A Junior Doctor at Birmingham and Solihull Mental Health Foundation Trust raised concerns with the Freedom to Speak Up Guardian after their educational supervisor had unexpectedly left the trust.

They said, “I was anxious about what the arrangements were going to be for the continuation of my supervision going forward. I was also worried about a shortage of consultant cover and feared that I would inadvertently have to step in and cover elements of the consultant’s role and responsibilities.”

The Junior Doctor was aware that the trust was experiencing pressure due to vacancies. A locum consultant was due to start at some point to help fill this gap, but the Junior Doctor was still worried that they would end up taking on consultant responsibilities as it could take some time before a locum was in post.

The Freedom to Speak Up Guardian said, “It was clear from our conversation that the Junior Doctor was totally committed to the patients and their placement with the trust. However, they were left feeling incredibly vulnerable due to these arrangements. This also posed a risk for patient care and in terms of clinical decision making so a more permanent solution was needed.”

After several conversations, the guardian agreed to contact the Associate Medical Director and the Clinical Director on the doctor’s behalf. Both replied to the guardian immediately and colleagues quickly arranged to meet with the Junior Doctor to follow up on these concerns.

There was an acknowledgement from the trust that improvements could be made to the consistency and quality of supervision offered in Work Base Placed Assessments (WBPAs) and that some of experiences of previous trainees could have been improved.

The trust made a commitment to include a reminder about how to complete WBPAs in the next trainer briefing session, in addition to offering further guidance about how they can also be used as a development tool.

The Associate Medical Director said, “I am really pleased that the Junior Doctor felt able to raise their concerns with the Freedom to Speak Up Guardian and that together we were able to improve both patient safety and the training we offer.”

After discussions with the clinical director, the Junior Doctor was given two options: to stay in their current post with a designated registered consultant with responsibility for any patient they saw, or to move to a different team with support from the Clinical Director. The Junior Doctor confirmed that they were happy with the assurances provided by the trust and decided to stay in their current post with the new arrangements in place.Colleagues also agreed that they would be regularly reviewing how this Junior Doctor’s placement was going.

In addition to offering assurances, senior medical colleagues asked the Junior Doctor for any suggestions they may have to improve the quality of supervision in the trust. They agreed to work together to develop a trainee survey to elicit more information about trainees’ experiences and to find out what is of importance to other trainees. This learning will then be used to inform further trainer education in that area.

Reflecting on this, the Freedom to Speak Up Guardian said, “We know that Junior Doctors can face particular barriers to speaking up; we hadn’t had any cases from this group in over two years. By making connections with the Junior Doctor medical leadership and presenting at the Junior Doctor Forum, we have raised awareness of Freedom to Speak Up. This additional channel for speaking up is so important as it gives a voice to those who may not have spoken up otherwise.”

This case study features as part of our 100 Voices campaign. If you would like to share a speaking up story for this campaign, please contact [email protected] for more information.