Olliers’ Gareth Martin considers the updated version of Good medical practice from the General Medical Council (GMC)
In recent days the actions and in some cases inaction of doctors, nurses and management at the Countess of Chester Hospital have quite properly been a major talking point following the conviction and sentencing of Lucy Letby.
Whilst not directly linked to the Letby case, the General Medical Council have recently (22 August 2023) published an updated version of their Good medical practice and although not in effect until 30 January 2024, all doctors in the UK should ensure that they are familiar with the same, particularly the key updates which are designed to help:
- 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
The GMC have taken on board the views and feedback of medical professionals, patients and other key stakeholders involved in the delivery of the UK’s health services. In doing so they have sought to make the updated guidance easier for doctors to navigate with clearly defined sections which provide a framework of professional standards which doctors should use their judgment to apply, in order to ensure not only safe, quality care for patients but also a safe and empowering environment for those involved in the delivery of that care.
Whilst we encourage all doctors to read and digest the updated guidance for themselves, we have also set out the key features, which as with the previous version, are centred around the four domains considered to make a good medical professional.
Knowledge, skills and development
A good medical professional will recognise that we live in a fast paced world in which medical, legal and societal developments are commonplace. This means that doctors and other medical professionals must be willing to not only maintain their existing skills and knowledge but learn and embrace new ones to provide good clinical care.
In order to keep your knowledge and skills up to date, you should reflect regularly on your standards of practice and also use feedback to develop personal and professional insight. You must, at all times, recognise and work within the limits of your competence.
You must assess your patient’s condition adequately and provide prompt advice, investigation or treatment, where necessary. You must only propose, provide or prescribe effective treatment based on the best available evidence and you must consult or seek advice from colleagues or your supervising clinician, where appropriate.
Patients, partnership and collaboration
It is important to remember that your patients are individuals and how you deal with them can have a significant and lasting impact on their life. As such, a good medical professional will listen to and support their patient through kindness, courtesy and respect.
You should share appropriate information with the patient and make sure that communications are clear and understood so that any decisions about treatment and care are taken on a fully informed basis. You should also recognise and respect the patient’s right to choose whether or not to accept your advice.
Patients should feel empowered to improve and maintain their own health and you must provide appropriate support to achieve this. This may include helping them access other services and supporting them to make decisions which will help improve their health and wellbeing.
You must always be mindful of maintaining patient confidentiality, however you must also consider your obligations to act promptly on any concerns that you have about those who may be at risk of abuse or neglect or indeed those who are being abused or neglected.
If things go wrong, for whatever reason, you must be open and honest. You must make any necessary reports promptly in line with your organisation’s policy and where possible things should be put right.
Colleagues, culture and safety
Whilst we encourage all doctors and associated professionals to review the guidance in full, domain three provides arguably the most significant updates. For the first time, the guidance explicitly addresses the sexual harassment of colleagues. It states, “You must not act in a sexual way towards colleagues with the effect or purpose of causing offence, embarrassment, humiliation or distress. What we mean by acting ‘in a sexual way’ can include – but isn’t limited to – verbal or written comments, displaying or sharing images, as well as unwelcome physical contact.”
Moreover, the updated Good medical practice document also provides guidance as to what professionals should do if they witness sexual harassment or indeed any form of abuse, discrimination, bullying or harassment. Witnesses are encouraged to:
- • speak to and offer support to anyone targeted or affected by the behaviour
- • challenge the behaviour with the person responsible
- • report the behaviour in line with your workplace policy, ideally with the knowledge and support of the person who was targeted
Significantly, those with a formal leadership or management role who witness or are made aware of such behaviour must act to make sure that it is adequately addressed; people are supported where necessary and concerns are dealt with promptly, including being escalated where necessary.
More generally, the topics covered by the domain aim to ensure that good medical professionals work towards shared values and behaviours which create a positive working environment, free from discrimination where everyone is respected and valued. This in turn, it is hoped, will create “civil and compassionate cultures where all staff can ask questions, talk about errors and raise concerns safely”.
Trust and professionalism
It may go without saying but patients must be able to trust doctors with their health and in some situations their lives, Medical professionals must also be able to trust each other.
As a good medical professional you must ensure that you are always honest about your experience, qualifications and role. You must also be honest in any financial and commercial dealings with patients, employers, insurers and others.
You must maintain professional boundaries and as such must not use your professional position to pursue any form of sexual or improper relationship with a patient or someone close to them. Equally, you must refrain from expressing any personal political, religious or moral beliefs which could cause your patient distress or exploit their vulnerabilities.
Your professional communications, including the use of social media to advertise your services or promote products, must be honest and accurate. You must make sure that it is in line with your duty to promote and protect the health of patients and the wider public. Even in circumstances where you are communicating privately, you should be mindful of the fact that messages may become public.
Amongst other issues, domain four also addresses the topic of co-operating with legal and regulatory requirements. In particular, you must inform the regulator, without delay, if, anywhere in the world, you have accepted a caution from a prosecuting authority; have been charged with and/or convicted of a criminal offence; criticised by an official inquiry or if another professional body has made a finding against your registration as a result of fitness to practise procedures.
What happens if a doctor doesn’t comply with Good medical practice?
The professional standards as set out in the Good medical practice are intended as a framework to guide and support doctors to deliver safe care to a good standard. They are not rules and doctors are expected to exercise their professional judgment, taking account of the standards relevant to the particular circumstances of the cases they deal with.
As such not every departure from the standards will be considered serious and result in a GMC investigation. Any concern raised about a doctor will be considered on its own merits. As part of this process, the GMC will consider the seriousness of the concern, the context that may impact on risk and also how the medical professional responded to the concern, having regard to any evidence of insight and remediation. Only then will a decision be made as to whether any regulatory action may be required.
What can we expect when Good medical practice 2024 comes into effect?
Whilst many of the key features of the updated guidance remain consistent with the current version, there is a very deliberate and greater emphasis on behaviours and values aimed at creating a more respectful and supportive workplace.
As has been seen in recent days with the tragic case in Chester, a lack of action or support when concerns around individual and/or organisational behaviours and performance can have far-reaching and devastating consequences.
The expectation of a zero-tolerance approach to sexual harassment in any form and the requirements for those in management positions to take a pro-active approach to deal effectively with any issues of bullying and harassment could well lead to an increase in the number of complaints of this nature which in turn could lead to an increased number of GMC investigations and even proceedings before the MPTS.
How can Olliers assist?
Olliers have a team of experienced solicitors who can provide legal advice and assistance to doctors facing investigation or proceedings brought by the GMC. Our experts have dealt with the full spectrum of cases, including allegations of poor performance, as well as, serious misconduct and those areas which are now very much the focus of the new guidance around sexual harassment and bullying.
We are able to provide expert representation for doctors throughout the course of their dealings with the GMC. As professionals, we understand the anxiety that such proceedings can cause and we appreciate the potentially far –reaching consequences for a doctor’s practice, as well as, their professional and personal reputation, finances and even their family life.
We work closely with our clients and take a pro-active approach. We have earned a reputation for meticulous preparation, sound advice and excellent results for those we represent in relation to professional disciplinary proceedings. Therefore, if you are subject to GMC/MPTS proceedings or find yourself under investigation by your NHS Trust or any other regulatory body, please get in touch and let us help you navigate the process.