2. Emerging and urgent concerns (non-routine/ad hoc bilateral sharing)

Referring a concern to the GMC is appropriate when the conduct, performance or health of a doctor raises potential issues about their fitness to practise. The GMC provides detailed guidance about raising a concern and the thresholds for sharing non-routine information with the GMC.

Referral to the GMC is also appropriate when serious concerns arise in an environment in which doctors are trained. Medical staffing and rota issues may mean that doctors in training are not getting the clinical supervision they require, which can put patients at risk.

Examples of when we share non-routine information are contained in Annexes 2 and 3.

Where there are concerns about an individual doctor, in almost all cases, the responsible officer (NHS England or Health Education England for doctors in training) should make the referral to GMC. Responsible officers are nominated or appointed by designated bodies under the Medical Profession (Responsible Officers) Regulations 2010. The designated bodies are listed in the schedule.

The purpose of liaising with the responsible officer is to ensure that:

• all the relevant information is available to the doctor’s responsible officer to allow them to fulfil their statutory role in the investigation of fitness to practise concerns
• appropriate support is available for the doctor
• appropriate support is available for relevant colleagues (such as doctors in training attached to the doctor)
• adequate resource is available for the investigation and remediation of concerns.

When communicating with the doctor’s responsible officer, the GMC’s local employer liaison adviser should be copied in to ensure that no delays occur that provide a risk to patient safety (see Annex 1). If the responsible officer does then decide to make a formal referral to the GMC, then the CQC inspector should ensure they are copied in to provide assurance that the referral has occurred. Relationships with responsible officers should be held at a local level and work within strategic agreements with NHS England and Health Education England.

Some issues involving doctors may be better addressed by the provider or referral to the NHSR Professional Practitioner Advisory Service if they include training or performance issues that do not directly place patients at risk. However, local action or an existing referral should not preclude either a CQC referral to the GMC, or contacting the local GMC team.

If you think a concern relates to the GMC’s remit, but are uncertain whether the concern is sufficiently serious to engage their processes, you should discuss with your manager and/or the key escalation contacts in Annex 1.

After considering the issue and the action that has been taken, it may be that CQC still wishes to make a referral to the GMC. In such instances there is a range of information that may be useful to include, such as:

• the doctor’s full name, or surname, initials and GMC reference number
• the name and address of the department, trust, hospital, care home or practice where they work
• a full account of the events or incidents that prompted the referral, with dates if possible, and a note of your concerns
• copies of any relevant papers and any other evidence you have. Where applicable, and particularly where the prescriber is not the patient’s usual GP in both remote and face to face contexts, this may include medical records relating to the episode of care (for example, prescriptions, medical histories considered before issuing the prescription, and medical records documenting additional advice provided to the patient and/or communication with the patient’s registered GP) and steps taken to verify information.
• details of any action you have taken already
• details of anyone else, or organisation, who can support the referral
• details of any investigation or action being taken by CQC and the local contact at CQC. 

Once you have decided to refer information about a doctor or an organisation you should record information on the referral in the appropriate place (for example through the customer relationship management system).

Confidential personal information must only be shared under this protocol where the purpose of that disclosure provides a legal basis for doing so, determined by considering the CQC statutory Code of Practice on Confidential Personal Information and Sharing Information Guidance. CQC will only share confidential information where it has considered the likely impact of making the disclosure, the implications of making the disclosure, and where we judge that the public interest to be served by sharing the information justifies doing so.

If CQC evidence points to serious concerns within healthcare environments that could impact on medical students or doctors in training undertaking placements, this should be shared so that the GMC could investigate further.

Details of the concerns and the provider, including the department and cohort of students or trainees affected, should be shared with the GMC outreach teams (see Annex 1).

These concerns should also be discussed with the local Health Education England office.

When the GMC identifies system concerns it should consider whether to share this information with CQC. Before sharing information with CQC, the GMC must also consider informing relevant bodies at a local level that may be able to provide immediate resolution. This can be discussed with the relevant regional head (Annex 1), or if the information was received at a local event, such as a training session with junior doctors, then consideration should be given to raising the concern directly with the local body in the first instance.

In most cases, consent is not required for the GMC to share the information. There may be instances where the GMC believes concerns are serious enough to share with CQC but an individual has raised concerns about sharing information. Decisions as to whether to share system concerns when someone has raised concerns about our sharing their information will be taken within individual directorates.

When sharing information with CQC, consideration must be given to the data protection principles. This means you must share only relevant information and the minimum information necessary to achieve the objective.

Examples of sharing non-routine information are contained in Annex 2 and 3.

After considering the issue and the action that has been taken, it may be that the GMC still wishes to share information with CQC. In such instances there is a range of information that may be useful to include:

• the event or issue identified
• the risks to patients, service users or staff
• how the risk was identified and whether it was verified
• incident location
• incident date
• system concern category
• reasons for referral.

If sharing information that relates to an unproven allegation, we must make it clear that the allegation is unproven.