Value of updating ethical standards

At the beginning of this year, the GMC published an updated version of its Good Medical Practice, the professional standards for all doctors in the UK, which came into effect on 30 January. 

With independent practitioners having now had several months to absorb and take on board the guidance, Dawn Hodgkins gives some of the key reflections from the Independent Healthcare Providers Network (IHPN) about what it all means for the sector.

As I represent the independent sector where many thousands of doctors work every year, I was delighted to have been invited to join the GMC’s independent advisory forum. 

This group helped to shape the GMC’s thinking throughout every step of its review of standards, acting as a ‘critical friend’, constructively challenging positions on key issues, offering diverse views and experiences, and generally to be a good sounding board. 

The GMC had clearly thought a great deal about what it wanted the advisory group to do and the role it wanted it to play in shaping the new standards, with a real focus on ensuring the group included people from a range of backgrounds. 

These included representatives from all sectors of the medical profession with different levels of experience, from the newly qualified to senior doctors. 

It also included equality, diversity and inclusion leaders, along with industry experts and system regulators. Likewise, connection to, or understanding of, the four nations of Northern Ireland, Scotland, Wales and England was also really important when it came to the make-up of the group.

The review’s importance 

Looking at the new guidance itself, fundamentally this is about establishing good practice when it comes to the standards of patient care and professional behaviour expected of all doctors in the UK across all specialties, career stages and sectors. 

This means doctors working, for example, in the NHS, in the independent sector, in research or in policy or regulation. 

Most doctors are committed professionals who work incredibly hard, be that in the direct delivery of care or in other areas, and their behaviours and professional standards are key to creating and supporting cultures where good care can flourish. 

So how does the revised Good Medical Practice (GMP) support good care and why is this review so important? 

As Independent Practitioner Today readers will no doubt be familiar, there have been a great number of inquiries and reviews that have highlighted failings in the health and care system.

These are failings that should have been identified and responded to through robust clinical governance – the processes and systems used by healthcare organisations to monitor and improve safety and quality. 

From an IHPN perspective, we have done important work in the area of medical governance and oversight and this has been an area of critical focus for us, and for our members, in the last few years. 

We have put much time, working with the GMC, Care Quality Commission (CQC) and others, into the Medical Pract­itioners Assurance Framework (MPAF), led originally by Sir Bruce Keogh.

Standardised approach

This was designed to ensure a more standardised approach to medical governance in the independent sector and ultimately drive up the quality and safety of care for patients. 

But this is not enough if the very standards that doctors work to are not sufficiently clear and fail to positively support the right behaviours and standards and allow meaningful discussion when those standards aren’t met. 

We also know that when things go wrong, patients and their families have not always been treated with kindness, openness or, at times, fairness. 

And we also know that some doctors, particularly those internationally educated and/or women, are more likely to have been treated unfairly. 

This tells me that the previous GMP did not sufficiently speak to the clinical governance agenda or the values and behaviours that are essential for good quality care. 

Key changes

So I was pleased to see some key changes in the new GMP standards which address some of the issues I have mentioned, notably: 

  • A stronger focus on behaviours and values that create respectful, fair and supportive workplaces;
  • A clearer promotion of patient-centred care; 
  • More specific consideration of tackling discrimination; 
  • Championing fair and inclusive leadership;
  • Supporting continuity of care and safe delegation. 

Tackling discrimination and supporting fair and inclusive leadership were two areas I found particularly important. 

We have to get better at this if we are to support all doctors, along with those who will be on the GMC register working in all areas of healthcare.  

With the guidance now already in place for a number of months, it is a good opportunity to look again and ensure that both independent providers and practitioners, including locums, understand the clinical governance arrangements in their place of work and what is expected of them, especially, for example, through induction processes.

Identify the gaps

Likewise, I would suggest that you ensure all policies and procedures are updated to reflect the new standards and that you identify any gaps between your current policies and procedures and the new standards. 

You will also want to ensure your staff members are aware that the new standards seek to create a more respectful, fair and supportive working environment and consider how you might make this a reality. 

You also might want to check out the GMC’s handbook on clinical governance aimed at organisations which employ, contract or oversee the practice of doctors in the UK and, of course, the IHPN’s MPAF. 

This framework, used by the CQC when assessing independent providers, aims to provide boards with a description of the core principles underpinning effective clinical governance for doctors, focusing particularly on responsibilities outlined in the Responsible Officer regulations. 

Independent practitioners pride themselves on their professionalism and desire to learn, grow and continuously improve. 

Dawn Hodgkins

The GMP guidance therefore provides an excellent opportunity to take stock and redouble the sector’s efforts to ensure we continue on this journey and that patients get the very best from us.

Dawn Hodgkins is the director of regulation at the Independent Healthcare Providers Network (IHPN)