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It is the cornerstone of professionalism and the primary duty of every surgeon, regardless of seniority or grade, to put the care and safety of patients above all other considerations and take action or ‘speak up’ through the appropriate channels when concerns arise. In meeting the standards of Good Medical Practice, you should:

• Recognise that your primary accountability is to the patient and support a culture of openness, honesty and objectivity where concerns can be raised safely by all staff members.
• Act promptly to rectify, or notify those responsible for rectifying, any incidents of poor quality of care or shortfalls in resources that might compromise safe care, including suitable facilities, equipment and support services. 
• Raise concerns at the earliest opportunity when you have reasonable belief that the care and wellbeing of patients may be put in jeopardy for any reason. Such a reason may include the conduct, performance or health of a colleague, as well as inadequate resources, systems and policies. You should not assume that someone else will take action. If you have concerns about patient safety, it is your responsibility to establish whether action is already being taken.
• Use local policies and resources for raising concerns in the first instance. Normally, you should raise your concerns to your immediate superior, followed by the medical director and the Chief Executive. 
• Escalate your concern to the appropriate regulator if you have not been satisfied that your concern has been adequately addressed through local channels. Concerns around the organisational standards of quality and safety should be escalated to the Care Quality Commission*. Concerns about the fitness to practise of colleagues should be raised with the GMC or other appropriate regulator (for example, the Nursing and Midwifery Council). 
• As a final recourse, if neither local nor regulatory processes have appropriately addressed your concern, bring your concern to general public attention. You should seek advice before going public with your concern as outlined in the GMC guidance Raising and Acting on Concerns about Patient Safety (GMC, 2012). 
• Support others who are taking steps to raise valid concerns on patient safety. You must ensure that your own knowledge, understanding and any evidence of wrongdoing available to you is put at the service of the person leading the response to a concern.
• Keep a dated and verifiable record of how you have raised your concerns, including notes of any supporting evidence, taking into account patient confidentiality.
• Not conflate a legitimate concern around patient safety with a personal grievance. If you have both a concern around care quality and a personal employment grievance, you should pursue these separately. 

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