Dr Gerard Panting comments on the latest edition of Good Medical Practice and points out how healthcare professionals can modify their practice accordingly


 

   

The General Medical Council (GMC) has recently published the latest edition of Good Medical Practice,1 which all doctors should now have received. A total of 240 000 copies were dispatched to doctors on the UK Medical Register.2

The GMC has come a long way since the days of the 'Blue Book' with its formal tone and Victorian approach to language.2 This latest offering is 'plain English approved', and has a number of key changes in content and style.

Updated content

Partnership, both with colleagues and patients, is one theme that runs throughout the guidance. Predictably, issues such as standards of care, good communication, relationships with patients and colleagues, probity, conscientious objections, responsibilities towards children and young people, and dealing with relatives, carers and partners, are all highlighted.1

Good Medical Practice also cleverly paves the way for relicensing and revalidation without in any way pre-empting the outcome of the consultation on the Chief Medical Officer's working paper on the future of the GMC.4

As the text itself explains: 'The guidance… describes what is expected of all doctors registered with the GMC. It is your responsibility to be familiar with Good Medical Practice and to follow the guidance it contains. It is guidance, not a statutory code, so you must use your judgement to apply the principles to the various situations you will face as a doctor, whether or not you routinely see patients. You must be prepared to explain and justify your decisions and actions.'

But later comes the stark warning: 'Serious or persistent failure to follow this guidance will put your registration at risk.'

Providing care

Paragraph three of the guidance (Box 1) states what doctors must do when providing care.

Good Medical Practice also exhorts doctors to encourage patients and the public to take an interest in their health and also to take action to improve and maintain it. This includes giving advice on how life choices affect health, as well as the possible outcomes of treatment.

The guidance specifically states that doctors should avoid providing medical care to anyone with whom they have a close personal relationship.

Furthermore, it says that doctors should be registered with a GP outside their family, to ensure that they have access to independent and objective care.

This is intended to protect patients, colleagues, and yourself by making sure you are immunized against common serious communicable diseases where vaccines are available.

Paragraph 14 of the document paves the way for relicensing and revalidation. It sets out nine requirements as indicated in Box 2.

Box 1: A doctor's responsibilities

In providing care you must:

  • recognize and work within the limits of your competence
  • prescribe drugs or treatment, including repeat prescriptions, only when you have adequate knowledge of the patient's health, and are satisfied that the drugs or treatment serve the patient's needs
  • provide effective treatments based on the best available evidence
  • take steps to alleviate pain and distress whether or not a cure may be possible
  • respect the patient's right to seek a second opinion
  • keep clear, accurate, and legible records reporting the relevant clinical findings, the decisions made, the information given to patients, and any drugs prescribed or other investigation or treatment
  • make records at the same time as the events you are recording or as soon as possible afterwards
  • be readily accessible when you are on duty
  • consult and take advice from colleagues, when appropriate
  • make good use of the resources available to you

Reproduced with kind permission from the General Medical Council

Box 2: Maintaining and improving your performance

You must work with colleagues and patients to maintain and improve the quality of your work and promote patient safety. In particular, you must:

  • maintain a folder of information and evidence drawn from your medical practice
  • reflect regularly on your standards of medical practice in accordance with GMC guidance on licensing and revalidation
  • take part in regular and systematic audit
  • take part in systems of quality assurance and quality improvement
  • respond constructively to the outcome of audit, appraisals, and performance reviews, undertaking further training where necessary
  • help to resolve uncertainties about the effects of treatments
  • contribute to confidential inquiries, and adverse event recognition and reporting, to help reduce risk to patients
  • report suspected adverse drug reactions in accordance with the relevant reporting scheme
  • cooperate with legitimate requests for information from organizations monitoring public health – when doing so you must follow the guidance in Confidentiality: protecting and providing information5
 

Reproduced with kind permission from the General Medical Council

Raising concerns

Following Bristol, Shipman, and all the other scandals of the '90s, the GMC has incorporated a section on raising concerns about patient safety. The text states that if you have reason to believe patient safety is jeopardized by inadequate resources, including premises, equipment, policies, or systems, you should put things right if you can. But in all other cases, you should inform the employing or contracting body and if they do not take action, you should seek independent advice on how to pursue the issue. It is important to record your concerns and the actions you have taken in an attempt to resolve them.

Emergencies

The nature of a doctor's responsibilities when stumbling across emergencies is a common question in any lecture on medicine and the law. On this topic, the GMC now says: 'In an emergency, wherever it arises, you must offer assistance, taking account of your own safety, your competence, and the availability of other options for care.' Presumably what this really means is that if you perceive the risk to the patient of doing nothing is greater than attempting to provide help with the limited resources available to you, you should go ahead and provide whatever assistance you believe will be beneficial.1

Relationships with patients

The next section refers to the doctor – patient partnership. It sets down six requirements for fulfilling the doctor's role in this particular relationship (Box 3).

The GMC's advice on good communication has also been updated. It is suggested that to communicate effectively you must:

  • listen to patients, ask for and respect their views about their health, and respond to their concerns and preferences
  • share with patients, in a way they can understand, the information they want or need to know about their condition, its likely progression, and the treatment options available to them, including associated risks and uncertainties
  • respond to a patient's questions and keep them informed about the progress of their care
  • make sure that patients are informed about how information is shared within teams and among those who will be providing their care.

Another aspect of good communication is ensuring that, wherever practical, arrangements are in place to meet patients' language and communication needs.

There is also advice on ending professional relationships with patients. The GMC advises that therapeutic relationships should not be terminated simply because the patient has complained, and that before ending a relationship, you must be satisfied that doing so is fair and does not discriminate unfairly against the patient.

Whatever the circumstances, the GMC states that it is the doctor's responsibility to ensure arrangements are made for continuity of care of the patient. The doctor must also see to it that the patient's medical records are passed on to the new medical team without delay.

Box 3: The doctor–patient partnership

Relationships based on openness, trust, and good communication will enable you to work in partnership with your patients to address their individual needs

To fulfil your role in the doctor-patient partnership you must:

  • be polite, considerate, and honest
  • treat patients with dignity
  • treat each patient as an individual
  • respect patients' privacy and right to confidentiality
  • support patients in caring for themselves to improve and maintain their health
  • encourage patients who have knowledge about their condition to use this when they are making decisions about their care

Reproduced with kind permission from the General Medical Council

Teamworking

Teamworking is another theme within the document. Most doctors work in teams with colleagues from other professions in primary care, for example, care for patients with chronic conditions is likely to be shared with community physiotherapists and occupational therapists, as well as community nursing staff. When working in a team you should act as a good role model, and try to inspire and motivate other team members. Remember to:

  • respect the skills and contributions of your colleagues
  • communicate effectively with colleagues within and outside the team
  • make sure that your patients and colleagues understand your role and responsibilities in the team, and who is responsible for each aspect of patient care
  • participate in regular reviews and audits of the standards and performance of the team, taking steps to remedy any deficiencies
  • support colleagues who have problems with performance, conduct or health.

If you are responsible for leading a team, you must follow the relevant GMC guidance.6

Probity and health

Honesty and trustworthiness are addressed under the general heading 'Probity'. It goes without saying that the GMC sets and expects high standards in all aspects of a doctor's professional life. Finally, the guidance comes on to the issue of health. It stresses that where doctors believe they may have a condition that can be passed on to patients or jeopardize patient care, the doctor must consult a suitably qualified colleague and follow their advice about investigation, treatment, and changes to practice that they consider necessary, as opposed to relying on their own assessment of the risk that may be posed to patients.

 

Guidelines in Practice, December 2006, Volume 9( 12 )
© 2006 MGP Ltd
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  1. General Medical Council. Good Medical Practice, 2nd edition. London: GMC, 2006.
  2. www.gmc-uk.org/
  3. General Medical Council. Professional Conduct and Discipline: Fitness to Practise. London: GMC, 1979.
  4. Department of Health. Good doctors, safer patients: Proposals to strengthen the system to assure and improve the performance of doctors and to protect the safety of patients.A report by the Chief Medical Officer. London: DH, 2006.
  5. General Medical Council. Confidentiality: protecting and providing information. London: GMC, 2004.
  6. General Medical Council. Management for doctors. London: GMC, 2006.