GMC a bit vague in its rulebook revise

Following the launch of a consultation on a new version of Good Medical Practice, Dr Caroline Fryar shares some initial reflections and asks whether the GMC guidance represents the realities of medical practice or, instead, the aspirations for what it should be.

It has been almost a decade since the last revision of Good Medical Practice. 

If you take just a moment to pause and reflect on all the developments and events that have taken place in UK healthcare since then, it is perhaps unsurprising that the GMC has decided to introduce a new version of this fundamental piece of guidance. 

However, what is surprising, is the scale of the change the GMC is proposing in this new version.

Judged against it

Good Medical Practice is central to everything the GMC does. Indeed, it is one of the core tools used by the GMC in its fitness-to-practise processes, so every paragraph and every single word in the guidance document really does matter, as doctors will be judged against it. 

A consultation on the new version of the guidance runs until 20 July. The MDU is forensically scrutinising all the changes and additions and will respond on behalf of our members. 

In the first instance, here are some of our initial impressions.

This is a fundamental redraft of the guidance. Spread over four ‘domains’ – as before – but with three of the four now falling under new headings. 

They are:

1. Working with colleaguesdescribing how professionals should treat each other and work together in the interests of patients and service improvement.

2. Working with patients describing the different aspects of good doctor-patient relationships, particularly communication and shared decision-making as set out in the GMC’s more recent consent guidance.

3. Professional capabilities an expanded section describing the range of capabilities that underpin safe, effective practice, including demonstrating leadership and reflective practice.

4. Maintaining trust describing the conduct needed to maintain public confidence in the profession, with new duties concerning social media and dealing with sexual harassment.

Focus on leadership

Two central themes underpinning many of the changes and additions are a greater focus on the leadership expectations of all doctors as well as an increase in focus from the GMC on doctors using their professional judgement in a variety of situations.  

In launching this new version of the guidance, the GMC is on record as saying that it believes all doctors are leaders. 

This is a bold statement and may be challenging in practice. It is a statement that underpins a large number of the changes in the guidance – where the GMC has drawn heavily from Leadership and Management for Doctors and incorporated much of that into the new version of Good Medical Practice. 

However, when taken with an increase in focus on professional judgement, particularly with doctors’ obligations to maintain a good workplace culture, we have some concerns about the potential unintended consequences here.

Is it clear what the GMC expects? Let’s take paragraph 7 as an example. It states: ‘You should take action, or support others to take action, if you witness or are made aware of bullying, harassment or unfair discrimination.’

Now, quite rightly, the GMC does not want to be prescriptive about what kind of ‘action’ should be taken in these situations. So, what action would be sufficient? 

Discriminatory comment

The GMC suggests it might be sufficient to simply ask the person on the receiving end of this treatment if they are OK; but is that really enough? 

If everyone in a team meeting hears a discriminatory comment, are all doctors present expected to be involved in taking action about that; what if the person subject to the treatment you witness specifically asks you not to take it any further? 

These are just some of the open questions posed by these sorts of additions to the guidance, and underline why it is so important to attain maximum clarity from the GMC while not creating sweeping and burdensome duties on individual doctors. 

Another example can be found at paragraph 22. It states: ‘You should treat patients with kindness, courtesy and respect.’ 

Focusing in this instance simply on the word ‘kindness’, doctors, of course, want to be kind to their patients – but what does it mean to be kind? 

The GMC has said it is testing the word’s inclusion in Good Medical Practice, acknowledging that it means something different to different professionals. We also suggest it can mean something very different to different patients. 

These proposed additions are all linked to a fundamental question at the heart of this new version of Good Medical Practice: what the guidance is trying to be, and what it actually is.

Aspiration or reality

There have already been many comments made about some of the new additions to Good Medical Practice – from the inclusion of that word ‘kindness’; to obligations not to condone certain behaviour on social media; to having regard for global health when taking account of the resources available to treat patients. 

Kindness, tackling abuse on social media, climate change – all of these issues matter profoundly and are of the utmost importance. 

However, Good Medical Practice is not a manifesto outlining the aspirations for the healthcare system: it is the principal document by which doctors and their registration with the GMC are held to account. 

Hence, the duties and responsibilities it places on the profession must reflect the realities of the healthcare system and the individual doctors within it. The guidance must be accessible, understandable and achievable for doctors.

Through guiding, supporting and defending our members in GMC matters, we have considerable experience of how Good Medical Practice is viewed by both doctors and the GMC itself. 

We are thoroughly engaging with this consultation, as we want to ensure the guidance delivers for doctors, so they can deliver for patients.

This is a rare opportunity to actively shape a fundamental piece of guidance from the GMC. Independent practitioners can to share their views with the MDU.

Dr Caroline Fryar (right) is the MDU’s director of medical services