Operationalising Good Medical Practice

August 2007

Introduction

The GMC exists to protect, promote and maintain the health and safety of the public by ensuring proper standards in the practice of medicine.

Our guidance booklet Good Medical Practice sets out the standards of conduct and care which society and the profession expects of all doctors (irrespective of their area of practice) throughout their careers - from medical school onwards.

As a result Good Medical Practice has become a pivotal reference point in the current structures and processes for healthcare regulation, service provision and inspection. 

This document sets out:

• The ways in which Good Medical Practice (GMP) is already embedded within medical education, registration and the processes for ensuring doctors’ continuing fitness to practise.
  
  
• The way GMP is integrated into the working practices of health service providers and the inspection bodies.
  
  
• The way the GMC and other organisations are further integrating GMP into the healthcare framework in the UK, to drive up standards of patient safety and care.
  

 

Education & Registration

Now

• GMP underpins the education and training provided to undergraduates and junior doctors in terms of:
  
  
  • Course content
  • Course outcomes
  • Content of policies for dealing with concerns about their fitness to practise

Details are in Tomorrows Doctors, The New Doctor and the Foundation Programme Curriculum.

• GMP also underpins the PLAB test – the process for assessing doctors qualified outside the EEA  who wish to register to practise in the UK.
  
  
• PMETB sets standards for postgraduate curricula, which require the providers of training to set out how GMP will be addressed within their curriculum content.
  
  
• PMETB sets out principles for assessment systems in postgraduate medical training, which require that assessment is mapped against all areas of GMP. 

In Progress

• The GMC is working with partners including PMETB, the Academy, and the Medical Schools, to look at:
  
  
  • New and improved ways of measuring how effectively GMP is embedded in the curriculum, for example specifying course outcomes.
  • Possible measures for ensuring that only graduates with a proven understanding of GMP are admitted to the medical register, for example explicitly mapping student assessments against the 7 GMP headings.
  • Future legal powers to allow the GMC to take account of student fitness to practise findings in decisions about entry to the Medical Register.

• PMETB has developed training curricula with all specialties, based around the 7 GMP headings. The curricula cover the period from the end of Foundation training, leading to qualification to enter practice as a specialist.
  
  
• As part of the new registration framework, which will come into effect in October 2007, the GMC is introducing Approved Practice Settings (APS) for UK medical graduates and medical graduates from outside the EEA who are starting work in the UK for the first time as fully registered doctors. APS are organisations which have effective clinical governance systems and so provide a suitable environment for newly fully registered doctors. These governance systems are expected to support doctors in meeting the requirements in GMP.

 

Continuing professional development

Now

• The GMC publishes guidance on continuing professional development (CPD), which is developed in collaboration with organisations providing and accrediting CPD programmes, patients and the public and employers. The guidance:
  
  
  • Sets out the principles for CPD.
  • Identifies under each of the 7 GMP headings, areas of knowledge, skill, attitudes and behaviour which can be maintained through CPD.
  • Explains the roles of doctors and other organisations in ensuring the quality of CPD.

In progress

• The GMC is exploring the creation of a CPD Board (as part of a 3 Board model for supervising the education and training of doctors) to provide a more rigorous oversight of CPD, which supports doctors in meeting the requirements of revalidation. This new Board should provide another way of ensuring that the core values in GMP become embedded in doctors’ day to day practice.

 

Revalidation of practising doctors

Now

• The GMC is preparing to introduce licences to practise with periodic renewal (‘revalidation’), based on positive evidence that a doctor remains up to date and fit to practise. The Government’s White Paper, Trust, Assurance and Safety – The Regulation of Health Professionals in the 21st Century, published in February 2007, proposes that revalidation will consist of two core components: re-licensing for all doctors and specialist re-certification.
  
  
• Re-licensing and re-certification will depend on an objective assessment of a doctor’s fitness to practise against clear standards. Good Medical Practice will form the basis for those standards.

In progress

• The GMC, in consultation with key interest groups, is working to translate GMP (2006) into a framework which will support annual appraisal of individual doctors (by the NHS and other employing or contracting bodies), and provide a sound basis for GMC decisions about their re-licensing.
  
  
• The Academy of Medical Royal Colleges will lead work to develop the standards for specialist re-certification, working closely with the GMC to ensure these standards are consistent across the specialities, and that the process will provide sound evidence to support the GMC’s decision on revalidation.

 

Fitness to Practise processes

Now

• Good Medical Practice is used by the GMC:
  
  
  • To help potential public complainants understand whether their complaint is one for the GMC, or whether it would be more suitable to raise via the NHS or other local procedures (See A patient’s guide - How you can refer a doctor to the GMC)
  • To help employers understand when it would be appropriate to refer concerns about a doctor to the GMC (See How to make a complaint about a doctor: A guide for doctors, medical directors and clinical governance managers)
  • To underpin decision-making during the investigation of cases – see the guidance for case examiners (See Guidance for case examiners and the Investigation Committee( pdf))
  • As a benchmark during Adjudication to inform decisions on whether a doctor’s fitness to practise is impaired (See Sanctions guidance (information for lawyers and others)

• The NHS National Clinical Assessment Service uses GMP in its work to assess and support doctors, where concerns have been raised locally about the standard of their clinical practice.

In Progress

• The online version of GMP includes links to anonymised cases which illustrate the possible consequences for doctors who do not follow the guidance in GMP. This will be added to as new cases are decided.
  
  
• The GMC is considering other ways to capture ‘learning points’ from its fitness to practise cases and making these available to employers.
  
  
• The GMC is discussing with its Employers Reference Group other ways to support employers in deciding whether or when to refer a concern about a doctor to the GMC.

 

National service standards & inspection processes

Now

• NHS and independent sector core and developmental standards, in the 4 countries:
  
  
  • Contain many statements about required standards of practice and conduct which are similar to those in GMP.
  • Include a requirement for the service provider to have systems in place that support doctors to meet the requirements of their professional regulator.
  • Form the basis of regular inspection and monitoring of service quality.

In future

• Work to implement the recent White Paper proposals for professional regulation should provide fresh opportunities to make clear links between the standards in GMP, national service standards and systems for inspecting local service providers.  

 

Further Information

For further information, contact standards@gmc-uk.org