The doctors – their patients, their colleagues and the GMC

As the GMC’s consultation on a new version of Good Medical Practice continues, the Medical Defence Union’s Dr Caroline Fryar takes a closer look at one of the four domains in the guidance and highlights some of the potential problems with what is proposed.

When I set out on my medical career, my primary motivation was crystal clear: I wanted to care for patients. My aim was not unique. Indeed, I believe it is the motivation of the overwhelming majority of my medical colleagues.

So, in studying Domain 2 of the GMC’s proposed new edition of Good Medical Practice, I am immediately struck by its title – Working with patients. Surely, given how central this is to the very essence of what it means to be a doctor, this should be Domain 1, rather than number two? 

That overarching point aside, there are many paragraphs in Domain 2 that give the MDU cause for concern. Let’s look at some examples:

Paragraph 22: You must treat patients with kindness, courtesy and respect.

A common theme across many of the concerns we have about this revised guidance is the significant expansion of the use of subjective terms.

‘Courtesy’ and ‘respect’ are subjective terms, but ‘kindness’ is especially so. While most doctors undoubtedly set out in the morning to be kind – what does that word ‘kindness’ mean? 

It, of course, means something different to everyone: patients and doctors. The question I pose is a simple one: does the word ‘kindness’ need to be included in this paragraph and in the guidance at all? 

‘Courtesy’ and ‘respect’ are well understood in terms of what is meant by them in a professional setting with patients, but the same simply isn’t true of ‘kindness’. 

We increasingly see GMC guidance quoted back at doctors in complaints and we are concerned that reference to kindness could be used against doctors in an unreasonable way. 

We are also concerned that, in some cases, doctors seeking to demonstrate that they are complying with the GMC’s edict to be kind may inadvertently find themselves close to – or over –
the line of the doctor-patient relationship. 

A duty to treat patients with courtesy and respect would seem amply sufficient.

Paragraph 37a: In providing clinical care, you must propose, provide or prescribe drugs or treatment (including repeat prescriptions) only when you have adequate knowledge of the patient’s health and are satisfied that the drugs or treatment serve the patient’s needs.

Overriding duty

The use of the words ‘you must’ is highly significant in Good Medical Practice. The GMC defines the statement as ‘an overriding duty or principle that will usually apply’. 

Alternatively, the statement ‘you should’ is used. This is in part defined by the GMC as an instance ‘where the duty or principle will not apply to all situations or circumstances’.

We believe this paragraph is a prime example of where the guidance needs to read ‘you should’ rather than ‘you must’. 

Why is that? Paragraph 37a says that drugs ‘must’ only be prescribed when the doctor is ‘satisfied that the drugs or treatment serve the patient’s needs’. Plainly put, we do not believe this reflects the realities of medicine. 

In medicine, there are many situations where a number of seemingly appropriate drugs may be available, and doctors have to begin by prescribing one to see if it works. It will only be then they can be satisfied that it serves the patient’s needs. 

There are times when a doctor needs to prescribe without being sure it will serve the patient’s needs, so we believe the GMC needs to change the wording of this paragraph.

Paragraph 44: You must not unreasonably deny a patient access to treatment or care that meets their needs….

The following scenario is not an unheard-of occurrence. A patient arrives for a consultation with a clear view of what course of action will meet their needs. Yet, the patient’s perception of what meets their needs differs considerably from what the doctor considers clinically appropriate. 

Doctors are, of course, obliged to not stray beyond such realms. So, this paragraph would benefit from a small but consequential addition. We believe the word ‘appropriate’ should be added, so it reads ‘access to appropriate treatment or care that meets their needs’. 

This is the first substantial edit of Good Medical Practice since 2013. We can therefore expect the end-product of this consultation exercise to carry the profession through into the 2030s. The GMC must get this right. 

We at the MDU are continuing to formulate a comprehensive and robust response to this consultation and we are committed to working with the GMC so that this guidance delivers for the profession. 

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

The GMC’s consultation deadline is 20 July.

Dr Caroline Fryar (right) is head of advisory services at the MDU