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30th January 2024 update
Good Medical Practice 2024 – Everything Changes and Everything Stays the Same?
From the ubiquity of smart phones and social media to living in a post-Covid world, much has changed since 2013 when the previous version of the GMC’s Good Medical Practice(GMP) was published. Having consulted with over 3000 medical professionals, patients and
other key stakeholders in the delivery of healthcare, the GMC has issued a new version of its core ethical framework which will come into effect on 30 January 2024 (GMP 2024). OTSIS members have until that date to familiarise themselves with the guidance, which sets out
the professional standards expected of orthopaedic surgeons and all other medical professionals regulated by the GMC (to include Physician Associates and Anaesthesia Associates later in 2024).
So, what’s new?
GMP was never a set of legal rules and the same applies to the new version. You won’t automatically have broken the law if you don’t meet a particular professional standard, but you are expected to use your professional judgement to apply the standards to your daily
orthopaedic practice. In the real world, that means understanding which standards apply to your specific circumstances and using your knowledge, skills and experience to follow them n that context. If there has been a serious departure from the relevant standard, this is
where the GMC may investigate a fitness to practise concern and, in the most serious cases, refer the mater for a hearing at the Medical Practitioners’ Tribunal Service (MPTS).
No doubt at the request of doctors’ representatives, there is an entirely new section within GMP 2024 explaining how the professional standards relate to the GMC’s fitness to practise procedures. When the GMC receives a complaint, it will review –
• How serious the concern is. Not every departure from a relevant standard is serious. Issues to consider include whether the conduct was persistent or premeditated, whether there was an abuse of power, whether the concern was an isolated incident or has been repeated.
• Relevant context impacting on risk. This would apply, for example, to a doctor working within a dysfunctional department or where a doctor is very junior. Systemic or interpersonal factors may affect a doctor’s working environment.
• The doctor’s response. The vital component here is how the doctor responded to the concern and whether the doctor has demonstrated insight and remediation Only once the above factors have been assessed will the GMC determine whether to institute its regulatory procedures.
Are there any new duties or have they simply been reworded?
GMP 2024 is very much in the language of the 2020s rather than the 2010s. Long gone is the paternalistic phraseology of a doctor providing good clinical care to serve a patient’s needs. Now “If you assess, diagnose or treat patients, you must work in partnership with them to assess their needs and priorities. The investigation or treatment you propose, provide or arrange must be based on this assessment, and on your clinical judgement about the likely effectiveness of the treatment options.”
Many would say that this is the GMC finally catching up with the concept of genuine, patient-centred care which orthopaedic surgeons have been practising for many years. Whilst the four domains around which the professional standards are centred remain the same (although reworded), there are a number of new duties in GMP 2024, which are all designed to help –
• 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.
What are the new duties relevant to OTSIS members?
The new duties apply to all orthopaedic surgeons (and other medical professionals), with additional duties for those in management or leadership positions. Whilst there is no substitute for reviewing and digesting GMP 2024 in detail, the key new duties include –
• Taking a full history from a patient not only includes their symptoms, views, needs and values but also their relevant psychological, spiritual, social, economic and cultural factors.
• Clinical care must be safe and effective whether in person or via remote consultations.
• Reflecting on your own practice includes considering how your life experience, culture and beliefs influence your interactions with others and may impact on the decisions you make and the care you provide.
• If care is not compromised, you should choose sustainable solutions.
• Patients are to be treated with kindness and courtesy (in addition to respect which was in the previous version of GMP). This includes listening to patients and recognising their own knowledge of their health and being willing to explain your reasons for the options you offer and those you don’t offer including the option of no treatment. However, this does not mean agreeing to every request from a patient, nor does it mean that you should withhold information your patient might find upsetting or unwelcome.
• You should check patients’ understanding of the information they have been given, and do your best to ensure that they have the time and support they need to make informed decisions if they are able to.
• You should take a proportionate approach to the level of detail in a patient’s records, but you should include a contemporaneous record of any concerns or preferences expressed by the patient and all decisions made, including the decision to take no action.
Being open if things go wrong
GMP 2024 explicitly states, as is widely understood in the NHS and private sectors, that apologising, where things go wrong and a patient has suffered harm or distress “does not, of itself, mean that you are admitting legal liability for what’s happened”. Doctors are expected
to comply with their professional duty of candour. OTSIS members should contact the medicolegal advisory service for advice and support in any such situation.
Doctors should also report the incident in line with their organisation’s policy so it can be reviewed or investigated, and lessons learned to protect others from harm. Delay in reporting an incident which has resulted in avoidable harm may itself be a fitness to practise concern.
Colleagues, culture and safety
Culture is a central theme in GMP 2024 ; the word appears five times as much in GMP 2024 as compared to the previous version. The key new duties for OTSIS members include –
• Treating colleagues (medical and non-medical) with kindness and courtesy in addition to respect.
• Listening to colleagues and communicating clearly, politely and considerately.
• Helping to create a culture that is respectful, fair, supportive and compassionate by role modelling behaviours consistent with these values.
• Being aware of the risk of bias.
• Not bullying or harassing anyone.
Acting in a sexual way
For the first time, and at a manifestly opportune moment given the British Journal of Surgery publication in September 2023 concluding that 63.3% of female surgeons and 23.7% of male surgeons had been the target of sexual harassment by colleagues, GMP 2024 explicitly
prohibits acting in a sexual way towards colleagues.
“You must not act in a sexual way towards colleagues with the effect or purpose of causing offence, embarrassment, humiliation or distress. What we mean by acting ‘in a sexual way’ can include – but isn’t limited to – verbal or written comments, displaying or sharing images, as well as unwelcome physical contact.”
GMP 2024 goes on to mandate that you must take action, including challenging your colleague and potentially reporting the behaviour, if you witness a colleague discriminating, bullying, harassing or acting in a sexual way towards colleagues. If you are in a formal leadership or management role, you have an additional duty to ensure that such behaviours are adequately addressed, people are supported, and concerns are dealt with “promptly”. Although the subject mater is vastly different, this demonstrates the growing disparity of accountability between clinical and non-clinical management. Revelations from the Lucy Letby case, where non-clinical managers comprehensively failed to deal with concerns in a timely manner, have rightly galvanised calls for the urgent regulation of non-clinical managers within the healthcare sector.
In the meantime, and in respect of orthopaedic surgeons, the British Orthopaedic Association (BOA) is working with the Department of Health and Social Care (DHSC) to reform the reporting and investigation processes of sexual misconduct in healthcare, to improve safety
and confidence in raising concerns and to ensure investigations are external, fit for purpose and independent.
So, what should I do?
It’s tempting for individual GMC registrants to feel pessimistic about the central theme of creating respectful, fair and compassionate workplaces within healthcare. Culture is extremely difficult to change on an individual basis, and, in the writer’s view, the GMC is
unlikely to investigate an orthopaedic surgeon for failure to do so, unless the failure was extremely serious or persistent. However, there are a number of practical steps all OTSIS members can take, in order to minimise the risk of a GMC concern;
1. Familiarise yourself with the expanded and new duties within GMP 2024.
2. Discuss with your appraiser how and when to transition to GMP 2024. Doctors are currently being appraised based on the 2013 version of GMP. As appraisal portfolio reviews are carried out retrospectively, and cycles usually take place from April to March, the GMC’s aim is for all appraisals to be using the 2024 edition by April 2025.
3. Undertake targeted CPD in relation to the new and expanded duties within GMP 2024.
4. Take a zero tolerance approach to sexual harassment (or any other abusive behaviour) in any form.
If all of the above are implemented and embedded within an OTSIS member’s practice, the chance of a GMC investigation will be considerably reduced. More broadly, cultural change will be facilitated and, as the saying goes, from small acorns, mighty oaks grow!
Juliette Mellman-Jones is a practising solicitor in England and Wales and a former Medico-Legal Director who advised OTSIS members. She has over 25 years of experience representing doctors who have GMC or other disciplinary proceedings. She is now resident outside the UK but offers legal advice on a consultancy basis. Her contact details are email@example.com