Medical Protection Society (MPS) recently submitted a response to the review of Good Medical Practice (GMP) carried out by the General Medical Council (GMC). Patricia Canedo, Policy and Public Affairs Manager, breaks down the new additions to GMP and Medical Protection's response to the amendments.

Good medical practice is the GMC’s central piece of guidance. It sets out the professional behaviours and standards expected of doctors practising in the UK. It is also one of the tools used by the GMC in its fitness to practise processes. 

The GMC tends to review Good medical practice every ten years or so to make sure it stays up to date and relevant to modern times. It is essential that the GMC gets this right. This is why MPS submitted a detailed response to the range of questions, and why we set out our significant concerns about the extent to which some of the proposed amendments could lead to an increase in referrals and investigations. 

Threshold statement

The GMC are proposing to remove the text from their existing threshold’ statement which states that ‘only serious or persistent failure to follow this guidance will put your registration at risk’. In its place, they propose to state that the GMC will take action ‘where there is a risk to patients, or public confidence in medical professionals, or where it is necessary to maintain professional standards.’ 

In our response, we strongly urged the GMC to retain the text within the threshold statement. 

In recent times the GMC has received an average of 8,600 enquiries a year in relation to a doctor’s fitness to practise. Less than 2% of this number led to erasure or suspension each year. This clearly suggest that there is a significant disconnect between the expectations of those referring doctors to the GMC and the purpose and operation of the regulator. 

The ‘serious and persistent’ text in the current threshold statement at least plays a role in combatting the lack of awareness regarding the high bar that exists for GMC action. Removing this language will send out precisely the wrong message in terms of the nature of complaints that should be the business of the GMC at a time when there is consensus that regulation should ‘move upstream’ with only the most serious and egregious of cases being dealt with by the regulator. More significantly, if the regulator no longer has to deem something to be ‘serious or persistent’ in order for a referral to progress, there is an increased chance that more lower level concerns could progress to an investigation.

New additions 

In our response, we also express significant concerns as to whether a number of the proposed new additions to Good medical practice are the best way to achieve positive change and also that there could be significant implications from their inclusion.

GMC guidance has to strike a fine balance; it has to outline the standard of professional conduct that the public expects from its doctors while also setting out the appropriate principles that underpin the decisions the GMC will make about a doctor’s fitness-to-practise. 

Patients, employers and colleagues can point to the requirements in GMC guidance when considering a doctor’s actions, including whether to refer a complaint about a doctor to the GMC; and the regulator considers whether action is required based on the requirements set out in Good medical practice and other guidance. 

Based on our experience and expertise in supporting doctors who are faced with a regulatory investigation, we have serious concerns that the proposed updates to this guidance  could be misused by employers, colleagues and patients, leaving medical professionals increasingly subject to distressing referrals and investigations.

the new guidance emphasises the importance of effective teamwork and interaction with colleagues. We of course support this principle but in seeking to optimise team dynamics we believe that the GMC is expanding the areas under the purview of the regulator which could be dealt with more proportionately at a local and managerial level. An example is the addition of a requirement for healthcare professionals to be ‘courteous’.  While ideally we would all aim to be courteous, compassionate, inclusive and supportive at all times, the reality of practice sometimes makes it highly difficult to showcase these attributes. We are concerned that these changes could see the door being left open to a deluge of subjective referrals raised by disgruntled colleagues, which could be followed by tit-for-tat complaints, with prolonged legal debates about what is and is not considered ‘courteous’ or ‘compassionate’.

Similarly, the revised version includes the requirement for healthcare professionals to treat patients with kindness, courtesy and respect. While of course it would be desirable for all doctors to be kind and courteous measuring those attributes is very challenging. Also, must a doctor who is a not kind to a patient be referred to the regulator? What is the threshold for when this becomes an issue that calls into question a doctor’s fitness to practice? In our view, being respectful to patients is a must, and while being kind and courteous are desirable attributes, they are too subjective and emotive terms to set the bar for referrals to a regulator.

Next steps

The GMC aim to publish a final version of an update Good medical practice in 2023. In the meantime, we know the GMC are digesting the large number of submissions they have received. We will continue to meet with the GMC throughout this time to influence the drafting of the final version with the aim of ensuring it is as good as it can be for our members. 

Should you require further information about any aspects of our response to this consultation, please do not hesitate to contact us.