GMC guidelines revamped to reflect society

The new and updated version of Good Medical Practice comes into effect in January 2024 and will set standards of prof­ess­ional behaviour for many years to come. The MDU’s Dr Udvitha Nandasoma looks at what it means for independent practitioners.

Setting standards for doctors is one of the GMC’s most important functions, providing a ‘framework for ethical decision-making’ by practitioners and also for fitness-to-practise decisions. 

The publication of the new core guidance in August was therefore a significant moment which followed more than 18 months of consultation by the GMC. 

In the years ahead, Good Medical Practice 2024 (GMP) will ‘set out the principles, values, standards of care and professional behaviour expected of all medical professionals’. 

The GMC stresses that GMP isn’t a set of rules, as the regulator says it will take into account factors like the extent of any departure from professional standards, whether this was premeditated or persistent, or involved abuse of power when assessing the risk posed by a doctor after concerns have been raised. 

By familiarising yourself with the contents of the new 28-page edition and understanding how the guidance applies to your own practice what you should be able to have confidence that you understand the GMC’s expectations. 

To get you started, the Medical Defence Union has put together this quick guide to some of what’s in there and most relevant for independent practitioners.

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Slightly longer than its predecessor at 101 paragraphs – compared with 80 paragraphs in 2013 – the new GMP addresses changes in medical practice, such as remote consulting, as well as broader social changes.

It covers communication as a professional in greater depth and, for the first time, it focuses on how doctors should respond if they witness sexual harassment, bullying and discrimination in a new section devoted to contributing to a positive working and training environment. 

As before, the guidance topics are set out in four domains, although each of these now has a short introduction which summarises the behaviour expected of good medical professionals. 

These are different to 2013, including a completely new domain called ‘colleagues, culture and safety’ which reflects the GMC’s concern with workplace culture and has implications for senior doctors or for those with their own practice or clinic.

Domain 1 Knowledge, skills and development (paras 1-15)

This section of the guidance focuses on you should do to maintain your professional knowledge, skills and performance. As well as clinical practice, the GMC says you ‘must be competent in all aspects of your work, including, where applicable, formal leadership or management roles’ (para 1). 

To keep professional skills and knowledge up to date, the GMC requires you to ‘take part in systems of quality assurance and quality improvement to promote patient safety across the whole scope of your practice’, such as regular reviews and audits of your work (para 13).

Besides setting out the ingredients for effective clinical care (para 8), this section re-iterates GMC guidance on remote consultations and the need to offer an alternative if it’s not possible to provide safe and effective care through a particular mode of consultation. (para 9).

Domain 2 Patients, partner­ship and communication (paras 16-47)

Following the Montgomery Judgment of 2015, doctors have had a duty to discuss the material risks of treatment options with patients and support them to make an informed decision. This section looks in detail at your professional relationship with patients and how to work in partnership with them. 

Much of this section echoes the content of the GMC’s current Consent guidance from 2020, such as para 31 which says ‘you should check patients’ understanding of the information they’ve been given and do your best to make sure they have the time and support they need to make informed decisions’. 

There’s also more on treating patients fairly, with kindness, courtesy and respect (paras 16-23) which emphasises the significance of communication skills, listening and being aware of body language. Para 23f, for example, refers to ‘being alert to signs of pain and distress’. 

While the patient may have been referred to you about a specific problem, the GMC says your role requires you to care ‘for the whole patient’ which includes asking them about other treatment and guarding against the risks of polypharmacy. Para 40 says: ‘You should consider the overall impact of the patient’s treatments and whether the benefits outweigh any risk of harm’.

Finally, the GMC reiterates the responsibilities set out in its guidance on the professional duty of candour (updated 2022) and makes the important distinction that ‘apologising does not, of itself, mean that you are admitting legal liability for what’s happened’. (para 45b).

Domain 3 Colleagues, culture and safety (paras 48-80)

The previous version of GMP covered effective teamwork with colleagues, but this time, the GMC has expanded on this to incorporate workplace culture, as well as more familiar aspects like hand­overs and continuity of care. 

The regulator has raised concerns about discrimination recently in the context of NHS workforce shortages and made specific references to it in its most recent training survey. 

The GMC gives examples of how doctors can contribute to ‘a positive working and training environment’ by ‘showing respect for and sensitivity towards others’ life experience, cultures and beliefs’ (para 55) or taking action if you witness abuse, discrimination, bullying or harassment (para 58) although it recognises some might find it harder to speak up. 

On the other hand, those in a formal leadership role, such as a practice owner/employer, are expected to take greater responsibility. Para 59 says that if you are made aware of this behaviour, ‘you must act’ to ensure the behaviour is adequately addressed, that people are supported and concerns are dealt with/escalated promptly. 

We advise independent practitioners to have a disciplinary/grievance procedure in place and contact their medical defence body or seek advice from an employment lawyer if they have concerns about how to deal with this situation. 

Under the heading ‘Keeping patients safe’, the GMC says you should use the risk management structures in ‘any organisation that you work for or are contracted to’ and must help keep patients safe by contributing to processes like confidential inquiries, adverse event reporting and incident reviews. 

This point is essentially repeated under para 98 which requires doctors to ‘co-operate with formal enquiries, patient safety investigations and complaints procedures’.

Domain 4 Trust and professionalism (para 81-101)

The final domain covers similar territory to the current guidance (Maintaining trust), concentrating on the need to behave with integrity and avoid conflicts of interest. 

Perhaps due to the increased profile of media doctors during the pandemic, the GMC has included guidance on communicating as a medical professional, including social media and instant messaging, and signposting readers to its supplementary guidance on this topic.   

Finally, while doctors have always been expected to ensure they have adequate and appropriate indemnity, para 101 goes further by saying this has to cover the full scope of your practice and the level of cover should be kept under regular review. 

Good Medical Practice takes effect on 30 January 2024 and although that means there’s still time to get to grips with the GMC’s new guidance, this is in the context of the enormous pressure that many doctors are under. 

For our part, the MDU will be doing everything we can to clarify and explain what the new guidance means for members, but, more importantly, we’ll be there to advise and support them with GMC matters in the years ahead.

Dr Udvitha Nandasoma (right) is head of advisory services at the Medical Defence Union