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A key role of the GMC is to set out the standards expected of you so you can practice medicine within a 'framework for ethical decision-making'. Not only does this guide your everyday practice, it also informs any fitness to practise decisions by the regulator.
In August, the GMC published the first update to its 'Good medical practice' (GMP) guidance in a decade. The guidance comes into effect on 30 January 2024 and is something all doctors need to be aware of.
In a recent MDU survey of over 600 doctors, nearly all (96%) told us they had referred to the guidance at some point in their working lives. The top reasons for referring to GMP were to support their decisions around consent and capacity, confidentiality concerns such as whether to disclose information, and to reflect on a complaint.
With some significant changes in the new, longer guidance, it's vital to familiarise yourself with the content ahead of time. The MDU has called for doctors to be given protected time to do this.
Being familiar with the contents of the new 28-page edition and understanding how the guidance applies to your own practice should stand you in good stead to practice in line with GMC expectations.
There will also be further updates on the MDU website before the guidance comes into effect.
What are the main updates to the guidance?
The GMC's website says that the main updates in the guidance are aiming to:
- create respectful, fair and compassionate workplaces for colleagues and patients
- promote patient centred care
- tackle discrimination
- champion fair and inclusive leadership
- support continuity of care and safe delegation.
The guidance addresses changes in medical practice, such as remote consulting, as well as broader social changes. There is also more in-depth advice on communication skills including on treating patients fairly, with kindness, courtesy and respect.
For the first time, it includes how doctors should respond if they witness sexual harassment, bullying and discrimination in a new section devoted to contributing to a positive working and training environment.
There will also be a new suite of supplementary guidance giving more detailed information on areas like use of social media, maintaining boundaries and conflicts of interest.
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How will the GMC use the guidance if investigating my fitness to practise?
The GMC stresses that 'Good medical practice' isn't a set of rules. While the current version states that, "only serious or persistent failure to follow our guidance that poses a risk to patient safety or public trust in doctors will put your registration at risk", the 2024 guidance provides more explanation.
It explains that when assessing the risk posed by a doctor, the GMC will consider factors like the extent of any departure from professional standards, whether this was premeditated or persistent, or involved abuse of power. There is also recognition that mitigating factors like your response to the concern and any remediation undertaken will be considered.
What are the four new domains in the guidance?
Domain 1 - Knowledge, skills and development
This focuses on how you can maintain your professional knowledge, skills and performance. It specifies you 'must be competent in all aspects of your work including, where applicable formal leadership or management roles'.
To keep up to date, the GMC requires you to 'take part in systems of quality assurance and quality improvement', such as regular reviews and audits. There is also an expectation that you will respond constructively to the outcomes of such reviews which could include altering your practice; arranging staff training; or implementing/updating relevant practice policies.
It reiterates GMC guidance on remote consultations and the need to offer an alternative if it's not possible to provide safe and effective care through a particular mode of consultation.
Domain 2 - Patients, partnership and communication
This section looks in detail at your professional relationship with patients and how to work in partnership with them. It deals with obtaining patient consent (see also the GMC's consent guidance) and includes your duty to discuss the material risks of treatment options with patients and support them to make an informed decision. This follows the Montgomery Judgment of 2015.
There is a new focus on treating patients fairly, with kindness, courtesy and respect, which emphasises the significance of communication skills, listening and being aware of body language.
The GMC says your role requires you to care 'for the whole patient', which includes asking them about other treatment and considering 'the overall impact of the patient's treatments and whether the benefits outweigh any risk of harm'.
Finally, the GMC reiterates the responsibilities set out in its guidance on the professional duty of candour and makes the important distinction that 'apologising does not, of itself, mean that you are admitting legal liability for what's happened'.
In a recent MDU survey of over 600 doctors, nearly all (96%) told us they had referred to the guidance at some point in their working lives.
Domain 3 - Colleagues, culture and safety
This new section includes not only advice on effective teamwork but also on workplace culture, as well as more familiar aspects like handovers and continuity of care.
The GMC gives examples of how doctors can contribute to 'a positive working and training environment' by 'showing respect for and sensitivity towards others' life experience, cultures and beliefs'. It also specifies taking action if you witness abuse, discrimination, bullying or harassment although it recognises some might find it harder to speak up.
Those in a formal leadership role, such as a practice owner/employer, are expected to take greater responsibility and must act to ensure the behaviour is adequately addressed, that people are supported and concerns are addressed promptly.
We advise having a disciplinary/grievance procedure in place and seek appropriate legal guidance on employment/contract law as necessary.
Domain 4 - Trust and professionalism
The final domain replaces the current guidance on maintaining trust, covering similar ground including the need to behave with integrity and avoid conflicts of interest.
There is new guidance on communicating as a medical professional, including social media and instant messaging. Supplementary guidance on social media will also be updated
Finally, while doctors have always been expected to ensure they have adequate and appropriate indemnity, paragraph 101 goes further by saying this has to cover the full scope of your practice and the level of cover should be kept under regular review.
What should I do now?
The updated standards in 'Good medical practice' focus on principles and conduct which support good teamwork, encourage individuals that they are safe when speaking up and empower doctors to provide quality care. This is important guidance which it is vital you become familiar with before it takes effect in January 2024.
Recognising that this may be a challenge, given the enormous pressure that many doctors are under, the MDU will be doing everything we can to clarify and explain what the new guidance means for you. More importantly, we will be there to advise and support members with GMC matters in the years ahead.
This article first appeared on GPonline in September '23 and has been edited for publication.
Dr Udvitha Nandasoma
Head of advisory services
Dr Udvitha Nandasoma
Head of advisory services
BA MBBChir MRCP (UK) LLB(Hons)(Open) PhD MFFLM
Dr Nandasoma joined the MDU as a medico-legal adviser in 2008 after completing specialist training in gastroenterology. He became head of advisory services in 2022 and was a practising hepatologist until early 2023.
See more by Dr Udvitha Nandasoma