The GMC has published the draft  updated Good Medical Practice for doctors for consultation.  We look at the changes proposed and importance of reading the Good Medical Practice.

The updated Good Medical Practice focus on four main areas:

• Tackling discrimination and promoting fairness and inclusion
• Working in partnership with patients
• Working effectively with colleagues
• Leadership and organisational culture

Proposed changes in detail:

1. Communication and partnership working (open dialogue, language, reasonable adjustments)

The updated guidance says that medical professionals must treat patients with kindness, courtesy and respect.

The GMC explained: “This is because patients need to feel comfortable being honest with medical professionals to make sure their health needs are met. We think kindness matters, as patients often have contact with medical professionals at times when they are dealing with difficult issues and may be vulnerable, anxious, upset, or in pain.

“We’ve used the word ‘must’ as we feel this highlights how important it is that medical professionals do this.”

The updated guidance says that medical professionals must:

• take all reasonable steps to meet patients’ language and communication needs
• have open conversations with patients to find out what matters to patients
• check patients’ understanding of the information they’ve been given
• consider and respond to the needs of patients with disabilities.

The GMC explained: “It’s vital that healthcare is accessible to everyone.

“Medical professionals should also make reasonable adjustments to their practice so patients with disabilities receive care to meet their needs. This includes making best use of innovations in technology.”

2. Joined up care

The updated guidance:

• emphasise the importance of joined up care, particularly for patients with complex health conditions
• say that medical professionals must not assume that someone else will pass on the information needed for patient care
• say that medical professionals must take prompt action to deal with any problems arising from poor communication or unclear responsibilities within or between teams.

The GMC explained: “The updated guidance is clear on how we expect medical professionals to work together to provide care. But we know this doesn’t always happen effectively and in the way patients might reasonably expect.”

Access to care

The updated guidance say medical professionals must not unreasonably deny a patient access to treatment or care that meets their needs. They should take all available steps to minimise the risk before providing treatment or making suitable alternative arrangements.

The GMC explained: “Medical professionals have a duty to make the care of their patient their first concern. But to provide the best possible care, it’s also important that they look after their own health and wellbeing. Unfortunately, there are occasions where a patient has a health condition that presents a risk to a medical professional’s own wellbeing or the health and safety of other patients or staff. For example, diseases that can spread from one person to another unless safeguards are in place, such as hepatitis or tuberculosis.

“We think this approach should also apply when dealing with other risks to a medical professional’s own wellbeing, such as:

• a patient threatening them
• a patient behaving in a discriminatory manner, such as refusing to be treated by a particular person because of their ethnicity.”

3. Tackling discrimination and promoting fairness and inclusion (how to respond when patients and colleagues discriminate against others)

The updated guidance emphasises the responsibilities of medical professionals, and the organisations they work in, to tackle discrimination and bias. And it highlights the importance of positively promoting equality, diversity and inclusion for the benefit of patients and colleagues.

The GMC explained: “Our guidance already reminds medical professionals not to unfairly discriminate against patients by allowing personal views to affect relationships or treatments.

“We’ve added a new duty which says that medical professionals should consider how their personal beliefs, views and biases (which may be unconscious) may affect patients. For example, how these could potentially contribute to health inequalities or barriers to accessing some treatments.

“Recent events, such as the COVID-19 pandemic, have highlighted how poverty and a patient’s socio-economic situation can directly impact on health outcomes.

“We’re trying to encourage medical professionals to think about how a patient’s socio-economic circumstances can impact their health. So we’ve added this to the range of factors medical professionals should take into account, in addition to symptoms, when assessing a patient. Other factors include psychological, spiritual, social and cultural factors.

4. Maintaining trust

Communicating in public

The updated guidance says that when communicating publicly, medical professionals must:

• be honest and trustworthy
• make clear the limits of their knowledge
• make reasonable checks to make sure any information they give is not misleading
• declare any conflicts of interest
• maintain patient confidentiality.

All forms of communication

The updated guidance says medical professionals must not abuse, discriminate against, bully, exploit, or harass anyone, or condone such behaviour by others. This applies to all forms of communication, including on social media and networking sites, so it might include:

• making discriminatory remarks about patients in a private chat forum (such as Google Hangouts)
• making comments that bully or harass colleagues on a Facebook page which is visible to everyone
• making a speech on live television which exploits vulnerable people.

The GMC explained: “We expect medical professionals to behave in a way that means patients and the public can trust them and have confidence in them.

“This applies to all forms of written, spoken and digital communication.

“We feel this is needed because we’re concerned about behaviour such as:

• making false claims about the effectiveness of a medical treatment which can’t be supported by evidence
• spreading fake news about the ingredients used in a particular medicine.”

Conflicts of interest

The updated guidance says medical professionals must be more open about any potential or actual conflicts of interest that may influence the treatment and care options they share with patients.

The GMC explained: “Recent public inquiries and reviews have highlighted the importance of medical professionals being open with patients about personal or professional interests that may influence their practice.

“These are referred to as conflicts of interest, and they may come up in a range of situations. Conflicts of interest are not just about financial interests. For example, they may include:

• involvement in research into how effective a medicine is in treating a particular condition.
• friendship or a relationship with someone who invented a medicine.

“Our updated guidance says medical professionals must be more open about any potential or actual conflicts of interest that may influence the treatment and care options they share with patients.”

5. Personal beliefs (conscientious objections to procedures)

The updated guidance proposes changes to existing guidance to help medical professionals use their discretion when deciding whether to tell the patient the reason they are unable to provide care themselves.

The GMC explained: “Medical professionals should be able to practise medicine in line with their personal beliefs, while respecting and valuing a patient’s own beliefs. They shouldn’t impose their personal beliefs on patients or prevent patients from accessing appropriate medical treatment or services.

“There may be circumstances where medical professionals have personal beliefs which means they object to providing a particular type of care or treatment. For example, abortion or withdrawing treatment from a patient at the end of their life. This is known as a ‘conscientious objection’. In these circumstances, we think they should be able to refer the patient to someone else.

“This can be upsetting for everyone involved.

“For example, being told about someone’s conscientious objection could cause unnecessary additional trauma where:

• parents are already distressed about making the difficult decision to withdraw care from their terminally ill child
• a woman is very upset and seeking an abortion because she feels unable to cope with having another child.

“However, if the patient asks any questions, we would still expect medical professionals to answer honestly and openly. This may include disclosing their conscientious objection.”

Good Medical Practice – when was the last time you actually read it?

The Good Medical Practice (GMP) is the key document in which the GMC sets out your ethical duties as a doctor, and it is used as a benchmark in virtually all tribunal decisions. Is the GMP important?

When listing factors that help to determine the seriousness of sanctions that would be appropriate, the top item on the list is:

“The extent to which the doctor departed from the principles of Good Medical Practice.”

In addition, when listing factors that suggest erasure would be required, the top item is again specifically related to GMP:

“A particularly serious departure from the principles set out in Good Medical Practice where the behaviour is fundamentally incompatible with being a doctor.”