Lifestyle medicine is an evolving speciality within medicine. It focuses on using evidence-based techniques to support behaviour change, and lifestyle interventions to prevent and manage chronic disease.

The RCGP has recently published a framework providing guidance for GPs wanting to expand their role and practice as a GP with extended role in lifestyle medicine. For GPs already working in this field, this framework provides a benchmark and recommendations for professional development.

Lifestyle medicine as a specialty, however, is not just the domain of general practice. Many practitioners in other healthcare fields, including doctors in other specialties, dieticians, physiotherapists and others, can adopt it to provide lifestyle medicine interventions to patients with long-term conditions - as may healthcare practitioners from other disciplines such as nursing, physiotherapy and nutritional therapy.

Indemnity

In 'Good medical practice' (2024), the GMC states you must make sure you have appropriate and adequate insurance or indemnity that covers the full scope of your practice, and that you should keep your level of cover under regular review.

Doctors who are going to include a lifestyle medicine component to their practice need to ensure they have appropriate indemnity for their work. Lifestyle medicine is a new specialty, so it's important to discuss it with existing indemnity providers - even more so if it will be carried out in the private sector.

If you're planning on practising lifestyle medicine through a limited company or as a sole trader, you need to also consider the need for corporate indemnity.

Treatment delivered within the NHS should fall within one of the state schemes for clinical negligence claims. But where arrangements are more complicated - for example, services delivered in a local authority or even private facility, but where NHS clinicians are contracted to do the work - it's important to clarify with your employer the indemnity arrangements or agreements reached as part of the contracting process.

You may want to specifically clarify whether you, as in individual clinician, need to get your own indemnity for the work.

At the time of writing, there's no state indemnity for primary care in place in Scotland or Northern Ireland. Practitioners in primary care in these countries will likely need to secure their own indemnity. 

It's also important to understand that the state backed schemes are only relevant to clinical negligence claims. Even if all your work is NHS indemnified, you should also let your MDO know you're doing this work in case you need support for other issues like complaints, inquests or the GMC.

Regulation

CQC registration

Lifestyle medicine isn't considered alternative and complementary medicine. If provided by doctors, or under the supervision of a doctor, it could be described as 'doctors consultation services' according to the CQC service types, and as such is a regulated activity.

This would likely require CQC registration unless a specific exemption applies. Doctors should therefore make sure they have sought advice about the requirement for CQC registration - especially in the private sector, where they may not be practising under an existing CQC registration for this service type.

Appraisal and revalidation

Any doctor working in lifestyle medicine (or proposing to do so) should include this in the scope of work as part of their annual appraisal portfolio. They should also undertake CPD and other activities required for revalidation in this field, as well as any other scopes of practice they work in.

Supporting information might include online learning opportunities - like webinars, conferences or training days provided by organisations accredited for CPD - in the fields you're practising in that are relevant to lifestyle medicine.

These may fall within any of the six pillars of lifestyle medicine:

• healthy eating
• mental wellbeing
• minimising harmful substances
• heathy relationships
• sleep
• physical activity.

More generic learning aimed at helping patients address their difficulties might also be applicable across all these pillars, such as motivational interviewing and other behaviour change techniques.

Supporting information for the purpose of quality improvement activities could include case discussions, collation of patient outcome measures and practice audits.

Medico-legal considerations

Setting up or expanding any type of practice naturally involves many wider financial and business considerations around issues like marketing, data protection, record keeping, fees and so on.

But there also specific medico-legal considerations that will need to be addressed, including but not limited to those set out below.

Complaints

You will need to make sure your practice has a complaints policy that is accessible to patients using your service.

For NHS funded treatment, complaints must be handled in accordance with the relevant statutory framework. There is no single defined framework in the private sector. But if you're practising under the CQC umbrella of a private hospital or clinic, you'll likely be following its complaints procedure, which may involve the Independent Sector Complaints Adjudication Service.

If you're working out of your own practice with your own CQC registration, you will need to have your own complaints policy in place and make sure it's accessible to patients using your service.

• For more information on complaints, see our dedicated complaints hub.

Ethical guidance

If you're practicing lifestyle medicine, you must follow GMC ethical guidance on professional standards for doctors.

This might relate to liaising and sharing information with other clinicians involved in the patient's care, and obtaining appropriate consent from the patient to do so, if required.

The GMC gives detailed guidance on these points in Confidentiality - Using and disclosing patient information for direct care.

If you're prescribing treatments and you are not the patient's GP, the GMC requires you to share information with the patient's GP, as set out in Good practice in prescribing and managing medicines and devices.

Remote consultations

As part of your practice, you might consider offering remote consultations in lifestyle medicine. The GMC's ethical hub on remote consultations offers guidance on managing patient safety risks and how to decide whether it is safe to treat patients remotely.

For example, you need to be satisfied that the type of assessment allows you to obtain adequate knowledge of a patient's health and is suitable for the type of care your practice will provide.

You also have to be able to obtain the patient's consent and be able to engage with them to discuss the treatments being offered, ensuring they understand the risks, benefits, burdens and limits of the proposed treatment. This especially important where off-license prescribing may be a recommended treatment.

You should also ensure that your indemnity provider can cover you for remote consultations in this field.