Good Medical Practice states that, in providing care, doctors must recognise and work within the limits of their competence. The relevance of this duty is clear to those who are asked to work in specialties other than that in which they usually work. The propriety of agreeing to the request would depend on a professional judgement made by the individual doctor concerned, having taken appropriate advice (from senior colleagues, defence organisations or professional bodies like your own, as appropriate) about the safe limits of their own competence.

Of course, medical managers also have a responsibility to ensure that care is provided and supervised only be staff who have the appropriate skills, experience, training and qualifications, as explained in our Management for Doctors. In addition, managers must ensure significant risks to patients (and staff) are identified, assessed and addressed to minimise risk. They must also make sure that working practices are lawful.

All doctors, whatever their position, should follow the advice in GMP on raising concerns about patient safety:

6. If you have good reason to think that patient safety is or may be seriously compromised by inadequate premises, equipment, or other resources, policies or systems, you should put the matter right if that is possible. In all other cases you should draw the matter to the attention of your employing or contracting body. If they do not take adequate action, you should take independent advice on how to take the matter further. You must record your concerns and the steps you have taken to try to resolve them.

If doctors are concerned that their working hours are putting patients at risk because of fatigue, for example, they should put the matter right. They should also ensure that, when they are off duty, suitable arrangements are made for patients' care. If they are concerned that such arrangements are not suitable, they should follow the advice in paragraph 6 of GMP.

Management for Doctors contains advice about raising concerns publicly in the event that efforts to address them directly or through management structures fail. That booklet also includes references to the Public Interest Disclosures Act 1998, Health Service Circular 1998/198 and Public Concern at Work.

Hospital managers have moral and legal/contractual obligations to fulfil too. There are obligations on senior doctors and other managers requiring doctors to work extra hours or in unfamiliar roles which are separate from doctors’ individual choice as to whether they do what they are asked. When it's a question of fitness to practise, the risks to which the doctor's patients are exposed by their insisting on working within their contract would clearly be a key factor in the consideration of any complaint, and doctors should consider those risks, alternatives, etc. when thinking of refusing to work extra hours or take on roles outside their experience (if not competence).

If doctors are concerned about bullying or harassment by consultants, they should consider the advice and references outlined above. They should also consider using formal complaints or grievance procedures within the Trust or NHS or complaining directly to the GMC. You can find out more about our fitness to practise procedures at www.gmc-uk.org/concerns .

Doctors must make the care of their patients their first concern. They have a duty to work with colleagues for the benefit of patients, identifying risks to patients welfare and participating in systems to address these risks and improve care generally. That might involve working outside normal roles or hours. Of course doctors should not be expected to consistently work beyond the limits of their contractual requirements and should never be required or bullied into breaking the law. We cannot give legal advice about the implications of the Working Time Directive, about which you should seek your own specific legal advice.

Finally, while it must be right in theoretically extreme circumstances to close a unit/department, doctors considering such a step must balance the risks of so doing against the risks of continuing to work (e.g. beyond competence or while fatigued). In the end, this has to be a judgement about what is in the best interests of patients.