Sometimes you may be concerned that patient safety is (or may be) seriously compromised by issues related to inadequate premises, equipment or other resources, or about the systems, policies or protocols you are asked to work to.

Paragraph 8.1.1 of the GDC guidance advises that you must raise any concern that patients might be at risk ‘due to any aspect of the environment where treatment is provided’. This might include poor decontamination processes in your surgery or failure to maintain essential dental surgery equipment in good working order. Your first duty is always to act in the patients’ best interests and this means that you are under an obligation to take appropriate action which was initially to alert the practice owner. If the response is delayed, you could follow up the initial request, to get the equipment fixed, with an email or letter expressing your concern at the delay.

These situations are always difficult for all concerned. It can seem counterintuitive to take steps that may cause your practice to close, affecting your own livelihood. Health issues are challenging for all concerned - the best advice is to talk to one of our experienced advisory team who can listen to your concerns and help you balance your professional obligations with your own personal interests. If there is another dentist in the practice it might be helpful to talk to them as they may be able to seek practical support from their Local Dental Committee and perhaps the local PASS (Practitioner Advice and Support Scheme).

In any case, where concerns are to be raised outside the practice, you would be wise to think about the following points to ensure you are not vulnerable to criticism during any ensuing investigation:

• What is the real background to this episode, Is there a 'back story' that has not (yet) been disclosed, and about which you may be unaware?
• Is there anything in my relationship with this person/the practice that might support an allegation that this concern was raised to gain a competitive advantage?
• Could a reasonable and neutral observer detect any personal motive associated with raising your concerns?
• Is there any objective evidence available to support and justify the concerns?

The GDC Standards guidance at 8.2.2 confirms that you should not have to prove your concern for it to be investigated and that the fact that you raised the concern should not be held against you as long as you were justified in raising the concern.

Nevertheless, it can be extremely hard to whistleblow, even in the most obvious of circumstances. It is understandable that there may be a genuine fear and risk that you, as the whistleblower, will subsequently be scrutinised yourself, particularly if the case against the first clinician cannot be proved.

The Public Interest Disclosure Act 1998 (PIDA) gives protection to registrants who raise genuine concerns about potentially illegal or dangerous practices in the workplace.

PIDA applies to all employed dental professionals working within the NHS or the private sector, and to self-employed dental professionals contracted to provide NHS services.

Concerns you raise with the GDC, or with any other professional regulatory organisation, will be protected under PIDA if the concerns are about:

• crime
• someone breaking a legal obligation
• a miscarriage of justice
• danger to health and safety or the environment;
• or a cover-up of any of the above

This protection applies as long as you:

• are acting in good faith
• honestly and reasonably believe that the information and any allegation in it are substantially true
• are not raising concerns mainly for the purpose of personal gain, and
• have taken steps to raise concerns first with the employing or contracting authority (unless you reasonably believe that you would be victimised if you did so, or you reasonably believe a cover-up is likely or the matter is very serious

You do not have to prove your concerns, as long as you make them in good faith.

The GDC prefers that, when you report concerns, you give your name. This is because it is harder to investigate concerns if people cannot ask follow-up questions. It is also easier for you to get protection under PIDA if you raise your concerns openly. If you are concerned about revealing your name when raising a concern, give your name but ask that it is not revealed more widely without your consent.

If you are anxious that there may be related professional issues that mean that you may find yourself vulnerable to criticism during an investigation, discuss the matter with one of our dentolegal advsiers.

Deciding what to do when you have concerns about a colleague’s behaviour is always uncomfortable. Your duty to raise any concerns you have, however, overrides any personal and professional loyalty.

The guidance makes it clear that the safety of patients must come first at all times. This means that any dental professional who has concerns that a colleague may not be fit to practise must take prompt and appropriate action. You should explain your concerns clearly and honestly to an appropriate person from your contracting body or employer.

Salaried employee
If you are working as an employed dental professional, any specific local procedures should be followed (your contract may well define them). You should expect that your employer will promote and support a culture of openness and that you should be made aware of the local processes to follow. Your employer must support you if you need to raise a concern and take your concerns seriously, creating a culture where you should not fear reprisal.

In such circumstances it would also be prudent to seek advice from Dental Protection about how to raise your concerns, to ensure that your own position is protected. Make sure that you keep a record of your concern and the steps you have taken to try to remedy the situation.

Self-employed
For those who are self-employed, if the dental professional is not appropriately receptive to constructive criticism or is not able to improve performance to a level that removes any risk to patients, paragraph 8.2.5 of the GDC’s guidance makes it clear that you must act on your concerns promptly.

If local procedures have not resolved the problems, or the person to whom you would normally report your concerns is part of the reason you are concerned, you should refer your concern to the GDC.

If you need to contact the GDC for this reason, it would be wise to contact Dental Protection and speak to a dento-legal adviser about how to take the matter further. To facilitate that conversation it would be helpful to have available a record of your concerns and the steps you have already taken to try to remedy matters.

Although the decision to raise concerns is entirely personal and is not one that any other clinician can make for you, it is best to speak with one of our dento-legal advisers and ask for their guidance. Every case will be different and there is no one answer that will fit every occasion. If there are related professional issues that you think could leave you vulnerable to criticism during an investigation, Dental Protection will know how best to assist and support you. Doing nothing, however, in a situation where you have concerns about patient safety is not an option. Failing to act in such circumstances may put your own registration at risk.

In summary, if in doubt, always raise a concern. Try to raise concerns locally first. If you have already done that, and no action has been taken, you must act on your concerns promptly. You should not be asked to prove your concerns although you might need to explain your decision.