Setting standards for doctors is a key function of the GMC. By clearly defining the values and professional behaviour that it expects of doctors, the regulator is providing a ‘framework for ethical decision-making’ by practitioners but also for fitness to practise decisions.
The principles in Good Medical Practice (GMP) underpin the relationship of trust between doctors and patients. Failure to follow them could lead to a fitness to practise investigation – undoubtedly one of the most stressful experiences a doctor could face. That’s why it’s vital the guidance reflects the realities of medical practice and not a vision of perfection.
The GMC last updated its core guidance in 2013 so its current consultation on a new version is likely to set the standards for doctors into the 2030s. Having scrutinised the draft document, the MDU is concerned that some sections do not reflect the realities of doctors' daily working lives or will have unintended consequences.
Here are four areas where we are asking the GMC to reconsider or review the proposed wording.
Action against bullying, harassment and discrimination
The GMC is right to be looking at what it can do to support a safe and inclusive workplace culture in healthcare. However, the relevant paragraphs are currently unclear about the extent of doctors’ responsibilities raising more questions than answers.
For example, paragraph seven of the proposed new GMP guidance says: 'You should take action, or support others to take action, if you witness or are made aware of bullying, harassment, or unfair discrimination.'
Quite rightly, the GMC does not want to be prescriptive about what kind of 'action' should be taken in these situations, but it's then left to the doctor to decide what to do. The GMC suggests it may be sufficient to simply ask the person on the receiving end of this treatment if they are okay, but we question whether that is really enough. Would registrants be obliged to ‘call out’ the behaviour at the time or report it through local disciplinary processes?
What if everyone in a team meeting hears a discriminatory comment – are all doctors present expected to be involved in 'taking action'? Also, what if the person subject to the treatment you witness specifically asks you not to take it any further?
It is important to have maximum clarity from the GMC without creating sweeping and burdensome duties on doctors who may not be in a position to control events.
Paragraph 38 of the proposed new guidance is particularly relevant for GPs. It says that 'where possible, you should agree with the patient which mode of consultation is most suitable to their individual needs and circumstances'.
However, in general practice, the mode of consultation is not usually decided upon by individual GPs but by administrative staff, according to practice protocols. It is unrealistic and impractical to expect GPs, as a norm, to agree with patients in advance of their consultation which mode is most suitable for their individual needs.
The current version of GMP says doctors must be polite and considerate towards patients, treating them fairly and with respect but the draft broadens this to say doctors 'must treat patients with kindness, courtesy and respect' (paragraph 22).
The inclusion of the word ‘kindness’ is notable and the GMC itself recognises there are mixed views about what this means to different healthcare professionals. Acting with kindness is what all healthcare professionals aim for but it is also important to maintain professional boundaries. We are strongly of the view that there is no place for such a subjective term in the guidance.
The consultation provides an opportunity to look afresh at wording of Good Medical Practice to reflect changing times. For example, paragraph 73 says: 'You must not express your personal beliefs (including political, religious and moral beliefs) to patients in ways that exploit their vulnerability or are likely to cause them distress.'
In the current climate where debate is increasingly polarised, it’s foreseeable that a patient might cite this in complaining about something they see during a consultation, such as a picture of the doctor and their same sex spouse or a badge showing support for a particular cause.
While there’s little doubt that such a complaint to the GMC would be triaged out, we feel this paragraph should be amended to provide reassurance to doctors. We suggest: ‘… to patients in ways that exploit their vulnerability or could reasonably cause them distress.’
Have your say
The MDU is raising these issues and more in our response to the consultation because we believe GMP must be accessible, understandable and achievable in the interests of doctors and their patients.
But it is not just about what we think. We hope all doctors will take this once-in-a-decade opportunity to make their voice heard on this important document before the deadline of 20 July. Full details of the consultation and how to make your views known are on the GMC website here.