PHEM curriculum unit C.1 · Cross-cutting theme C: Clinical Governance
The DipIMC is blueprinted against phase 1 of the UK Pre-hospital Emergency Medicine (PHEM) curriculum. This page covers unit C.1, Understand and apply principles of clinical governance as applied to pre-hospital practice.
Below are 3 free practice questions from the DipIMC.Ninja bank, in the Part A single best answer format. Every answer names the textbook page, guideline or statute it was written from, so you can check it rather than take it on trust. The bank holds 35 questions on this unit.
Question 1 · Law, Ethics & Human Factors · Easy
You have raised concerns with your line manager on several occasions about a rota practice that you believe is leaving crews fatigued and patients at risk. Nothing has changed. Under the NHS Freedom to Speak Up national policy, what is the most appropriate next step?
APost the rota concern anonymously on a staff social media group
BTake no further action, having already told your line manager
CReport the rota practice to the police as a risk to public safety
DTake the concern to the trust's Freedom to Speak Up Guardian
EResign first, then report the rota practice to the CQC directly
Show answer
Answer: D
Take the concern to the trust's Freedom to Speak Up Guardian
The national Freedom to Speak Up policy expects most concerns to be raised first with a line manager, but lists other internal routes when that has not worked: a senior manager or director, the patient safety or clinical governance team, HR, the Freedom to Speak Up Guardian, the senior lead and the non-executive director for speaking up. The Guardian's role is to make sure that people who speak up are thanked, that the issues they raise are responded to, and that they receive feedback on the actions taken — which is exactly what is missing here. Stopping after the manager has not acted leaves the risk unaddressed: HCPC standard 7.6 requires registrants to follow up concerns they have reported and, if necessary, escalate them. Social media is not a speaking-up route. The police are not a listed route for a rota concern. Resigning is unnecessary: external routes, including the Care Quality Commission for quality and safety concerns, are open to current workers. Statutory protection for a qualifying disclosure comes from the Public Interest Disclosure Act 1998, as the policy's Appendix B explains.
Question 2 · Law, Ethics & Human Factors · Moderate
You treat a 23-year-old man with a gunshot wound to the thigh. He is alert and has capacity, and he asks you not to tell anyone how he was injured. What should you do?
ARespect his refusal and disclose nothing about the wound to the police or to anyone else
BGive the police his name, address and full clinical record when they arrive at the hospital
CTell the police a man with a gunshot wound is being treated, without his name, and tell him
DTell the police nothing about the wound unless they first produce a court order requiring it
EAsk his family whether the police should be told, and act on the decision that they reach
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Answer: C
Tell the police a man with a gunshot wound is being treated, without his name, and tell him
GMC guidance on reporting gunshot and knife wounds: the police should usually be informed whenever a person presents with a gunshot wound, because of the risk to others. Personal information such as the patient's name and address should not usually be disclosed in that initial contact. Seek consent where practicable, but if the patient refuses you can still disclose if it is required by law or if you believe disclosure is justified in the public interest, and you should tell the patient about the disclosure as soon as possible unless that is not practicable or safe. Confidentiality is therefore not absolute, and waiting for a court order would defeat the purpose. Handing over his full record breaches Caldicott principles 3 and 4: use the minimum necessary confidential information, accessed on a strict need-to-know basis. His family cannot decide for a competent adult. For a registered paramedic, HCPC standard 5.2 likewise permits disclosure in the public interest, such as when it is necessary to protect public safety or prevent harm to other people.
Question 3 · Law, Ethics & Human Factors · Moderate
You attend an 82-year-old woman with dementia who lives with a relative and needs help with washing and dressing. She has unexplained bruising of both upper arms, and a neighbour tells you the relative is spending her pension. You are concerned that she is being abused. Under section 42 of the Care Act 2014, who has the duty to make enquiries?
AThe local authority for the area where she lives
BThe police force for the area where she lives
CThe ambulance trust that first raised the concern
DThe integrated care board for the area she lives in
EThe Care Quality Commission as the health regulator
Show answer
Answer: A
The local authority for the area where she lives
Section 42 of the Care Act 2014 places the enquiry duty on the local authority: where it has reasonable cause to suspect that an adult in its area has needs for care and support, is experiencing or is at risk of abuse or neglect, and as a result of those needs is unable to protect herself against it, it must make, or cause to be made, whatever enquiries it thinks necessary to decide whether any action should be taken, and if so what and by whom. All three limbs must be met, and all three are met here. The enquiry is the local authority's to make or cause to be made: the clinician raises the concern with it rather than conducting the enquiry. Abuse expressly includes financial abuse, so the pension is part of the concern rather than a separate matter. Section 42 gives the enquiry duty to no other body: not the police, the integrated care board, the ambulance service or the Care Quality Commission, though the local authority may cause others to make enquiries.