The GMC has unveiled the first major changes to doctors’ practice requirements in a decade, due to come in from January next year.
The new Good Medical Practice (GMP) guidance for doctors, published last week, takes a zero-tolerance approach to sexual harassment towards colleagues for the first time. An entirely new section on creating a positive working environment also urges doctors to take action if they witness abuse, discrimination, bullying or harassment at work.
The standards on patient interactions now also include an explicit obligation for doctors to be ‘kind’, whereas before the GMP only referenced being polite and considerate.
Good Medical Practice serves as a guide to what the regulator expects of the medical profession, and the previous version came into effect in 2013. While small amendments have been made since then, today’s changes are the first significant updates to the guidance in 10 years, following a public consultation on a draft version conducted last year.
In its new guidance, the GMC has updated the names of the four ‘domains’, however many of the standards remain very similar.
In its introduction, the GMP also now includes an explanation of how these professional standards relate to the regulator’s fitness to practise (FTP) procedures.
The consultation last year proposed inclusion of a commitment to consider the ‘context’ a doctor was working in if a complaint arises, and also to remove the ‘threshold’ statement for launching a FTP investigation, which previously said: ‘Only serious or persistent failure to follow this guidance will put your registration at risk.’
Today’s new guidance removes this explicit threshold and instead says the GMC will assess if the medical professional poses any current and ongoing risk to protecting the health of the public, maintaining public confidence in the medical professions, and promoting proper professional standards.
At the end of the consultation last year, several groups criticised the proposed changes, saying they could ‘open the floodgates’ to FTP investigations.
While the wording around FTP procedures is not the same as the draft version published last year, the guidance still refers to considering the ‘context’ in which a doctor is working.
It says it will take into account ‘any relevant context that may impact on risk, for example systems factors and interpersonal factors in the medical professional’s working environment or their role and level of experience’.
Medical director at the Medical Protection Society (MPS) Dr Rob Hendry said they ‘welcome’ the GMC’s inclusion of this language around context, but said it is ‘crucial that the GMC abides by this definition’.
Where before the GMP only addressed sexual harassment towards patients, it now addresses interactions between colleagues, and covers verbal and written comments, the sharing of images, and physical contact.
It says: ‘You must not act in a sexual way towards colleagues with the effect or purpose of causing offence, embarrassment, humiliation or distress.’
The GMC has also emphasised the importance of reducing personal bias and being inclusive of colleagues’ protected characteristics.
The guidelines say: ‘You must show respect for, and sensitivity towards, others’ life experience, cultures and beliefs.
‘You must not abuse, discriminate against, bully, or harass anyone based on their personal characteristics, or for any other reason.
‘By “personal characteristics” we mean someone’s appearance, lifestyle, culture, their social or economic status, or any of the characteristics protected by legislation – age, disability, gender reassignment, race, marriage and civil partnership, pregnancy and maternity, religion or belief, sex and sexual orientation.’
If doctors observe such bullying or harassment, the GMP now recommends that they take action such as supporting anyone targeted by the behaviour, challenging the person responsible, or reporting it to a colleague.
The GMP says: ‘We recognise some people may find it harder than others to speak up but everyone has a responsibility – to themselves and their colleagues – to do something to prevent these behaviours continuing and contributing to a negative, unsafe environment.’
With regards to patient interactions, the standards now say doctors must ‘treat patients with kindness, courtesy and respect’. However, the GMC emphasises that this does not mean ‘agreeing to every request’ or ‘withholding relevant information that may be upsetting or unwelcome’.
This section also includes more comprehensive guidelines on how to exemplify kindness and respect, such as communicating sensitively, recognising patients’ knowledge of their own health, and trying not to make assumptions about what patients think.
As well as new guidelines on sexual harassment and bullying, the GMC has made other additions such as obliging doctors to ‘provide safe and effective clinical care whether face to face, or through remote consultations’.
There is also a recommendation to ‘choose sustainable solutions’ when possible and to support initiatives ‘to reduce the environmental impact of healthcare’.
Earlier this year, the GMC admitted it was wrong to suggest to an MPTS tribunal that a doctor’s apology to a patient was an admission of guilt.
The GMP stipulates that doctors must offer an apology to patients when things go wrong, but the new version now includes the explicit caveat that ‘apologising does not, of itself, mean that you are admitting legal liability for what’s happened’.
GMC chair and consultant ophthalmologist Professor Dame Carrie MacEwen said the regulator hopes that addressing issues surrounding workplace culture ‘so clearly’ in the GMP will ‘spark discussion on making meaningful cultural change throughout medicine’.
She said: ‘Sexual harassment, bullying and discrimination are entirely unacceptable. Where workplace cultures of this kind of behaviour go unchecked, they are detrimental to wellbeing, performance and patient safety.
‘Doctors are increasingly, and bravely, speaking out about it, and as a regulator, it is important we leave no doubt that such behaviour has no place in our health services.’
Dr John Holden, chief medical officer at MDDUS, said: ‘The revised version we see today is the result of considerable consultation, which MDDUS was pleased to be a part of.
‘Overall, this update is welcome and has many laudable aims not least the inclusion for the first time of a clear statement that doctors must treat patients kindly.
‘Quite clearly this is something no one can disagree with. However, kindness is subjective, and we will monitor this closely to see how this develops in practice and whether it creates an increase in referrals to the GMC.’
Ahead of full implementation at the end of January, doctors will have five months to familiarise themselves with updated standards.
However, the Medical Defence Union (MDU) warned that doctors need more time to digest and implement the new guidance, especially over the busy winter period.
The organisation conducted a survey of 610 doctors, of which 31% were GPs and GP trainees, which found that only half were confident ‘they would have time to fully absorb the new standards before they are implemented’.
Responding to the updated GMP, the BMA has said it supports many of the changes but is concerned that the standards do not sufficiently reflect the difficult situation doctors are working in.
BMA council chair Professor Phil Banfield said: ‘While many of the updates are reasonable on an individual level, when placed in the context of an extremely challenging health service – navigating chronic under-resourcing and the biggest backlog in the history of the NHS – doctors are rightly concerned that this will simply extend opportunities for individuals to be scapegoated when services (and the systems behind them) fail to meet the needs of patients.
‘Doctors come to work to do the best job we can to care for our patients, and the GMC should not underestimate the impact that systemic pressures and failures have on doctors’ ability to provide safe care.’
The union called for a ‘three-tier approach’ which focuses not just on reporting bad behaviours but also improving how problems are resolved. It also said the GMC needs to address the ‘fear and distrust’ the profession currently has towards it.
The GMC has also said that while currently it only regulates doctors, once physician associates and anaesthesia associates come under its regulation this guidance will also apply to them.
A version of this story first appeared on our sister title Pulse.
