The core ethical guidance for doctors practising in the UK is changing. On Wednesday 27 April, the General Medical Council (GMC) published a new draft of the Good Medical Practice guide, which is now subject to a 12-week consultation.
The GMC has said the update is designed ‘to reflect the type of fair, inclusive and compassionate workplaces we all want to see, and that are good for doctors as well as for patients’.
Here we look at some of the proposed amendments…
The four domains
There have been some changes to the structure of the guidance. It still includes four domains, although some of the names of these have changed and new duties have been added. The four domains in the new draft are: working with colleagues, working with the public, professional capabilities and maintaining trust.
Domain 1: Working with colleagues
The first domain, working with colleagues, covers the link between working culture and outcomes for professionals and patients. It features new duties on communication and teamworking.
The domain includes a new definition to clarify what the GMC means by colleagues. This is ‘anyone you work with, whether or not they are a medical professional’.
Eradicating ‘toxic’ workplace cultures is a key focus of the updated guidance, and the GMC has also introduced two new duties designed to address workplace bullying and sexual harassment. The first – included in domain 1 – instructs registrants that they must not ‘abuse, discriminate against, bully, exploit, or harass anyone, or condone such behaviour by others’. This applies to all interactions, including on social media, the guidance says.
Registrants are also advised that they should take action, or support others to take action, if they ‘witness or are made aware of bullying, harassment, or unfair discrimination’.
In domain four, a specific duty on sexual harassment says: ‘You must not demonstrate uninvited or unwelcome behaviour that can be reasonably interpreted as sexual and that offends, embarrasses, humiliates, intimidates, or otherwise harms an individual or group’.
Continuity of care
The ‘working with colleagues’ domain also covers how medical professionals should work together on continuity of care. The wording has changed – moving away from just ‘safe transfer’ of patients between healthcare providers to requiring that registrants ‘must contribute to continuity and coordination of patient care’. This is particularly important when patient care is shared between teams, or when patients are transferred between care providers, the draft guidance says.
Two duties from existing GMC guidance on leadership have been added:
- You must not assume that someone else will pass on the information needed for patient care.
- If you identify problems arising from poor communication or unclear responsibilities within or between teams, you must act promptly to deal with them.
The GMC said both duties had been included in the GMP and promoted to a ‘must’ because of the ‘adverse consequences that can arise when communication fails’ – most fitness to practise complaints received from patients have a communication element, it added.
Domain 2: Working with the public
Domain two is about working in partnership with patients.
A notable addition to this section is a new duty on providing safe care regardless of whether a consultation is delivered face-to-face or remotely. The draft guidance says: ‘Whether you provide clinical care in a face-to-face setting, or through remote consultations via telephone, video-link, or online services, you must provide safe and effective care. Where possible, you should agree with the patient which mode of consultation is most suitable to their individual needs and circumstances.’
It adds that where doctors can’t provide safe care through the mode of consultation they are using, they should offer an alternative if possible, or signpost to other services.
The GMC said this duty had been brought in from its existing good practice guidance on prescribing and managing medicines and devices to ensure the mode of consultation allows for safe care.
The draft guidance includes a greater focus on respecting patients’ rights, including legal rights on privacy and dignity. It also expands the GMC’s existing advice on decision making and consent.
A new duty – taken from the GMC’s existing guidance on decision making and consent – says that doctors ‘must try and find out what matters to patients so [they] can share relevant information about the benefits and harms of proposed options and reasonable alternatives, including the option to take no action’.
The draft guidance also highlights registrants’ responsibilities in relation to mental capacity legislation. This includes the duty that medical professionals ‘must start from the presumption that all adult patients have capacity to make decisions about their treatment and care’.
It adds: ‘You must be aware of your duties under relevant legislation and have regard to relevant codes of practice.’
Domain 3: Professional capabilities
This domain focuses on continuing professional development. Much of the content remains from the existing guidance, but there are several new duties around teamworking and fairness of opportunity.
- Medical professionals must seek and respond constructively to feedback.
- Medical professionals should consider how their personal beliefs, views and biases may affect colleagues and patients.
- Those with responsibilities for helping staff access training and development and employment opportunities should do this fairly.
The GMC said it is also looking at whether it needs to be more explicit about sustainability and the use of resources, as well as more clearly acknowledging ‘the tensions that can arise between the needs and expectations of individual patients and the interests of the wider population’. The organisation said it has faced calls to give more attention ‘to the risk to public health arising from climate change’.
The draft guidance therefore includes the following duty: ‘You must provide the best service possible within the resources available, taking account of your responsibilities to patients, the wider population and global health.’
Domain 4: Maintaining trust
Among the changes in this section is the GMC’s response to calls for greater clarity on how medical professionals should use social media. Existing duties from the 2013 version of the guidance have been strengthened, with medical professionals given five points to follow in their communications:
- Be honest and trustworthy
- Make clear the limits of your knowledge
- Make reasonable checks to make sure any information you give is not misleading
- Declare any conflicts of interest
- Maintain patient confidentiality
The GMC said these points should apply to all forms of written, spoken, and digital communication.
The wording around insurance and indemnity has also been amended. The existing guidance says that registrants should ensure they have ‘adequate’ insurance and indemnity cover, but the GMC said it is often queried on what ‘adequate’ means and is unable to provide advice on this. The new draft guidance has therefore been changed to insurance and indemnity that covers ‘the full scope of your practice’ – which means it should cover all activities wherever they take place.
Other proposed amendments
Replacing existing doctor duties
The existing doctor duties are replaced in the new draft guidance with 12 ‘behaviours’ that registrants should commit to. The GMC said that most of the underlying principles remain unchanged, but new expectations around working with colleagues and leadership have been added.
The GMC is proposing to remove the ‘threshold’ statement for when it would launch a fitness-to-practise investigation, which currently says: ‘Only serious or persistent failure to follow this guidance will put your registration at risk.’ This would be replaced by an explanation that the GMC will act ‘where there is a risk to patients or public confidence in medical professionals, or where it is necessary to maintain professional standards’.
The draft guidance also includes a more detailed account of the range of factors considered by the GMC when they’re assessing this risk. These include: the extent of a registrant’s failure to meet the professional standards, factors that increase and decrease the risk to public protection (including the context in which they were working), and how they responded to the concerns raised.
The GMC’s consultation on the draft guidance runs until Wednesday 20 July. GPs can respond here.