Raising Concerns

Message from Dr Ian Steele, Postgraduate Medical Dean, NIMDTA

GMC Definition of Bullying and Undermining

Bullying is behaviour that hurts or frightens someone who is less powerful, often forcing them to do something they do not want to do.
Undermining is behaviour that subverts, weakens or wears away confidence.

NIMDTA does not tolerate bullying and undermining. If you feel unable to raise concerns through your Clinical/Educational Supervisor, Clinical Lead, or Director of Medical Education, you should complete this form.

GMC Definition of Patient Safety

Raising concerns about potential patient safety issues or unprofessional behaviour on the part of staff, which may affect patient safety, is an important part of the duties of a doctor.

If you have any concerns about potential patient safety whilst on placement, which you feel unable to discuss with the Clinical Lead or Educational/Clinical Supervisor, you should complete this form.

Any information you submit will be treated confidentially and accessible only by a very small number of senior members of NIMDTA staff approved to do so by the Postgraduate Dean. We will acknowledge receipt of your concerns within 5 working days.

1. Name *

2. Email Address: *

3. GMC/GDC Number *

4. My issue relates to: *

Bullying and Undermining
Patient Safety
Unsatisfactory Training Environment
Other (please specify):

5. Where? *

Hospital
GP Practice
Dental Practice
Other (please specify):

6. Name of hospital site/practice/other (e.g. PHA)? *

7. Name/number of ward/clinical room (if known)

8. Date of incident? *

	DD/MM/YYYY

Who was involved?

*

Nature of incident: *

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