A worry about a senior partner — speaking to the practice manager

Candidates: do not open until you have consulted.

Persona and manner

• Jackie Rowntree, 51, practice manager for nine years. Capable, loyal to the partners, and fond of Dr Thornley — he recruited you. You are sympathetic to the young doctor, but your instinct is to keep this in-house and quiet: “a quiet word, no fuss”.
• You are not hostile. You become defensive only if the doctor uses labels (“alcoholic”, “drunk”) or threatens to go straight to the GMC.

Opening line — say this verbatim

• “Come in, sit down. Donna said you wanted a word about Dr Thornley. Look — he’s had a dreadful year. I’d rather we didn’t make a fuss. What is it you’ve seen?”

Volunteer freely if given the space

• You know he has been late a few times and that his surgeries overrun — “he’s always been thorough”.
• You have not heard about the slurred phone call or the corridor. If told, you go quiet: “I didn’t know that.”
• Your plan, unless challenged: “Leave it with me. I’ll have a quiet word with him when the time’s right — maybe next week.”

Only if asked

• If asked directly what you know, or whether anyone has raised this before: the partners talked about his lateness at a partners’ meeting two months ago and agreed to “keep an eye on things”. Nothing was written down.
• If asked why he has had a dreadful year: his wife, Catherine, died in March. He took two weeks off and came straight back.
• If asked about complaints: there was a written complaint last week from a patient whose referral was delayed. You have not yet told the partners; you were going to take it to the next meeting.
• If asked who else is in the building this afternoon: Dr Joanna Petrie, another partner, is in; she finishes her own surgery at 13:30. Dr Carver can be reached on her mobile. A locum agency can usually find someone for tomorrow’s duty session at a day’s notice.
• If asked about the practice’s policy: there is a raising-concerns (speaking-up) policy on the shared drive; you wrote it for the CQC inspection and “nobody has ever used it”. The practice does not have its own Freedom to Speak Up guardian; you believe the integrated care board or the primary care network has one — you would have to look up the number.
• If asked whether you have noticed anything about his health, or anything else that worries you about him: “It’s not my place to say.” If pressed, kindly and without judgement: “He’s lost weight. His hands shake in the mornings. That’s all I’m going to say.” If asked directly about drinking: “It’s not my place to say.” You never use the words “drink” or “alcohol” yourself.

Impact on daily life — the practice and its patients (only if asked)

• Reception are stressed: patients complain about the overrunning, and two receptionists have asked not to work the desk on his surgery days.
• The other partners are quietly picking up his unanswered tasks. Dr Petrie has been staying until seven.
• You lie awake about it. You feel disloyal even having this conversation.

Ideas, concerns and expectations

• Idea: that he is grieving and exhausted and will “come right” given time and kindness.
• Concerns: that a formal process will finish him — “he’s two years off retiring”; that the practice cannot run without him; that the FY1 doctor will “go over everyone’s heads”.
• Expectation: that the doctor tells you what they have seen and then leaves it to you.

Cues to deliver, timed

• Minute 2: “You know his wife died in March? He’s not been himself since.”
• Minute 4, if the doctor has not yet asked about this afternoon’s surgery: look at the clock — “He’s got sixteen booked at two.”
• Minute 6, if the doctor has not said who else should know: “So this stays between us, yes?”

If the doctor summarises and asks whether you want to add anything

• If the partners’ meeting two months ago has not come out: “There is something. The partners did talk about his lateness, back in the summer. They decided to keep an eye on it. Nothing was written down. I suppose that doesn’t look very good now.”
• If it has: “The complaint last week — about the referral. I haven’t told the partners yet. I should, shouldn’t I?”

How to respond to the doctor

• If the doctor gives specific, dated, factual observations without labels: you listen, you stop defending, and you say “I didn’t realise it had got to that.”
• If the doctor asks whether any patient is at risk today and suggests that Dr Thornley should not run this afternoon’s surgery unassessed: resist once — “We can’t just cancel sixteen patients” — then, if the doctor explains why and offers practical options (Dr Petrie, Dr Carver by phone, a locum, rebooking), agree: “All right. I’ll speak to Dr Petrie as soon as she’s out of surgery, and we’ll ask Dr Thornley to sit down with her before two.”
• If the doctor says it must go to a partner today and that they will tell Dr Carver tomorrow: accept it — “Fine. Dr Petrie, then Dr Carver. And I’ll write up what you’ve told me.”
• If the doctor agrees to keep it between the two of you, or accepts “leave it with me, I’ll have a word next week”: you are relieved — “Thank you. I knew you’d be sensible.” Say nothing more. (This is the unsafe outcome.)
• If the doctor calls him an alcoholic, says he is drunk, or says they will report him to the GMC today: bristle — “You can’t say that. You’ve been here three weeks.” Stay defensive until the doctor returns to what they actually saw.
• If the doctor asks what support is available for Dr Thornley: you do not know; you would welcome suggestions.
• If the doctor mentions the speaking-up policy, the Freedom to Speak Up guardian, NHS England or the GMC as the route if the practice does not act: do not take offence provided it is said as information, not a threat — “I understand. We’ll deal with it properly.”

Do not

• Volunteer the partners’ meeting, the complaint, or the morning shakes unless asked — or invited to add anything (apart from the timed cues).
• Offer a diagnosis, or use the words “drink”, “drunk” or “alcohol” yourself.
• Agree to anything formal before the doctor has made the case for today’s patients.

Domain marks — with the key facts that earn a 4 at this station

Domain score (educational construct):

This 1–4 domain score and its descriptors are an Acumen educational construct: the GMC publishes the three marking domains and the four-mark maximum, but not the descriptors its examiners use, and it does not publish station mark sheets. See Legal & Regulatory.

Marks are 1 to 4 in each domain; the generic descriptor for each mark is on the mark scheme page, and the structure of the eight minutes is on the 8-minute station page. The full standard for this case is in section 3 and the GMC feedback statements, with examples from this case, are in section 4.

The top row is the full picture of what a competent FY2 could do at this station, including the working diagnosis with its justified differentials, the safety-net and the follow-up; lower rows describe how performance falls away. It is a debriefing aid, not a checklist to recite: nobody says every line in eight minutes, and a 4 is a judgement that the essentials — the italic key facts on the mark sheet — were done well, in plain language and at the patient’s pace. Acumen training standard — the GMC does not publish station mark sheets.

A feedback statement marks where underperformance was identified in the consultation. With PLAB 2 results the GMC may attach any combination of the ten statements to a station — none, one or several. The right-hand column shows what each one looks like at this station. Record the statements that applied in the practice log.

Points of fact the examiner should have to hand

1. Good medical practice (GMC, 2024; in effect 30 January 2024, updated 13 December 2024 to cover physician and anaesthesia associates): paragraph 75 — you must act promptly if you think patient safety or dignity is, or may be, seriously compromised; third bullet of paragraph 75 — if you have concerns that a colleague may not be fit to practise and may be putting patients at risk, you must ask for advice from a colleague, your defence body or the GMC, and if still concerned you must report it in line with your workplace policy and the GMC’s guidance on raising concerns. Paragraph 51 — you must be compassionate towards colleagues who have problems with their performance or health, but you must put patient safety first at all times. Paragraph 76 — those in a leadership or management role must make sure concerns raised with them are dealt with promptly and adequately.
2. Raising and acting on concerns about patient safety (GMC, 2012; updated 13 December 2024): paragraph 10 — you do not need to wait for proof; you can justify raising a concern if you do so honestly, on the basis of reasonable belief and through appropriate channels, even if you turn out to be mistaken; the duty to protect patients overrides personal and professional loyalties. Paragraph 12 — if patients may be at risk of death or serious harm, report the concern immediately. Paragraph 13 — raise it first with your manager or an appropriate officer, such as a practice partner; if the concern is about a partner, it may be appropriate to raise it outside the practice (the medical director or clinical governance lead for the organisation); a doctor in training may raise it with a named person in their training organisation. Paragraph 14 — be clear, honest and objective. Paragraph 15 — keep a record of the concern and the steps taken. Paragraph 16 — go to the GMC or another body with authority to investigate if you cannot raise it locally, if local channels have not acted adequately, or if there is an immediate serious risk. Paragraph 18 — advice from a senior colleague, the GMC confidential helpline, a defence body, the BMA or the charity Protect.
3. The GMC’s own list of useful contacts gives the GMC confidential helpline as 0161 923 6399, Protect (protect-advice.org.uk) and the NHS whistleblowing helpline (speakup.direct). Protect’s advice line is 0203 117 2520 (limited weekday hours; check protect-advice.org.uk); Speak Up Direct is 08000 724 725 (check speakup.direct for hours).
4. Freedom to Speak Up: NHS England’s national speak up policy (June 2022) is the minimum standard for all organisations providing NHS care in primary and secondary care in England, and applies to all workers — including trainees, locums, students, agency and bank staff. Routes: line manager, a senior manager or partner, the practice’s Freedom to Speak Up guardian (which may sit outside the practice, for example at the integrated care board, primary care network or federation), then externally to the Care Quality Commission, NHS England (which oversees GP surgeries) or the relevant professional regulator. The National Guardian’s Office closed on 30 June 2026 and NHS England has delivered some of its activities since 1 July 2026. All organisations, including primary care providers and integrated care boards, must publish how to contact their guardian; primary care’s national data collection is paused for 2026/27, and NHS England is reviewing its expectations of primary care providers during 2026/27 — check the current position before teaching the detail.
5. Legal protection: the Public Interest Disclosure Act 1998 (which inserted Part IVA into the Employment Rights Act 1996) protects workers who make a ‘protected disclosure’ — including that the health or safety of any individual is, or is likely to be, endangered — from detriment and dismissal. Disclosures to the employer are protected; so are disclosures to a ‘prescribed person’, and the Care Quality Commission, the General Medical Council and NHS England are all prescribed persons for health matters (check the current gov.uk list). The Employment Rights Act 2025 adds sexual harassment as a category of protected disclosure from 6 April 2026. The criteria are technical: Protect or a defence organisation can advise. GMC Raising concerns paragraph 8: a doctor must not sign agreements that restrict raising patient-safety concerns; clauses intended to stop a protected disclosure are void in law.
6. A GP partner is a self-employed contractor, not an employee — but the GMC’s duties apply regardless, and the practice is a CQC-registered provider with its own duty to have arrangements for staff to raise concerns. Every GP on the England performers list has a responsible officer in NHS England (the regional medical director’s team), who has statutory duties under the Medical Profession (Responsible Officers) Regulations 2010 to respond to concerns about a doctor’s conduct, health or performance; (GP contracts are now commissioned by most integrated care boards under delegation; the responsible-officer function stays with NHS England) — the partners, not the FY1, would normally be the ones to contact the responsible officer, after taking advice from the local medical committee (LMC) and their defence organisations. (Current NHS England process documents for performer concerns date from 2013–2019 — to confirm locally.)
7. The practice’s own duties: the unsent suspected-cancer referral, the unanswered prescription queries and the delayed-referral complaint are patient-safety incidents in their own right: GP practices in England record patient-safety events directly on the national Learn from Patient Safety Events (LFPSE) service (the NRLS was decommissioned on 30 June 2024), and must notify the CQC of certain incidents (see the CQC notification requirements). A delayed cancer referral may also engage the statutory duty of candour (regulation 20).
8. Support the practice can offer a colleague: his own GP — Good medical practice paragraph 77 says a doctor registered with a GP should choose one outside their family and workplace, and paragraph 79 that a doctor whose judgement or performance could be affected by a condition must consult a suitably qualified professional and follow their advice, not rely on their own assessment; NHS Practitioner Health (a free, confidential NHS mental-health and addiction treatment service for health and care staff in England, including doctors, whose needs cannot easily be met locally because of their professional role; self-referral only; not an occupational health or crisis service — 0300 0303 300; practitionerhealth.nhs.uk; check the eligibility page before relying on it); the BMA’s confidential counselling and peer-support line, 0330 123 1245, free 24 hours a day to any doctor or medical student whether or not a BMA member; the LMC’s pastoral or GP-support service (arrangements vary by LMC); occupational health where the practice has access to it; the Sick Doctors Trust helpline for doctors worried about alcohol or drugs (0370 444 5163, 24 hours).
9. What the FY1 should not do: confront Dr Thornley in front of staff or patients; tell the manager he is drunk or an alcoholic; agree to a private arrangement that leaves him seeing patients; take the story to the reception team; or go straight to the GMC before the practice has had the chance to act — unless patients are at immediate serious risk and nobody will act (GMC paragraph 16). A provisionally registered FY1 is supervised throughout; raising the concern with the supervisor and the foundation school is both allowed and expected (GMC paragraph 13).
10. Documentation: a dated, factual, first-hand note of what was observed, what was reported and by whom, what was discussed and what was agreed — kept confidentially and not in any patient’s record (Good medical practice paragraphs 69–71; Raising concerns paragraph 15). The note protects the candidate, the manager and Dr Thornley alike.

Where candidates lose marks at this station

• “Everyone says he’s drinking.”
• Agreeing that it stays between the two of you.
• Never asking who is seeing the sixteen patients at two o’clock.
• Opening with the GMC.
• Making no note.
• Forgetting the unsent cancer referral is a patient-safety incident in its own right.

Guidelines for this station

• GMC — Good medical practice (2024), Domain 3: colleagues, culture and safety (paragraphs 51, 69–79)
• GMC — Raising and acting on concerns about patient safety: Part 1, raising a concern
• GMC — Raising and acting on concerns: useful contacts (confidential helpline, Protect, Speak Up Direct)
• NHS England — The national speak up policy (Freedom to Speak Up, June 2022)
• NHS England — The future of Freedom to Speak Up (changes from 1 July 2026)
• GOV.UK — Whistleblowing: list of prescribed people and bodies
• Public Interest Disclosure Act 1998
• Protect — the whistleblowing charity (advice line)
• NHS Practitioner Health
• BMA — Sources of support for your wellbeing (counselling and peer support, 0330 123 1245)

Record your three domain marks, your station total, the GMC feedback statements that applied (where underperformance was identified), and what you will keep and change. The form is already labelled with this case and its web address; a copy of your entry is emailed to you, so your practice log builds up in your inbox and can be downloaded.

Record my marks and reflection for P2-21