where you are concerned a colleague may not be fit to practise and may be putting patients at risk, you must ask for advice and, if still concerned, report in line with workplace policy.

Some options can sound supportive while leaving a risk unresolved: covering for the colleague without telling anyone, sending them home with no handover, or agreeing to “keep an eye on them”. Each leaves patients exposed or relies on you to supervise someone you have no authority over.

For concerns about your own health or fitness, see your health, limits and commitments.

Delegation and handover

Safe delegation involves an appropriately capable colleague, clear instructions, relevant information and a shared understanding of when help is needed. Accepting a task carries responsibilities too; seek help if it cannot be done safely.

Exam application: “Leave a list on the desk” and “agree a handover with the receiving clinician” give you different levels of assurance that the task will be done. A task is not safely transferred just because you have sent a message. Equally, accepting everything yourself can create a new unsafe workload.

An error has occurred

Look separately for immediate care, appropriate senior involvement, honest communication and learning. When care has gone wrong and caused or may cause harm or distress, appropriate patient communication and an apology should not wait for the completed investigation. Be clear about what is known and uncertain. The appropriate team member should lead the discussion; do not assume that seeking their help excuses silence indefinitely.

Reporting an incident supports organisational learning; it does not itself treat a patient or inform them.

A near miss is an incident that could have caused harm but did not. An error that has reached the patient and may still cause harm is not a near miss: the GMC says the patient must be told and the event reported. For true near misses, disclosure to the patient requires judgement; the GMC advises seeking senior or team advice if unsure. Avoid “never disclose if no harm” and “every intercepted error requires exactly the same conversation”.

Conflict, bullying or discrimination

Teams share responsibility for addressing problems, and colleagues’ contributions deserve respect across professional roles. Discrimination should be challenged and relevant workplace policies followed.

A calm private discussion can suit an ordinary misunderstanding. You can seek help with intimidation or serious misconduct without approaching the person privately first. Consider the target’s support needs, your safety, the power relationship and the risk of repetition. Avoid retaliatory humiliation or blaming the person targeted for failing to resolve it alone.

Requests to hide or misrepresent

Name the action precisely: changing a record, claiming an assessment occurred, or supplying an explanation you know is false. Friendship does not remove the integrity problem. Look for a response that clearly refuses the dishonest request and offers a legitimate alternative. Avoiding the conversation may leave the request unresolved. Misleading someone can occur through omission as well as an explicit false statement; read the proposed action in context.