The GMC is due to publish a new edition of 'Good medical practice' later this year. This will be the first significant revision to its core guidance for doctors since 2013 and one that will set professional expectations for many years to come.

The world in which these new standards will be applied is very different to the one that doctors worked in when the current standards were set. Over the last ten years, rapid medical advances, the pandemic, workforce shortages, funding shortfalls and relentless pressure have transformed the healthcare environment and exacted a heavy toll on overworked healthcare professionals.

The contrast between then and now is obvious from a few telling statistics.

• Back in December 2013, there were 2.9 million patients referred and waiting to start treatment, of which 317 people had waited longer than a year. But at the end of 2022, there were 7.2 million patients on the list, of which more than 400,000 had waited longer than a year.
• The NHS's first published staff vacancy statistics showed 58,032 vacancies advertised between March and May 2014. The most recent statistics show there were 133,446 staff vacancies in September 2022.
• In December 2013, the staff sickness absence rate for NHS England was estimated at 4.35%,but the provisional statistics for September 2022 reveal a sickness absence rate of 5%, with mental health problems like anxiety and depression the most common reported reason (24.9% of all sickness absence).

Patients are increasingly questioning whether the health service is capable of meeting their needs, and frontline staff are bearing the brunt, despite their best efforts. This is reflected in the latest NHS complaints figures, which show a total of 225,570 written complaints recorded in 2021/22, up by a third on the previous 12 months (170,013). For GPs alone, there were 99,459 written complaints in 2021/22 compared with 72,087 the previous year (in 2013/14 the equivalent number was 27,711).

Meanwhile, six in ten respondents to our member survey in January felt relationships with patients and colleagues had become more strained over the past two to three years, and 20% had experienced abuse or threats.

Patients know there is a problem. Doctors know there is a problem. It is incumbent on those setting the standards to act accordingly.

In this context, the GMC must take care not to further burden doctors with unattainable expectations - after all, the standard being set is 'Good medical practice', not 'Perfect…'.

The MDU has raised a number of concerns about passages in the draft guidance that we felt were too prescriptive, vague or impractical to follow.

One example is the responsibility to "take action, or support others to take action, if you witness or are made aware of bullying, harassment, or unfair discrimination." We agreed with the principle, but questioned whether the wording imposes a sweeping duty on doctors that they may not be in a position to carry out. Should, for example, a junior doctor working in A&E feel obliged to confront an aggressive or intoxicated patient who is verbally harassing other patients in the waiting area?

As a profession, we recognise the value of guidance that helps us maintain public trust and navigate the challenging situations we encounter in our working lives. But 'Good medical practice' also needs to reflect the real world if it is to underpin fair and proportionate decision-making during the fitness to practise process.

We made this point in our response to the GMC's consultation because we know the stress and anxiety that a GMC investigation - or the prospect of one - can cause. We see the impact on members when we support them, and we can also empathise because we are doctors ourselves.

The MDU is owned by its members, and led and staffed by doctors from a wide range of different medical backgrounds at every level of the organisation. We have more than fifty medically qualified advisers and claims handlers standing by to counsel, support and defend you, a panel of eminent clinicians to represent your interests on our cases committee, and a network of members on hand to provide peer-to-peer support.

This doctors-for-doctors ethos inspires us - and indeed, requires us - as an organisation to go the extra mile for our members, and our track record at the GMC speaks for itself. Between 2016 and 2020, MDU solicitors representing members at the Medical Practitioner Tribunal service (MPTS) achieved an outcome with no finding of impairment in 42% of cases, compared to the published average of 21.5%.

At the same time, we will continue to make the case that doctors should only be subjected to a GMC investigation if it is necessary to protect the public. That means long overdue regulatory reform and ethical standards that are achievable rather than onerous.

Society makes huge demands on our doctors and is often too ready to focus on perceived failures. In standing up for our members, the MDU is doing its best to redress the balance.