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GMC to require ‘kindness’ as part of significant guidance update

GMC to require ‘kindness’ as part of significant guidance update

The GMC has unveiled the first major changes to doctors’ practise requirements in a decade, due to come in from January next year.

The new Good Medical Practice guidance for doctors, published today, takes a zero-tolerance approach to sexual harassment towards colleagues for the first time. An entirely new section on creating a positive working environment also urges doctors to take action if they witness abuse, discrimination, bullying or harassment at work.

The standards on patient interactions now also include an explicit obligation for doctors to be ‘kind’, where before the GMP only referenced being polite and considerate.

Good Medical Practice (GMP) serves as a guide to what the regulator expects of the medical profession, and the version up until today came into effect in 2013. While small amendments have been made since then, today’s changes are the first significant updates to the guidance in 10 years, following a public consultation on a draft version conducted last year.

In its new guidance, the GMC has updated the names of the four ‘domains’, however many of the standards remain very similar.

In its introduction, the GMP also now includes an explanation of how these professional standards relate to the regulator’s fitness to practise (FTP) procedures.

The consultation last year proposed inclusion of a commitment to consider the ‘context’ a doctor was working in if a complaint arises, and also to remove the ‘threshold’ statement for launching a FTP investigation, which previously said: ‘Only serious or persistent failure to follow this guidance will put your registration at risk.’

Today’s new guidance removes this explicit threshold and instead says the GMC will assess if the medical professional poses any current and ongoing risk to protecting the health of the public, maintaining public confidence in the medical professions, and promoting proper professional standards.

At the end of the consultation last year, several groups criticised the proposed changes, saying they could ‘open the floodgates’ to FTP investigations.

While the wording around FTP procedures is not the same as the draft version published last year, the guidance still refers to considering the ‘context’ in which a doctor is working.

It says it will take into account ‘any relevant context that may impact on risk, for example systems factors and interpersonal factors in the medical professional’s working environment or their role and level of experience’.

Medical director at the Medical Protection Society (MPS) Dr Rob Hendry said they ‘welcome’ the GMC’s inclusion of this language around context, but said it is ‘crucial that the GMC abides by this definition’.

Where before the GMP only addressed sexual harassment towards patients, it now addresses interactions between colleagues, and covers verbal and written comments, the sharing of images, and physical contact. 

It says: ‘You must not act in a sexual way towards colleagues with the effect or purpose of causing offence, embarrassment, humiliation or distress.’

The GMC has also emphasised the importance of reducing personal bias and being inclusive of colleagues’ protected characteristics. 

The guidelines say: ‘You must show respect for, and sensitivity towards, others’ life experience, cultures and beliefs. 

‘You must not abuse, discriminate against, bully, or harass anyone based on their personal characteristics, or for any other reason. 

‘By “personal characteristics” we mean someone’s appearance, lifestyle, culture, their social or economic status, or any of the characteristics protected by legislation – age, disability, gender reassignment, race, marriage and civil partnership, pregnancy and maternity, religion or belief, sex and sexual orientation.’

If doctors observe such bullying or harassment, the GMP now recommends that they take action such as supporting anyone targeted by the behaviour, challenging the person responsible, or reporting it to a colleague. 

The GMP says: ‘We recognise some people may find it harder than others to speak up but everyone has a responsibility – to themselves and their colleagues – to do something to prevent these behaviours continuing and contributing to a negative, unsafe environment.’

With regards to patient interactions, the standards now say doctors must ‘treat patients with kindness, courtesy and respect’, however the GMC emphasises that this does not mean ‘agreeing to every request’ or ‘withholding relevant information that may be upsetting or unwelcome’.

This section also includes more comprehensive guidelines on how to exemplify kindness and respect, such as communicating sensitively, recognising patients’ knowledge of their own health, and trying not to make assumptions about what patients think.

As well as new guidelines on sexual harassment and bullying, the GMC has made other additions such as obliging doctors to ‘provide safe and effective clinical care whether face to face, or through remote consultations’.

There is also a recommendation to ‘choose sustainable solutions’ when possible and to support initiatives ‘to reduce the environmental impact of healthcare’.

Earlier this year, Pulse revealed that the GMC had admitted it was wrong to suggest to an MPTS tribunal that a doctor’s apology to a patient was an admission of guilt.

The GMP stipulates that doctors must offer an apology to patients when things go wrong, but the new version now includes the explicit caveat that ‘apologising does not, of itself, mean that you are admitting legal liability for what’s happened’.

GMC chair and consultant ophthalmologist Professor Dame Carrie MacEwen said the regulator hopes that addressing issues surrounding workplace culture ‘so clearly’ in the GMP will ‘spark discussion on making meaningful cultural change throughout medicine’. 

She said: ‘Sexual harassment, bullying and discrimination are entirely unacceptable. Where workplace cultures of this kind of behaviour go unchecked, they are detrimental to wellbeing, performance and patient safety. 

‘Doctors are increasingly, and bravely, speaking out about it, and as a regulator, it is important we leave no doubt that such behaviour has no place in our health services.’

Dr John Holden, chief medical officer at MDDUS, said: ‘The revised version we see today is the result of considerable consultation, which MDDUS was pleased to be a part of.  

‘Overall, this update is welcome and has many laudable aims not least the inclusion for the first time of a clear statement that doctors must treat patients kindly. 

‘Quite clearly this is something no one can disagree with. However, kindness is subjective, and we will monitor this closely to see how this develops in practice and whether it creates an increase in referrals to the GMC.’

Ahead of full implementation at the end of January, doctors will have five months to familiarise themselves with updated standards.

However, the Medical Defence Union (MDU) warned that doctors need more time to digest and implement the new guidance, especially over the busy winter period.

The organisation conducted a survey of 610 doctors, of which 31% were GPs and GP trainees, which found that only half were confident ‘they would have time to fully absorb the new standards before they are implemented’.

Responding to the updated GMP, the BMA has said it supports many of the changes but is concerned that the standards do not sufficiently reflect the difficult situation doctors are working in.

BMA council chair Professor Phil Banfield said: ‘While many of the updates are reasonable on an individual level, when placed in the context of an extremely challenging health service – navigating chronic under-resourcing and the biggest backlog in the history of the NHS – doctors are rightly concerned that this will simply extend opportunities for individuals to be scapegoated when services (and the systems behind them) fail to meet the needs of patients.

‘Doctors come to work to do the best job we can to care for our patients, and the GMC should not underestimate the impact that systemic pressures and failures have on doctors’ ability to provide safe care.’

The union called for a ‘three-tier approach’ which focuses not just on reporting bad behaviours but also improving how problems are resolved. It also said the GMC needs to address the ‘fear and distrust’ the profession currently has towards it.

The GMC has also said that while currently it only regulates doctors, once physician associates and anaesthesia associates come under its regulation this guidance will also apply to them.



Please note, only GPs are permitted to add comments to articles

Jonathan Heatley 22 August, 2023 7:20 am

the Lucy Letby case shows how toxic an environment some hospital departments are becoming. Allegations can be made that are vindictive on the one hand and genuine concerns can be dismissed as in this case. Where management and clinicians are in disagreement it is a ripe scenario for minor grievances to be escalated leading to a poisonous atmosphere. It is hard and unbelievbly slow to remediate and I feel sorry for any colleagues finding themselves in such working environments.

paul cundy 22 August, 2023 11:14 am

Dear All,
Coming from the GMC an invocation to be kind rather sticks in the throat!.

SUBHASH BHATT 22 August, 2023 11:47 am

Gmc says show kindness, why not start it at gmc. first.

Turn out The Lights 22 August, 2023 1:03 pm

Tell that to Dr BG and many more GMC.Get your house in order first.

Nathaniel Dixon 22 August, 2023 2:51 pm

Will make it considerably easier for management to start GMC processes or threat of them to silence dissenters much as it seems the hospital in the LL case did! Interesting timing. Kindness is a very subjective measure to threaten doctor’s careers with.

Michael Green 22 August, 2023 2:53 pm

Would you like fries with that?

Michael Mullineux 22 August, 2023 3:12 pm

‘Being friendly, generous and considerate’
Very rich coming from the GMC

Centreground Centreground 22 August, 2023 3:40 pm

The GMC itself needs a full investigation and someone to regulate its own ineptitude and incompetence- few organisations command such little respect from the professionals it supposedly regulates

Decorum Est 23 August, 2023 2:38 am

‘The new Good Medical Practice guidance for doctors, published today, takes a zero-tolerance approach to sexual harassment towards colleagues for the first time. An entirely new section on creating a positive working environment also urges doctors to take action if they witness abuse, discrimination, bullying or harassment at work.’
GMC – I’d prefer to go to the cells at the Lubyanka than take advise from you perverse assholes.

Simon Gilbert 23 August, 2023 5:47 am

Does this mean we can’t bounce back work dumps that start with the phrase ‘GP to kindly…’ anymore?

Turn out The Lights 23 August, 2023 8:30 am

SG I would replace I kindly thankyou for your request,I kindly ask what your last servaant died of.I kindly request if your would like (whatever doing) your would kindly F@@@ O@@.

Darren Tymens 23 August, 2023 10:06 am

Let’s explore the meaning of the word before deciding if it is appropriate.

Kindness means ‘the quality of being friendly, generous, and considerate’.

I am perfectly prepared to be friendly (defined as ‘pleasant’) to patients who are also friendly, but only within appropriate professional boundaries. To everyone else I am prepared to be professional.

I am prepared to be generous (‘showing a readiness to give more of something, especially money, than is strictly necessary or expected’) – with my time, and within my capacity – to patients who are appreciative. To everyone else I am prepared to give them the appropriate time as funded by the state.

I am prepared to be considerate (‘careful not to inconvenience or harm others’) to all patients.

Of these three, only the third would seem to be something that the GMC should regulate in any form. I am unhappy that my license to practise might be put at risk by unreasonable expectations to be friendly and/or generous.

Rupert Whitehead 23 August, 2023 5:10 pm

I’ve been putting off coming off the register having emigrated last year, but the absolute malicious idiocy of codifying kindness finally managed to motivate me to pay up to get the international letters of good standing, and complete all the necessary bureaucracy to apply for voluntary erasure.

S. Ali 23 August, 2023 6:21 pm

The hypocrisy of the GMC which they cannot apply to their own staff.

Further removing threshold, is to create a super fascist regulator to control and and all aspects of your life and undermine UK and international law

S. Ali 23 August, 2023 6:27 pm

I would highlight given the recent Lucy Letby case, these guidelines will make the environment worse. She would have advised the situation when more than being all the brown doctors into writing and giving an apology.

The GMC is determined to privatise the NHS and does not care how many patient and professional lives will be ruined

Dylan Summers 24 August, 2023 7:59 am

“show respect for… beliefs”

You hear this phrase everywhere, but what on earth does it mean?

If a patient believes that they have cancer, when they do not, what would it mean to “respect” that belief? Or if they do in fact have cancer, but refuse to accept the diagnosis?

If a patient believes that all ethnic minority doctors are incompetent, what would it mean to “respect” that belief?

John Evans 24 August, 2023 11:16 am

Sick joke. Ironically released around the time of the Letby case ending. That case surely demonstrated that Drs can already be brought to heel with the existing menus of threat and intimidation.

Whereas a major impediment to quality of care has been working conditions and lack of adequate Drs.
They have consistently failed to speak up about that. Whether it was over ruling working hours / human rights or inadequate consultant numbers in the past exposing juniors to less than adequate support / supervision or indeed.

How many oversights/errors due to the resulting time pressures or lack of continuity / handover?

A Non 24 August, 2023 11:16 pm

Medical regulation in the UK is close to becoming insane. All these fuzzy subjective obligations to be ‘kind’ ‘respectful’ and basically ‘nice’. Yeah all very well on the face of it, how could you really disagree with out being an a-hole right? but hang on what do these things actually mean? One persons “kind” is another persons “outrageous imposition”. This is a mandate for the thought police. Special interest groups with a pathological need to take offence will here be given a blank cheque to harass and bully clinical staff for not showing sufficient respect. Vague ill defined concepts lead to vague unpredictable out comes. This is all way way too complex, fuzzy and completely over steps the mark. Month on month the GMC gets a tighter grip on Drs throats. They need to back off, go back to keeping the list, strike off dangerous and incompetent Drs and stop telling everybody what to think. Its absolutely nuts

Dr No 24 August, 2023 11:43 pm

It’s about time the GMC (and the CQC for that matter – though I expect they are beyond rescue) started punching up and not down. The biggest by far issue causing danger for patients is government defunding of the NHS and primary care in particular. I’ve sent endless comment to the CQC every time they inform me about their “new regulatory approach” (daily FFS) to look to government policy instead of the crap they usually pick holes in. No replies so far, Government stooges,

David Church 26 August, 2023 9:38 am

While the GMC says ‘apologising does not, of itself, mean that you are admitting legal liability for what’s happened’, they appear to be restricting this caveat to ‘legal liability’. They have not excluded the implication that an “apology to a patient was an admission of guilt.” for the purposes of GMC regulation, rather than ‘legal liability’.
This is quite concerning.
And yes, ‘kind’ can be taken to far. It opens up risk we can be reported for not giving appointments to demanding people……. and money to people who think they need it! It can imply we should do extra hours for free, and abide by all requests from other services, however inappropriate.
But it also implies that we should give free prescriptions to all patients for all those drugs our HB/CCG Pharmacy advisers say that we should not give prescriptions for; and opioids to any addicts requesting them. This needs further careful advice.