Principle 8 - Raise concerns if patients are at risk

Iwan

Iwan is a student dental technician who is worried about raising a concern about the actions of a fellow student.

Student dental technician

On a work placement Iwan observed a fellow student Martin lick his fingers and then use them to adapt a wax baseplate for a record block for a patient. He also saw him blowing over a denture to remove dust that had been generated when grinding the periphery of the appliance which was to be given to a patient. This breached health and safety and infection control requirements.

After observing this Iwan raised the issue with Martin. He didn’t tell the supervisor as the students were friends and he was worried it could affect their work placement. Martin explained why he did this, for example it was more convenient than using the air-line to blow away the debris, but said he recognised it was breaching health and safety and infection control guidelines and would stop. Two weeks later Iwan noticed Martin doing this again.

What do you think Iwan should do next?

Select an option: 

• Leave Martin to carry on. After all he had told him about the dangers to his health and the possible risk to the patient so now it was up to him.
• Speak to Martin one last time in the hope that he would change his ways.
• Tell the work place supervisor what Martin had been doing.

See what Iwan and Martin did next...

Iwan

When Iwan told the supervisor what he had observed he was thanked for bringing the matter to the training provider’s attention. Iwan was asked whether it was the first time he had observed this happening and then he admitted that it wasn’t. He explained he felt under pressure not to say anything and that his friend had reassured him that they wouldn’t do it again.

Iwan recognised that there was an issue with not reporting the incident immediately and apologised, independently committing to always reporting a patient safety incident immediately in future. The supervisor reported the incident to the college tutor and an investigation into the incident ensued. Upon conclusion of the investigation Iwan was issued with a warning which was noted on his personal record.

Due to the fact that Iwan demonstrated immediate insight and apologised a student fitness to practise hearing wasn’t required. Iwan was not required to declare this on his GDC application form at the end of the course as it was an isolated warning and no formal student fitness to practise process took place. 

Martin

The supervisor met with Martin and notified him that an observation had been made about his practice in the work placement. Martin’s initial response was to ask who had reported this and appeared angry that someone had told on him. Martin also denied doing this. Martin was told that the incident would be reported to his college tutor and then investigated.

The investigation was carried out and another student came forward with the same observation. Martin then admitted that he did frequently lick his fingers to adapt the wax and blew over dentures to remove the debris but tried to minimise the seriousness of it to the investigator. As a result the investigator referred the issues to the student fitness to practise panel. During the hearing Martin apologised for his actions and said he recognised the health issues to himself and the possible risk to patients.

The outcome of the hearing was that Martin’s student fitness to practise was judged to be impaired and he received the following sanction: Martin was warned that his work placement could be suspended if he persisted. Martin was required to complete remedial tuition on patient safety and cross-contamination and infection control followed by increased supervision for six months on his work placement. Martin met the conditions and completed the course. This was noted on his personal record. Martin had to declare this on his application form to register with the GDC.

GDC principles

8.1 Always put patients’ safety first.

8.2 Act promptly if patients or colleagues are at risk and take measures to protect them.

Other guidance

GDC guidance on raising concerns

NHS guidance

Discussion points

• How would you deal with pressure not to tell on a fellow student or friend? 
• What might be the possible consequences of not reporting a concern? To you, to the patient, to the person causing the concern. 
• How would you feel if something bad happened to the patient and you hadn’t reported your concerns? 
• What support might you need after you had raised a concern?

_Disclaimer

_{These fictional case studies are for illustration purposes only and should not be relied on to make clinical decisions. Their aim is to put GDC guidance in context, exploring how some of the principles might work in practice.}

_{The case studies cannot be relied on to be clinically accurate. Nor do the case studies intend to show the "correct" interpretation of GDC guidance, only one (or more) possible interpretation(s).}