How has doctors’ guidance altered?

Good Medical Practice 2024: what you need to know from a legal viewpoint. Jordan Laybourn and Dr Tania Francis report.

Last summer, for the first time in a decade, the GMC updated its Good Medical Practice (GMP) guidance. 

The changes – which have already received lengthy coverage in previous issues of Independent Practitioner Today – were due to take effect last month on 30 January 2024 and, until then, the current GMP guidance remained applicable.

They follow a consultation period with feedback sought from a multitude of healthcare professionals, patients and members of the public, the goal being to:

  • Refine and enhance the existing guidance;
  • Make it fit for purpose in an ever-changing society; 
  • Provide clarity on what is expected from a doctor practising within the UK. 

While the guidance will only apply to doctors initially, the intention is that the GMC will in due course regulate physician associates and anaesthesia associates, at which point GMP will also apply to them.

Many of the underlying principles of GMP will be familiar to doctor because they will remain the same, but there are some revisions you need to make yourself aware of. 

The GMC states that the standards have been updated in five key areas to:

  • 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.

To achieve this, the GMC has renamed and restructured the domains contained within the guidance and substantiated a number of areas with written examples that can be applied to a contextual scenario, particularly where sexual misconduct and workplace bullying is concerned.

Sexual misconduct

These are two areas the council has clearly placed emphasis upon when preparing the new GMP. 

The first – included in Domain 1 – instructs doctors that they must not ‘abuse, discriminate against, bully, exploit, or harass anyone, or condone such behaviour by others’. 

This applies to all interactions, including online. In addition, doctors should take action, or support others to take action, if they ‘witness or are made aware of bullying, harassment or unfair discrimination’.

In Domain 4, a specific reference to sexual harassment says: ‘You must not demonstrate uninvited or unwelcome behaviour that can be reasonably interpreted as sexual and that offends, embarrasses, humiliates, intimidates or otherwise harms an individual or group’ – a topical addition, given the recent survey published in the British Journal of Surgery and reported in Independent Practitioner Today (October 2023).

New domains

The previous Domain 1 (Knowledge, skills and performance) has been replaced with ‘Knowledge, skills and development’. 

Domain 2 (Safety and quality) is now Domain 3 (Colleagues, culture and safety).

Domain 3 (Communication, partnership and teamwork) is now Domain 2 (Patients, partnerships and communication). 

Domain 4 (Trust and professionalism) is now ‘Maintaining trust’.

In a sign of the times, there is a new paragraph on remote consultations, making it clear that if you cannot provide safe care remotely, you should offer an alternative, if available, or signpost to other services.

Environmental impact

There is also recognition of the environmental impact of healthcare. 

You should choose sustainable solutions – although it is recognised that this is not always possible and should not affect patient care.

There is reference to supporting initiatives to reduce the environmental impact of healthcare, but the obligation is only to consider doing so.

There is more about the role of medical managers, who ‘must take active steps to create an environment in which people can talk about errors and concerns safely. This includes making sure that any concerns raised with you are dealt with promptly and adequately’. 

This is particularly topical given the recent discussions about the regulation of managers in the health service.

Alongside GMP, the GMC has published more detailed guidance covering:

  • Intimate examinations and chaperones;
  • Maintaining personal and professional boundaries;
  • Providing witness statements or expert evidence as part of legal proceedings; 
  • Using social media.  

The Medical Defence Union (MDU) expressed concern about the time needed by doctors to consider this guidance before it came into effect at the end of January 2024, particularly as the run-up was a very busy time of the year.

Of further note is the restructuring and rewording of GMP’s relationship with the GMC’s fitness-to-practise framework. 

The GMC has done away with the notion that only serious or persistent failure to follow GMP would put a doctor’s registration at risk. 

Instead, the GMC will act ‘where there is a risk to patients or public confidence in medical professionals or where it is necessary to maintain professional standards’. 

New language

The new language, which will be mirrored in guidance provided to both the GMC and the Medical Practitioner Tribunal Service, affirms that when a doctor’s fitness to practise is questioned, any investigation will consider any current or ongoing risk to one or more of the following – in line with what we have seen at hearings across the country for years:

  • Protecting, promoting and maintaining the health, safety and well-being of the public;
  • Promoting and maintaining public confidence in the medical professions;
  • Promoting and maintaining proper professional standards and conduct for members of those professions.

This will be done by considering how serious the concern is, any relevant context and how the doctor has responded to the concern. 

When looking at how serious the concern is, the GMC will consider how far the doctor has strayed from GMP, as well as evidence of premeditated or persistent behaviour, abuse of power, and whether the incident is isolated or has been repeated.

While this can be seen to align the guidance with what we see in practice, there has been criticism of the removal of the ‘serious or persistent’ statement – something which the Medical Protection Society is concerned may lead to an increase in cases pursued which fall well short of the threshold for action. Only time will tell. 

If you have received a letter from the GMC or you require independent advice with regard to an upcoming fitness-to-practise hearing, you should contact your insurer or defence organisation for assistance. Alternatively, one of our regulatory lawyers will be happy to assist.

First published in the February edition of Independent Practitioner Today.