A rising proportion of doctors will not blow the whistle over patient safety concerns for fear of retribution, leading medics said.
The British Medical Association (BMA) surveyed doctors from around the UK in 2018 and again in 2024.
A rising proportion said they would not feel confident raising concerns about patient care – 26% of 1,578 doctors in 2024 compared with 10% of around 7,900 doctors surveyed in 2018.
Three in five (61%) of those polled in 2024 said they may not raise concerns because they were “afraid” they they or colleagues could be “unfairly blamed or suffer adverse consequences”.
Meanwhile 45% said they feel that their managers discourage them from raising concerns – up from 20% in 2018.
The BMA said that doctors are now “more frightened than ever” to speak up when they see patient safety issues, or levels of care at risk.
Professor Philip Banfield, chairman of council at the BMA, is set to highlight a culture of “protectionism rather than accountability”.
On Monday, at the union’s national annual meeting in Belfast, Prof Banfield will reference the case of Lucy Letby, where whistleblowers’ concerns about the child serial killer were not addressed for months before she was finally taken off frontline duties.
He will say that the BMA “will not stand idly by as employers try to silence those who raise concerns, and it has not. Have we learned from Letby – let me tell you – I fear not.
“Pandora’s box of raising concerns is about to be thrown wide open. This is far bigger than the Post Office scandal and the BMA will do all it can to help uncover wrongdoing.”
He will say the union will “continue to fight for change and the issue of employers trying to silence those who dare to speak up” and call for NHS managers to be held accountable for their actions.
Prof Banfield will describe a “disgraceful revolving door of ineptitude”, saying that some poorly performing managers have been “conferred a degree of protection” and “shuffled out of prominent roles and into other senior positions”.
“That’s why we’re backing the regulation of non-medical managers. Because as long as this culture of protectionism, rather than accountability, holds sway, doctors will continue to face appalling victimisation,” he will say.
Prof Banfield will also highlight the “misuse” of physician associates (PAs) in the NHS.
As the NHS continues with plans to increase the number of PAs in the health service, concerns have been raised that patients are mistaking them for fully qualified doctors.
PAs have been under increased scrutiny following the death of Emily Chesterton in November 2022.
The 30-year-old had been under the impression that she was seeing a GP, but was actually seen twice by a PA who failed on both occasions to spot that her leg pain and breathlessness was a blood clot, which ultimately travelled to her lungs.
The BMA has previously called for a halt in any further recruitment of PAs while concerns highlighted by the union are addressed.
Earlier this week, the Royal College of GPs called for a pause of recruitment of PAs in general practice until they are regulated.
Prof Banfield will say: “NHS England says MAPs (medical associate professionals) are not doctors, but propose no ceiling on their scope of practice.
“How they can entertain both positions makes no sense.
“And we keep seeing examples of PAs being called ‘physicians’ or ‘specialists’.
“This is not just misleading the public, it incites a criminal offence.
“We will lobby for a return to the term ‘assistant’ and not ‘associate’.
“We will not back down in our call for a halt to any further recruitment of MAPs until the medical profession’s concerns are fully addressed.”
Last week, the union highlighted how eight in 10 locum GPs are struggling to find work, despite increased patient need for services.
Referencing the poll, Prof Banfield will tell delegates: “Nothing highlights this crisis more than finding that a shocking 84% of locum GPs in England are struggling to find work.
“A third are being forced out of the NHS entirely.
“Driven out by the cheapening of the medical workforce and the substitution of GPs with alternatives that superficially seem less expensive, but in reality cost lives.
“To have highly qualified doctors turning to other jobs to earn a living, whilst GP practices cannot meet the demands placed on them, is simply bonkers.”
Meanwhile he will call the Additional Roles Reimbursement Scheme – a £1.4 billion funding pot designed to boost GP practice staff including physician associates and pharmacists, but not GPs or practice nurses – a “Trojan horse sent into the heart of general practice to replace and substitute doctors”.
“We will not stand idly by to let standards of healthcare be driven down, nor accept shortcuts being imposed at the expense of patient safety,” Prof Banfield will say.
On whistleblowing concerns, a spokesman for NHS England said: “It is completely unacceptable for any member of staff to feel silenced or unable to speak up about issues affecting them or patients, not only should everyone working in the NHS feel they can raise concerns but they must know that they will be acted on and that they will be treated fairly, this is vital for ensuring that the NHS learns from mistakes and provides the best possible care for patients.
“Every NHS trust should be adopting the updated national freedom to speak up policy and NHS England has recently asked all local areas to urgently ensure staff have easy access to information on how they can raise concerns, including through having a dedicated freedom to speak up guardian in place.
“If people feel disadvantaged as a result of speaking up, NHS England has ensured there is additional help available with a national scheme in place so staff can receive additional intensive support in these circumstances.”
Earlier this month NHS England boss Amanda Pritchard told the NHSConfedExpo conference that the service will create a new code of practice for all managers and leaders.