Case study

  • Date:
  • Category:
    Concern involving HR
    Serious concern requiring Stage 2 investigation
    Where business as usual has not worked


A junior doctor felt over-worked, and when this had been going on for several months, they did not feel safe to sustain their current workload; putting patients at risk.  They had a good relationship with the consultant, but did not want to jeopardise this, or come across as being unable to manage their work.  

They sought support and advice from the NHS Scotland Confidential Alert Line, who suggested that the junior doctor discuss this situation with their professional body (as they were a member of the British Medical Association (BMA)).  They also advised that this could be considered whistleblowing, and the various forms of support that would be open to them if they were to take this further.  The BMA were clear that the junior doctor should report this issue within the board where they work, as a patient safety issue, and that this would be in keeping with the advice from the professional regulator, the General Medical Council (GMC).

After another week of long hours, they decided to raise the concerns with the consultant.  The consultant understood the junior doctors concerns, and thanked them for raising them.  However, they did not feel able to resolve the situation, as many of the issues related to resourcing.  They decided on an approach that would raise concerns at a higher level, and logged it initially as a stage 1 whistleblowing concern.  

A senior manager reviewed the concern and offered a meeting with the junior doctor about their working hours, with a representative if they chose.  The senior manager explained that resource restrictions meant there was no scope for employing more staff.  They discussed other options for limiting the junior doctor's workload, but the junior doctor was aware this would have an impact on other colleagues.  The senior manager said there was nothing further they could do if the junior doctor was unwilling to work with the potential improvements suggested.  The stage 1 whistleblowing concern was closed.

Three weeks later the junior doctor was working beyond their contracted hours, and made an error by prescribing too high a dose of a medication for a patient.  The error did not have any serious consequences, but it knocked the junior doctor's confidence.  

Two months later the workload issues had not improved, and they decided to raise another concern, as they were worried another error may happen.  They raised this as a stage 2 whistleblowing concern.  The pressure of the situation meant they felt unable to work.

While the junior doctor was off work, an unfamiliar senior manager contacted them, and explained they had been asked to investigate the situation, and were independent of the unit where the junior doctor worked.  They agreed to meet to discuss what had been happening and the junior doctor had access to a range of support options, including counselling, support from another member of staff who had been through the whistleblowing procedure, and consultation with an occupational health adviser in relation to maintaining their health at work.

At the meeting the junior doctor and the senior manager analysed the staffing level, the workload in the unit and the amount of work the junior doctor was doing.  The senior manager set out their proposals in terms of their investigation, and asked what outcomes the junior doctor was hoping for.  They discussed the resource limitations and explained what kind of outcomes may be achieved.  The senior manager explained that the investigation would take longer than 20 working days, but would keep them updated regularly.  

The investigation took six weeks, during which time the junior doctor was updated on progress and when they could expect the final outcome.  

The final report concluded that there was a shortage of medical staff in the unit, and that the workload was being exacerbated by sickness absence and low morale among medical and nursing staff.  The recommendations included a focus on improving nursing staffing and exploring options for recruiting another junior doctor, potentially on a shared basis with another complementary specialism.  

The junior doctor was informed of the outcome of the investigation and the improvements that were due to be made.  They were thanked for raising this issue, and the board apologised for the additional work they had done and the resulting stress they suffered.  They were also signposted to the INWO if they do not think that this concern has been resolved, or had concerns about how they were treated.

Updated: January 9, 2020