The key principle
This guidance reinforces a fundamental distinction:
All doctors are responsible for their own professional practice. Health Boards/NHS Employers are responsible for whether the system is safe.
Consultants and SAS doctors are not ordinarily accountable for wider system failures.
Some doctors have formal leadership or management roles as clinical or medical directors that have designated organisational responsibilities for the overall functioning of the health body. Doctors with these roles may be required to take further action within the scope of those responsibilities, including fostering an environment where people can safely raise errors or concerns, and potentially could have some liability for failing to act on wider system failures.
Scope of this guidance
This guidance reflects the legal and professional framework in Scotland, including:
Your professional responsibilities (GMC duties)
Under Good Medical Practice (2024), the areas you are personally accountable for your professional practice include:
Working within your competence
Recognising when you cannot deliver safe care
Taking reasonable steps to protect patients
Raising concerns where safety is compromised (see section below)
Being open and honest when things go wrong
Justifying your clinical decisions and actions
What the GMC does not require
You are not normally expected personally to resolve systemic failure. You do have a responsibility to identify and escalate risks and will be expected to take reasonable steps to protect patients, put matters right where that is possible within your role, and identify and escalate unresolved risks.
The GMC does not require doctors to:
Extend or alter their practice to compensate for organisational failure
Accept unmanageable workloads as a professional obligation
Work beyond your contractual hours or undertake extra-contractual work to maintain system safety
Doctors who engage in any of the three points above may put themselves, their registration, patients and other staff at a higher risk.
Raising and acting on concerns about safety
You have a professional duty to raise concerns where patient safety is at risk.
GMC Raising Concerns guidance (Part1, s10) states you should bear the following in mind if you are hesitating about reporting a concern:
You have a duty to put patients’ first and act to protect them, which overrides personal and professional loyalties.
The law provides legal protection against victimisation or dismissal for individuals who reveal information to raise genuine concerns and expose malpractice in the workplace.
You do not need to wait for proof – you will be able to justify raising a concern if you do so honestly, on the basis of reasonable belief and through appropriate channels, even if you are mistaken.
In practice:
Raising concerns protects you and patients
Failure to act may expose you to risk
Concerns should be escalated by the appropriate means (you should be familiar with local reporting systems, such as Datix or whistleblowing processes)
If there is no adequate response, you should use local escalation routes
All doctors are responsible for acting on concerns raised with them about patient safety, whether from patients, colleagues, or identified via crucial incident reports/clinical audit. Doctors should put the matter right if they can within the scope of their role/clinical practice. However, concerns about system failures will normally be outside the scope of what a doctor can rectify directly and should be reported to senior management or the relevant authority.
We know that raising concerns can be challenging professionally and personally. The BMA is here to support you - seek advice from local representative and by contacting the BMA who can advise you on how to raise concerns in your workplace and support you through the process.
Health Boards are legally responsible for safe staffing
Under the Health and Care (Staffing) (Scotland) Act 2019, Health Boards have a legal duty to ensure the right number of staff, with the right skills, in the right place to deliver safe, high-quality care.
What this means in practice
Unsafe staffing is a system and employer failure, not a failure of individual doctors working within that system. Failure to provide adequate workforce, rota design, or service configuration is a Health Board/Scottish Government failure.
Whilst the legislation is not prescriptive in terms of how the safe level of staffing is defined, we would regard the normal operational rota to be a de facto declaration of the safe level of staffing in terms of numbers of doctors and skill mix. If that level is breached for an unreasonable period, we would suggest that formal concerns are raised (and that doctors in formal management or leadership positions act in response to those concerns or escalate further if it is beyond their scope)
Doctors cannot lawfully be expected to compensate for gaps which persist for an unreasonable period. Of course, what constitutes “unreasonable” may vary in respect of different gaps, but the BMA suggests a good rule of thumb would be for any gap lasting longer than an on-call rota cycle as being longer than is reasonable.
Furthermore, BMA, Scottish Government, and NHS Employers are agreed as set out in DL(2026)04 that “The onus to source cover rests with the employer and doctors are not contractually obliged to provide this. If doctors are willing and able to cover the work, they will agree with the employer how the work will be remunerated. All parties need to consider whether it is safe, healthy, and sustainable for the individual doctor to take on more work”.
Doctors retain duties to protect patients, take reasonable action within the scope of their role, inform, escalate and document concerns, and decline unsafe practice where necessary. Health Boards retain responsibility for providing and maintaining safe services.
Your contract and job planning
Consultant contract (2004)
The consultant contract:
Defines what work is contracted (PAs, on call, availability)1
Establishes job planning as the mechanism to match work to capacity
Provides a framework for objectives, supporting activities, and limits
SAS doctor contracts (2022)
The SAS contracts:
Clarify the use of time and resources to meet individual, departmental, services and broader NHS objectives
Requires the employer to ensure that SAS doctors have the facilities, training development and support to deliver the commitment of the agreed Job Plan
Role of job planning
Job planning is explicitly designed to:
Ensure consultants/SAS doctors have the resources, facilities, time, and support to meet their responsibilities safely. You should ensure that your job plan sets this out. Scottish Government and BMA have recently agreed revised job planning guidance for NHS Employers in Scotland that may be helpful to you in understanding the process.
The terms and conditions of service, which govern each contract, do not:
Confer an individual responsibility for resolving system safety issues on doctors. That remains with the system
Create an obligation to work beyond contracted capacity (job plan) or at unreasonable intensity (often because of vacancies or gaps in rotas)
Require doctors to absorb risk created by under‑resourcing
Override GMC duties to practise safely
If the job plan cannot be delivered safely, the contractual mechanisms of review, mediation and appeal must be used to resolve this. In cases where there is an immediate safety risk, we would recommend that immediate interim agreements or measures are agreed to reduce risks as the contractual process may take some time to be worked through. This may include, for example, a re-statement of the limit on numbers of patients to be seen per clinic/list/session/post-take ward round, agreement on maximum levels of working beyond contracted hours, or the suspension of specific services until safe staffing levels can be established (at no detriment to the doctors engaged in the service).
Working time and rest (Working Time Regulations)
The BMA has provided comprehensive guidance for doctors on the European Working Time Directive and UK Working Time Regulations (WTR), which were established to prevent employers, including the NHS, from requiring their workforce to work excessively long hours that impact health and safety.
BMA recommends that all doctors should work WTR compliant rotas, which includes:
Working week maxima (requirement for an average 48-hour working week)
Rest requirements (11 hours rest each day, a day off each week, and a rest break if the working day is longer than 6 hours).
Where individuals decide voluntarily (without pressure from Employers) to opt-out of the WTR working week maxima, this should only be done on a time limited basis so it can be reviewed. The BMA does not support permanent WTR opt outs. It is not possible for individuals to opt-out of the WTR rest requirements.
If your rota is not compliant with the WTR, please contact the BMA for individual advice and support.
The BMA also provides guidance on compensatory rest where your daily rest is interrupted, starting from the last interruption, and taken as soon as possible (normally the following day).
Summary: who is responsible for what?
Doctors are responsible for:
Their own clinical decisions
Working within competence and capacity
Recognising and reporting unsafe conditions
Acting on concerns within their scope of practice to first protect patients
Escalating, documenting, and challenging risk
Refusing unsafe practice when necessary
Doctors should take reasonable steps to protect patients and put matters right where that is possible within their role. They are not required to sustain an unsafe system by routinely working beyond safe or contractual limits and should not endanger their own health or patient safety through excessive working or fatigue.
Health Boards are responsible for:
Safe services generally
Safe staffing levels
Rota design and resilience
Service configuration
Systems for doctors to report concerns about unsafe working
Frequently asked questions
How do I escalate my concerns about safety if I have them?
You should take reasonable steps to protect patients and, where possible, put the matter right within the scope of your practice.
You should then raise concerns promptly through local reporting systems (such as Datix or whistleblowing procedures), in line with GMC guidance. You do not need proof—reasonable belief is sufficient.
If your concerns are not addressed, you should escalate further through local processes. Raising concerns is a professional duty and protects both patients and you.
If you need support, contact your BMA representative or the BMA directly.
I've been up all night on call, haven’t had any rest and I’m tired, but I’m meant to be at work today. Do I have to go in?
No. You must not work if you are too fatigued to practise safely. You do need to inform your employer that you will not be working.
Remember that WTR rest requirements (including daily rest) are mandatory and cannot be opted out of. If working would compromise patient safety or your own health, you should escalate this and not undertake unsafe work.
One of the consultants on our on‑call rota has left. Do I have to increase the frequency of my on‑call working?
No. You are not required to compensate for rota gaps caused by staffing shortages or undertake work beyond your contractual obligations.
Ensuring safe staffing and rota design is the responsibility of the Health Board. You should raise concerns about sustainability and safety, but you should not be expected to absorb ongoing gaps or increases in workload beyond what is reasonable or contractual.
I think my working week might not be WTR compliant. What should I do?
You should seek advice from the BMA.
If your rota is not compliant, this should be addressed with employer support, and the BMA can assist you in doing so.
Work is so busy I’m doing admin (e.g. clinic letters) in my own time. What should I do?
This indicates that your job plan may not be deliverable safely within contracted time.
You should raise this through job planning processes and seek adjustments to workload, resources, or time allocation. You are not required to undertake regular unpaid work to maintain service delivery or compensate for under‑resourcing and so should stop undertaking this work outwith the contracted hours in your job plan until such time as a job plan review is concluded.
Work after on‑call is rising and the time allocated to undertake this work has not been increased. What should I do?
You should raise this through job planning and escalate if necessary.
If workload exceeds what can be delivered safely within your job plan, contractual mechanisms (review, mediation, appeal) should be used. Interim measures may also be required to reduce immediate risk. The BMA can provide support.
My colleague on the on‑call rota called in sick, I’m exhausted. Do I have to cover their shift?
No. You should not undertake work if you are too fatigued to do so safely.
While short-term flexibility may sometimes be appropriate, you are not required to work when this would compromise safe practice or your own wellbeing. Staffing gaps remain the responsibility of the Health Board, not individual doctors.
Even if you are not fatigued, the decision to cover the shift or not is yours and you do not have any contractual obligation to provide such cover.
Our electronic prescribing system went down. Is it on me if errors occur?
No. You remain responsible for your own clinical decisions, but system failures are the responsibility of the organisation.
You should take reasonable steps to protect patients, mitigate immediate risks, and escalate concerns. Where it is possible to put matters right or use a safe alternative within your competence and authority, you should do so. Responsibility for the underlying system failure will rest with the organisation, although doctors with formal leadership or management responsibilities may have additional responsibilities in relation to addressing system failures.
There is a shortage of administrative staff and I’m taking on clerical work to help. Is that appropriate?
Routine assumption of additional non‑contractual work to compensate for staffing shortages is not appropriate if it undermines safe practice or exceeds your job plan.
You should raise this through job planning processes and ensure your workload is aligned with agreed responsibilities and resources. The employer is responsible for providing you with adequate support.