Raising a concern

Member of the public:

You should choose this option if you are:

• a member of the public

• raising a concern about your own experience with a clinical physiologist

• a carer or raising a concern for a friend or relative

• a healthcare professional raising a concern about a clinical physiologist colleague

Who are you raising a concern about?

The information you provide

When we receive information about a clinical physiologist, we have a duty to investigate whether that clinical physiologist might pose a risk to the public or public confidence in the clinical physiology profession. As part of this process, we may need to disclose or share information about your concerns.

How we will handle your information

We value working with you to keep people safe and your ongoing help is important to us.

We will handle any personal information you provide about yourself or about anyone else very carefully. You can read more about how we do this in our privacy policy and fitness to practise.

Sharing your information

We will usually share the details of your concerns and any other supporting information that you provide to the clinical physiologist(s) concerned.

We may also need to share your concerns with other organisations, such as the police or other healthcare regulators/registration bodies.

In the process of investigating your concerns, we may need to share the details of your concerns, and other relevant information that we have gathered, with our fitness to practise committee panel members

Asking for more information

We may need more information about your concerns, for example copies of records from your organisation. We will only ask for information that is relevant to our investigation of your concerns.

Next steps

If you have any concerns or specific requests about how your information will be used, please tell us now so we can take them into account. We will consider what you say, but we may still have to go ahead and use your information to help protect the public. If that happens, we will tell you as soon as possible.

Declaration

I have read the above and understand how my personal information will be used by The Registration Council of Clinical Physiologists

Yes No

Are you helping someone else complete this form?

If you're raising a concern for someone else, such as a friend or neighbour, choose 'yes'.

We'll contact them and make sure they're happy for you to act on their behalf.

Choose 'no' if you're acting for yourself, or if you're acting for someone you look after, such as your child.

Are you helping someone else complete this form?

Yes No

Name

Postcode

House / Flat number / Building name

Street Name

Town

Country

Place of work

Telephone

Mobile

How would you like to be contacted?

Accessibility adjustments

The RCCP are committed to making adjustments to make sure that our processes are accessible for everyone. If you have a disability or injury, please tell us if you need any adjustments. This might include receiving our information in an alternative format such as large print or audio.

Do you require any adjustments?

Yes No

I am raising a concern about:

On which date(s) or over what time period does the concern relate to

Start date

End date

Where did the concern(s) take place?

Please provide a detailed description of what happened?

Have you raised this concern with the clinical physiologist(s) in question

Yes No

Have you raised this concern with an other organisation (e.g. employer/another regulator or the police)?

Yes No

Please list any witnesses, with their full names and contact details:

Anything else

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Concern

Fill in the form below to file your concern

Raising a concern

Declaration