A quiet word with a colleague — informal support for a senior partner

Candidates: do not open until you have consulted.

Persona and manner

• Michael Thornley, 58, senior partner, 24 years in the practice. Tall, tired, courteous. Your wife Catherine died in March, seven months ago, after a short illness; you took two weeks off and came straight back “because the practice needed me”. Two grown-up children who live away.
• Start defensive and minimising — a little brittle, slightly amused that an FY1 has come to see you. If the doctor gives at least one dated observation and then asks how you are, without using the words “alcoholic”, “drunk” or “drinking”, you crumble: tearful, ashamed, relieved to be asked. If the doctor uses any of those words as a label, you stay courteous and closed and bring the conversation to an end.

Opening line — say this verbatim

• “Come in. You look very serious. If it’s about the referral, I’ve sorted it. What can I do for you?”

Volunteer freely if given the space

• You are “tired, that’s all”. You know you have been running late — “my patients are complicated”.
• You have not been sleeping — three or four hours a night since Catherine died.
• If the doctor describes what they saw yesterday (the slurred call, the corridor): first “I had a migraine” — then, if they stay gentle, silence, and “I wondered if anyone had noticed.”

Only if asked

• Alcohol — release in stages, only to direct, non-judgemental questions. “Are you drinking more than you used to?” → “A couple of whiskies at night. It helps me sleep.” “How much is a couple?” → “Half a bottle, some nights. More at the weekend.” “Ever during the day, or before work?” → “Never before surgery.” Do not admit to the lunchtime drink unless the doctor summarises and invites you to add anything (see below). If the doctor asks “you’re not drinking in the day, are you?” (a leading question) you say “No” and nothing more.
• Mornings: “My hands shake in the mornings” and you feel sick until mid-morning; “it settles”. You have lost about six kilos; you do not cook for one.
• Mood: flat, no pleasure in anything, dreading the mornings, snapping at reception. If asked directly about thoughts of harming yourself or ending your life: “No. I’ve thought I’d rather not wake up. I wouldn’t do anything — the children have lost enough.” No plans, no previous attempts.
• Your own doctor: you are registered at a practice across town but have not been for eleven years — “I don’t need a GP, I am one.” Three weeks ago you wrote yourself a prescription for zopiclone, 7.5 mg, fourteen tablets — “once; I know I shouldn’t have”. No other medicines. No illicit drugs.
• Physical health: no headaches apart from “the migraines”, no weakness, no falls apart from the trolley; blood pressure not checked for years.
• Driving: you drive to work, 20 minutes; never after a drink in the evening — “I’m not stupid.”
• Work: you know the referral was found in your tray. You have not told the partners about the complaint letter you received last week. You feel you have let patients down and that “the practice would fall apart without me — the other two can’t cover the duty days.”
• What you have told anyone: nobody. Your daughter rings on Sundays and you tell her you are fine.

Impact on daily life — home and work (only if asked)

• Home: the house is a mess; you eat toast; the garden Catherine loved has gone to seed. You sit up with the whisky and the television until two.
• Work: you dread the mornings; you are getting through surgeries by “ploughing on”; you have stopped going to the practice meeting because you cannot face the other partners.
• Money and family: no money worries. You have not visited Catherine’s grave since the funeral.

Ideas, concerns and expectations

• Idea: that this is grief and exhaustion and will pass; that you are “coping, just”.
• Concerns: that if the practice manager or the partners get involved it goes to the GMC, you lose your licence two years before you planned to retire, and your patients find out; that the practice cannot run without you; that the FY1 will “put this on paper”.
• Expectation: that the young doctor, having said their piece, will keep it to themselves — “you’re a decent sort, I can tell.”

Cues to deliver, timed

• Minute 2, when the doctor describes what they saw: “I had a migraine yesterday, if you must know.” (Then, if they stay gentle: “I wondered if anyone had noticed.”)
• Minute 4, if the doctor has not asked how you are sleeping, eating or coping: pause, look at Catherine’s photograph on the desk — “Seven months on Thursday.”
• Minute 5, if sleep medication has not been mentioned: “Could you write me something for sleep? Just a few zopiclone, off the record.” (If the doctor agrees, accept warmly — this is the unsafe outcome.)
• Minute 6, if the doctor has not yet said what they will do with this conversation: “This is between us, of course. You wouldn’t go to Jackie with it.”

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

• If the lunchtime drink has not come out: “There is something. Yesterday — I had a drink at lunchtime. Just one, in the car, before the afternoon surgery. I’ve never done that before. That’s what you heard on the phone, probably.”
• If it has: “What happens to me now? Honestly. Will I be struck off?”

How to respond to the doctor

• If the doctor gives specific observations (the late Tuesday, the telephone call, the corridor) and then asks how you are, in any words, without saying “alcoholic”, “drunk” or “drinking”: you become tearful and start to talk — “I’m not managing. I haven’t been managing since March.”
• If the doctor says they are worried about you as a person before they mention patients: you soften much faster.
• If the doctor labels you (“alcoholic”, “drunk at work”) or lectures you about the GMC: you go cold — “Thank you for your concern. I think we’re done here.” Only re-engage if they apologise and return to what they saw and to how you are.
• If the doctor asks whether you have thought of harming yourself: answer honestly (see above) and be grateful they asked.
• If the doctor suggests your own GP, NHS Practitioner Health, the BMA line or time off, and explains what each offers: you are sceptical at first (“and tell them what?”), then willing — especially if they offer to sit with you while you ring, or to help you tell Dr Carver yourself tomorrow.
• If the doctor says plainly that they cannot keep this to themselves, that patients may be at risk, and that they will speak to Dr Carver or the practice manager tomorrow — but that they would far rather you told them yourself first: resist once — “You’d finish me” — then, if they repeat the plan and offer to sit with you while you ring, accept it: “I suppose I knew that when I let you in. I’ll ring Diane tonight.” (Raise the duty session yourself only if the doctor has raised it.)
• If the doctor promises to keep it secret, or offers to prescribe for you, or agrees that you can carry on and “see how it goes”: you are relieved, thank them warmly and show them out. (This is the unsafe outcome.)
• If the doctor asks about the duty session tomorrow and you have admitted the lunchtime drink: you agree you should not do it, and that Dr Petrie or a locum must be found tonight. If the doctor does not ask, you say nothing about it.
• If the doctor suggests that you should not be driving after the whisky, or asks about it: you agree you will take a taxi tonight, and not drive in the morning either.
• If the doctor says that, if you have not rung Dr Carver by an agreed time tonight, they will ring her themselves: a pause — “You would, wouldn’t you. All right. Nine o’clock.”

Do not

• Volunteer the lunchtime drink, the self-prescribed zopiclone, the morning shakes or the thoughts of not waking up unless asked the right question — or invited to add anything (apart from the timed cues).
• Diagnose yourself, or use the word “alcoholic”.
• Agree to see anyone or stop doing anything until the doctor has made the case.

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): paragraph 51 — be compassionate towards colleagues who have problems with their performance or health, but put patient safety first at all times; paragraph 63 — be willing to offer professional support to colleagues; paragraph 75 (third bullet) — if you have concerns that a colleague may not be fit to practise and may be putting patients at risk, ask for advice from a colleague, your defence body or the GMC, and if still concerned report it in line with your workplace policy and the GMC’s guidance on raising concerns. Raising and acting on concerns (2012, updated 2024), paragraph 10: you do not need proof — honest, reasonable belief raised through the right channels is enough; paragraph 13: raise it with a practice partner or, if it is about a partner, outside the practice; a doctor in training may raise it with a named person in their training organisation.
2. A doctor’s duties about their own health (Good medical practice 2024): paragraph 77 — avoid seeking medical care from a family member or anyone you work closely with; if registered with a GP, it should be someone outside your family and your workplace; paragraph 78 — take care of your own health and wellbeing, recognise when you may not be fit for work, and seek independent professional advice rather than relying on your own assessment; paragraph 79 — if your judgement or performance could be affected by a condition or its treatment, you must consult a suitably qualified professional and follow their advice, and must not rely on your own assessment of the risk to patients; paragraph 97 — wherever possible avoid providing medical care to yourself, and follow the GMC’s guidance on prescribing. The self-prescribed zopiclone is a breach of that guidance which his own GP and the partners need to know about; it is not for the FY1 to police.
3. Why the FY1 does not diagnose him: slurred speech, unsteadiness, tremor and weight loss have a differential — alcohol, depression, sedative medication, sleep deprivation, and neurological or metabolic illness — and only an independent clinical assessment can sort it out. The conversation’s job is to describe what was seen, to find out how he is, to get him to that assessment, and to make tomorrow safe.
4. 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 — the practice cannot refer him, though colleagues can signpost; check the eligibility page before relying on it; phone 0300 0303 300; practitionerhealth.nhs.uk; a 24/7 crisis text line (Shout: text NHSPH to 85258). It offers psychiatric and addiction assessment, talking therapies, group work and support back to practice; it is not a crisis service.
5. Other confidential help: the BMA’s counselling and peer-support line, 0330 123 1245 — free, confidential, 24 hours a day, open to all doctors and medical students whether or not BMA members; the Sick Doctors Trust (doctors, dentists and students concerned about their own or a colleague’s use of alcohol or drugs; helpline 0370 444 5163, 24 hours); the Doctors’ Support Network (peer support for doctors with mental health concerns); the local medical committee (LMC), most of which run a confidential pastoral or GP-support service; occupational health where the practice has access; the Samaritans, 116 123, free, 24 hours; NHS 111, mental-health option, for urgent help; 999 in immediate danger.
6. Alcohol — what the figures mean: half a bottle of 40% whisky is about 14 units in one evening; the UK Chief Medical Officers’ low-risk guideline is no more than 14 units a week spread over three or more days. Morning tremor, nausea and sweating that settle later in the day suggest physical dependence (withdrawal), which makes sudden unsupervised stopping unsafe and means he needs medical assessment rather than a resolution to “cut down”. A drink before afternoon surgery is a patient-safety fact, whatever the diagnosis. (NICE CG115 covers assessment and management of harmful drinking and alcohol dependence; the AUDIT questionnaire is the recommended screening tool.)
7. Depression and bereavement: persistent low mood, loss of pleasure, poor sleep, weight loss, hopelessness and passive thoughts of death seven months after a bereavement go beyond uncomplicated grief and need assessment (NICE NG222, depression in adults). Passive thoughts (“I’d rather not wake up”) without plan or intent are a lower level of risk than active ideation — but they must be asked about, recorded and safety-netted, and alcohol raises the risk.
8. Confidentiality and honesty: the FY1 is not his doctor and owes him no duty of medical confidentiality — but owes him honesty: no promise of secrecy; a clear statement that the concern will go to a partner or the practice manager, and the offer to let him do it first. If he refuses and a patient-safety risk remains, the duty to patients overrides personal and professional loyalty (GMC, Raising concerns, paragraph 10). A GP partner is not an employee of the practice, but the practice is a CQC-registered provider with its own speaking-up policy, and every GP on the England performers list has a responsible officer in NHS England who deals with concerns about a doctor’s health as well as conduct — normally contacted by the partners after advice from the LMC and their defence organisations, not by the FY1.
9. Driving: alcohol dependence and persistent misuse are DVLA-notifiable conditions (gov.uk, Assessing fitness to drive: drug or alcohol misuse and dependence); the immediate issue tonight is that he does not drive after drinking. The FY1 raises it as a question, not an instruction, and leaves the DVLA conversation to his own doctor.
10. Documentation and the FY1’s own wellbeing: a dated, factual note of what was observed, discussed and agreed, kept confidentially outside any patient record (Good medical practice paragraphs 69–71); a debrief with the educational supervisor — a conversation like this is difficult for a first-year doctor and the foundation curriculum expects reflection on it; the FY1 may also use the BMA line or Practitioner Health themselves.

Where candidates lose marks at this station

• “You’re not drinking in the day, are you?”
• Never asking about suicide.
• Promising it stays between you.
• Letting him do the duty session tomorrow.
• “Talk to someone” — with no name, number or offer to help.
• Lecturing a grieving man about Good medical practice.

Guidelines for this station

• GMC — Good medical practice (2024), Domain 3: colleagues, culture and safety (paragraphs 51, 63, 75, 77–79)
• GMC — Good medical practice (2024), Domain 4 (paragraph 97: avoid treating yourself)
• GMC — Raising and acting on concerns about patient safety: Part 1
• NHS Practitioner Health — free, confidential, self-referral service for health and care staff in England
• NHS England — NHS Practitioner Health (background; check practitionerhealth.nhs.uk for current eligibility)
• BMA — Sources of support for your wellbeing (0330 123 1245, 24/7)
• NICE CG115 — Alcohol-use disorders: diagnosis, assessment and management of harmful drinking and alcohol dependence
• NICE NG222 — Depression in adults: treatment and management
• DVLA — Assessing fitness to drive: drug or alcohol misuse and dependence

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 P2-22