The GMC’s Good Medical Practice guidance is designed to ‘set out the principles and values on which good practice is founded’ – or, in other words, to capture the timeless essence of what it means to be a doctor. The specifics of the guidance do change with time, of course, to reflect long-term shifts in our cultural appreciation of medicine, such as the increasing value now placed on patients playing an active role in decisions involving their health. But the guidance is almost as fundamental to modern-day medicine as the Hippocratic Oath, and needs to preserve a common strand – a universally agreed set of ethical standards – through each succeeding version.
So the GMC must be extremely careful when it releases new draft guidance that each fresh recommendation is seen to be founded in those universal principles.
The one thing the guidance must never become is a political tool, bent and morphed to fit the latest Government imperative. Yet that is exactly what appears to have happened with the release of the latest provisional version, and its hugely contentious suggestion that GPs should have an ethical duty to persuade patients to return to work.
Under the current wording, doctors will be considered to have ‘a duty to encourage patients with long-term conditions to stay in, or return to, employment’. The GMC has apparently agreed to look again at that wording, but not at the principle it describes. Getting patients back to work is now to be considered a fundamental part of what being a doctor is about, alongside recommendations on confidentiality, patient consent, the doctor-patient relationship and the need to be ‘honest and trustworthy’.
There is a good range of evidence to suggest that in many patients who are out of work through illness – though not all – returning to work can be beneficial for their mental and physical health. Most GPs would accept it is good practice to play a role in aiding return to work, if it feels the right thing to do for that individual, and always provided there is some prospect of work for the patient to be encouraged into. But accepting that work is often a good thing is a chasm away from agreeing that to promote it should be a universal duty, and failure to do so a matter for the regulator. Can doctors who fail to chase their patients to the job centre or challenge requests to be signed off sick really expect a GMC letter on their doorstep?
It is on one level simply ridiculous for the GMC to make a recommendation on such a specific aspect of a patient’s care – akin to making it an ethical duty to control a patient’s blood glucose or apply new guidance on ambulatory blood pressure monitoring. And does the ethical duty lapse if the evidence changes?
But it is more sinister than that. The GMC may deny it expects doctors to become ‘policemen of the state’, but its new advice seems to be driven far more by the political obsessions of today than anything to do with the immutable principles of medicine.