New standards to reflect real world
The GMC’s Good Medical Practice 2024 updates professional standards for doctors and sets out the principles of care and professional behaviour expected of all doctors in the UK.
Mark Swindells, the council’s assistant director of standards and guidance, sets out what independent practitioners can expect ahead of it coming into effect next year.
We’ve published an updated version of Good Medical Practice, which sets out the standards of care and professional behaviour expected of all doctors in the UK.
This is the first major revision of the standards for a decade and it has taken a huge amount of thought, investigation, listening and learning over the last two years to get to this point.
To give doctors plenty of time to become familiar with the updated standards, they won’t come into effect until 30 January 2024.
While many of the duties from the 2013 version are the same, we’re conscious that they will need time to familiarise themselves with the new structure and some new duties.
So we’d urge all doctors to read and get to know more about the updated standards as soon as they can, as they will govern every aspect of practitioners’ future interactions with patients and colleagues.
What is Good Medical Practice 2024?
The updated standards are a supportive framework to guide doctors when caring for patients and working with colleagues. They will underpin the care we all receive throughout our lives, so it’s vital they reflect the experiences of those who use and are affected by them.
The standards are also at the core of medical education and training, appraisals and revalidation.
To develop the updated standards, we’ve listened to and acted on feedback from thousands of medical professionals, patients and others supporting the UK’s health services, including organisations and individuals from the independent sector.
We also reviewed the findings of public inquiries and reviews when things have gone wrong in healthcare recently. This means they are a shared agreement of what good practice looks like, for patients and doctors.
How does Good Medical Practice 2024 affect independent practitioners?
The updated Good Medical Practice places greater emphasis on listening to patients.
It’s important for independent practitioners to continue to be open and honest with patients about any interests they have that may affect – or could be seen to affect – the way they propose, provide or prescribe treatments or refer patients. There is also a stronger emphasis on caring for the whole patient and ensuring continuity of care.
This is because recurrent themes of recent public inquiries sadly include a lack of candour when things go wrong, poor collaboration or communication and the failure to raise or act on patient safety concerns.
The standards will apply to all doctors on our register, in all four countries of the UK, at all stages of their career, whatever their specialty or field of practice and whether they work in the NHS, an independent care setting or both.
Why have the standards been updated?
We last reviewed Good Medical Practice in 2013. Since then, the way we all access care has changed. Demand and pressures on healthcare in the UK have continued to grow and the pandemic accelerated the use of new technologies and saw medical professionals continually adapting to new challenges.
An extensive public consultation, the largest we’ve ever undertaken, allowed us to carefully explore the collective impact of the updated standards on doctors, the UK’s health services and patient care.
We have also been guided by findings from public inquiries, our own and others’ research and data, and other developments in healthcare.
These diverse sources highlighted a range of emerging issues that are increasingly relevant to patient care, medical practice and professional behaviour today.
In particular, there was widespread support for Good Medical Practice being an opportunity to emphasise the importance of respectful, fair, inclusive, compassionate workplaces and cultures.
These types of environments enable good teamwork, they make everyone feel safe to speak up, they support doctors’ well-being and they empower them to provide good patient care.
Our role is also evolving. Regulatory reform means not only will the updated standards eventually apply to physician assistants and anaesthesia associates, but will also allow us to become a more effective regulator.
So, given all these developments over the last decade – both in medical practice and broader changes in UK society as a whole – it’s vital that all the medical professionals registered with us, now and in the future, are supported by standards that can enable them to deliver good quality, compassionate, safe patient care.
What has changed?
Doctors on the register will already be familiar with the broad principles in Good Medical Practice, including working in partnership with patients, keeping their knowledge and skills up to date and acting promptly if patient safety risks arise.
However, the standards have been updated in five key areas to help doctors to:
- Create respectful, fair and compassionate workplaces for colleagues and patients;
- Promote patient-centred care;
- Tackle discrimination;
- Champion fair and inclusive leadership;
- Support continuity of care and safe delegation;
We’ve also made it easier for busy medical professionals to find the information they’re looking for.
We’ve restructured the standards and made sure each section – or domain – more clearly reflects the content.
The new domains are:
- Knowledge, skills and development;
- Patients, partnership and communication;
- Colleagues, culture and safety;
- Trust and professionalism.
The feedback we had during the consultation strongly supported the continuing use of ‘musts’ and ‘shoulds’ in Good Medical Practice 2024 as a well-understood signal about the expectations for each specific duty.
We have, however, taken the opportunity to improve our description of what those expectations are, as follows.
We use the terms ‘you must’ and ‘you should’ in the following ways:
‘You must’ is used for a legal or ethical duty you are expected to meet – or be able to justify why you didn’t;
‘You should’ is used for duties or principles that either may not apply to you or to the situation you’re currently in, or you may not be able to comply with because of factors outside your control.
Have we considered the impact of these changes?
Yes, and we are fully aware of the pressure doctors across the UK are under. We’ve considered every paragraph of the updated Good Medical Practice 2024 in that context.
The diverse views we heard during our consultation have also helped to make sure the updated standards are reasonable to deliver in high-pressure environments.
The updated version will help doctors navigate the changes in medicine, working practices and UK society that have emerged since Good Medical Practice was last reviewed in 2013.
We have also given doctors five months to familiarise themselves with the updated standards before they formally come into effect on 30 January.
What happens if a doctor doesn’t meet the updated standards?
The updated standards describe the principles of good practice, but they aren’t a set of rules. You should apply them using your professional judgement, in the specific circumstances you face.
In response to feedback in our consultation, the updated Good Medical Practice also includes a detailed explanation about how the standards relate to our fitness-to-practise procedures.
If a concern is raised with us, we will always consider the individual circumstances and consider any relevant factors known to us, such as:
- How serious the concern is. This includes looking at the extent of the doctor’s departure from the standards, whether the behaviour is premeditated, whether the concern involves abuse of power and whether the behaviour or concern relates to an isolated incident or has been repeated;
- Systems and interpersonal factors in the doctor’s working environment and their role and level of experience;
- How the doctor responded to the concern, including whether they’ve shown insight and if there is evidence of remediation.
What’s next?
Our outreach, standards and strategic engagement teams are busy working with doctors, employers, healthcare leaders, royal colleges, medical defence organisations and other partners to ensure they are familiar with the updated standards before they come into effect.
At the same time, we’ll also be updating our more detailed guidance, building on the general principles contained in Good Medical Practice 2024 and providing more specific support on a range of areas:
Ending a professional relationship with a patient;
Delegation and referral;
Acting as a witness;
Conflicts of interest;
Social media;
Good practice in research;
Maintaining personal and professional boundaries;
Intimate examinations and chaperones.
While the updated standards come into effect on 30 January, that will not be the end of our work.
As we saw during the decade since they were last updated, we can’t predict what the next ten years or so may bring, in medical practice or in wider society. That’s why we’ll continue working to ensure the standards are relevant, achievable and support and enable the best outcomes, both for the professions we regulate and for patients.
See www.gmc-uk.org/ethical-guidance/good-medical-practice-2024/get-to-know-good-medical-practice-2024
