The standards expected of doctors registered with the GMC are detailed in Good Medical Practice, which has recently been updated.1
The new guidance reflects the changing demands and challenges of modern healthcare provision. There are now four categories, to assist doctors in submitting evidence at their appraisals:
1. Knowledge, skills and performance
2. Safety and quality
3. Communication, partnership and teamwork
4. Maintaining trust
The GMC has also published 10 explanatory documents to be read in conjunction with Good Medical Practice.2
What are the changes?
1. The GMC has always advised doctors to raise concerns about patient safety; however, the updated guidance states that doctors should take prompt action if a patient's dignity, comfort or basic care is compromised.
Doctors are also encouraged to promote and develop a culture that allows staff to raise concerns openly.
2. Greater expectations are placed on doctors in relation to offering assistance to vulnerable adults and children.
The guidance states that doctors should offer help to such individuals if you think their rights have been abused or denied, regardless of whether they are patients, if there are concerns about their welfare or needs.3
Doctors should remain vigilant to the possibility of abuse of children or vulnerable adults outside the healthcare setting, and take action when it appears necessary to do so.
3. The pitfalls of social media are outlined, with particular focus on the distinction between professional and personal life.
Doctors should review privacy settings so private posts do not become widely available to patients, employers or the public. Patient confidentiality must be maintained, even when using professional networking sites. The RCGP has published guidance on the use of social media.4
4. Doctors must consider and respond to the needs of disabled patients and make reasonable adjustments to their practice to meet these needs.
GPs should consider how this applies to them and changes they need to make to their own practice and the running of the surgery to accommodate this.
5. Doctors have a responsibility to ensure continuity of care by checking a named clinician has taken over responsibility when a patient's care is transferred.
The GMC emphasises the importance of good teamwork and encourages doctors to take part in mentoring and other structured support opportunities.
6. The guidance on maintaining boundaries has been expanded and separated into three pieces of guidance – intimate examinations and chaperones, maintaining professional boundaries with patients, and sexual behaviour and the duty to report. In particular, advice on relationships with former patients has been expanded and doctors are advised to consider this carefully.
7. The GMC recognises that commissioning NHS services could cause conflicts of interest – doctors may have two roles, such as being the patient's advocate and having commissioning responsibilities.
Doctors are advised to ensure that decisions are fair and transparent, that they follow local guidance and codes of practice, and that they declare any financial interests. When making referrals, doctors should ensure the service is approved by the commissioning body.
8. There are clear benefits in encouraging patients to have immunisations and to attend for screening and chronic disease clinics, but the GMC states that doctors should not put pressure on patients for reasons of financial gain, such as to meet financial targets for QOF payments. Similarly, while incentives to improve the cost-effective use of medicines should be encouraged, the individual patient's needs and safety should be considered.
9. Good Medical Practice states that doctors should review patient feedback. Many doctors will have provided patient satisfaction questionnaires as part of QOF; however, it is now a requirement of revalidation that doctors formally reflect on patient feedback at least every five years.
Taking the guidance further, practices may wish to consider a patient participation group.
10. Doctors are advised that they should support patients in caring for themselves and making the right lifestyle choices. The RCGP has encouraged GPs to empower patients in taking responsibility for their health for many years, but it is the first time the GMC has referred to this.
- Dr Birch is a GP and medico-legal adviser at the Medical Protection Society
|WHAT TO DO NOW
1. GMC. Good Medical Practice (2013)
3. MPS Press release (25 March 2013)
4. RCGP. Social Media Highway Code