First overhaul of Good Medical Practice advice in a decade targets toxic workplaces

Proposed changes to the GMC's Good Medical Practice guidance would create for the first time an explicit duty for doctors to act if they see workplace bullying, harassment or discrimination.

Sign reading 'General Medical Council'

In a consultation launched on 27 April, the regulator has called for feedback on what would be the first changes to its Good Medical Practice advice in a decade.

Updated advice for doctors would create a duty to act, or support others to act, if they become aware of workplace bullying, harassment or discrimination, and outlines a zero tolerance approach to sexual harassment.

The regulator has also updated advice for doctors on use of social media, making clear that they must not 'mislead' via digital channels and must make 'reasonable checks' to avoid doing so.

Good Medical Practice

Proposed changes to the guidance outlined in the consultation are spread across sections on working with colleagues, working with patients, professional capabilities and maintaining trust.

Although the existing version of Good Medical Practice includes a requirement to 'treat colleagues fairly and with respect', the proposed update would expand significantly on the wording with more explicit requirements.

These requirements cover areas including teamworking; clear, effective and courteous communication; and a statement that doctors must 'not abuse, discriminate against, bully, exploit, or harass anyone, or condone such behaviour by others' and that doctors must take action if they witness such behaviour.

The guidance also brings in more detail on doctors' duty to support continuity of care, and on delegation of work - with updated lines drawn from other areas of GMC advice in some cases.

Professional standards

Updates to the guidance make clear it is 'not set of rules' and that people regulated by the GMC should use their judgment to apply professional standards. The GMC has replaced its existing 'threshold' statement, which says that 'onle serious or persistent failure to follow this guidance will put your registration at risk - and replaced it with a new statement and comments that it believes explain 'more fully when we might take action.

The updated version says the regulator will act 'where there is a risk to patients or public confidence in medical professionals, or where it is necessary to maintain professional standards' and provides a 'fuller account of the range of factors considered by GMC decision makers when they’re assessing risk, including the context in which the registrant was working in'.

Further changes factor in changes to how consultations are provided, reminding doctors of the need to provide safe and effective care 'whether you provide clinical care in a face-to-face setting, or through remote consultations via telephone, video-link, or online services'.

GMC notes on its proposed changes say that the regulator is exploring whether sustainability should be factored in more to its advice following calls to reflect public health risks linked to climate change in Good Medical Practice.

Sustainability

Doctors could be told to 'provide the best service possible within the resources available, taking account of your responsibilities to patients, the wider population and global health'.

A list of 12 overarching commitments has also been proposed for addition to the guidance for the first time. The proposed update says: 'As a medical professional I will:

  • Make the care of patients my first concern.
  • Work effectively with colleagues in ways that best serve the interests of patients.
  • Act promptly if I think the safety, dignity or comfort of patients or colleagues are being compromised.
  • Treat patients as individuals and respect their dignity and privacy.
  • Listen to, support and work in partnership with patients, to help them to make informed decisions about their care.
  • Provide a good standard of practice and care, and be honest and open when things go wrong.
  • Work within my competence and keep my knowledge and skills up to date.
  • Demonstrate leadership as appropriate to my role, and work with others to make healthcare more supportive, inclusive and fair.
  • Protect and promote the health of patients and the public.
  • Act with honesty and integrity.
  • Never discriminate unfairly against patients or colleagues.
  • Make sure my conduct justifies my patients’ trust in me and the public’s trust in my profession.'

Workload pressure

GMC chief executive Charlie Massey said: ‘Good Medical Practice applies to all doctors registered with us, regardless of specialty, grade, role type or sector. It’s therefore important that it is as relevant and realistic for doctors working in primary care as for those employed elsewhere.

‘For that reason, we really want to hear from GPs as part of our consultation. We know that GPs continue to face huge workload pressures, and we want our guidance to provide a helpful framework to navigate professional and ethical challenges, without creating any additional burdens.'

The GMC chief executive said the update was 'designed to reflect the type of fair, inclusive and compassionate workplaces we all want to see, and that are good for doctors as well as for patients'.

Royal College of Physicians of Edinburgh president Professor Andrew Elder said: 'Given the pressures on the medical workforce, it is vital that medicine remains an attractive career. As such, everything possible must be done to ensure a positive, open, honest and diverse culture in the health service.

'Improving health service culture is about enhancing the wellbeing of healthcare workers, and ensuring patient safety. Our medical workforce must be valued and supported at all stages of their careers, from medical student, to junior doctor, to consultant and to medical director.'

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