The challenge ahead...
In this month's think piece, Professor Jim McKillop, Chair of the Review Group, tells us about the challenges ahead for the Review of Good Medical Practice.
Good Medical Practice (GMP) sets out the core standards of behaviour expected of doctors practising in the UK. It applies to us all, whatever our specialty and whether or not we practise within the NHS. It provides guidance on achieving ‘good’ standards of practice rather than minimally acceptable ones.
As a clinician and medical educator I have found GMP very relevant to everyday practice. Other GMC guidance explores particular aspects of practice in more detail but the underlying principles remain those espoused in GMP.
Why review GMP?
First issued in 1995 and most recently in 2006, GMP has been widely praised for its clarity, brevity and comprehensiveness. A number of other countries have adopted it for their own use. Why then, should we review it now?
Although the key principles of professional behaviour don't change, aspects of medical practice do. How doctors approach their practice has to reflect changes both in society and in patients' attitudes and desires. This may raise new challenges or make existing areas of guidance more prominent, and experience of using GMP inevitably identifies areas where clarification or amendments are necessary.
In developing the new draft GMP for consultation, the Working Group believes it should remain a brief statement of high level principles, applicable to all doctors. It must reflect the realities of current medical practice in the UK. It should continue to be the basis for educational and other processes designed to improve the quality of patient care and of patient safety. Finally, it should be a guide for patients and for organisations on the standards they can expect of their doctors.
Challenges faced in the review
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The first challenge is the need to be applicable throughout the UK. The structure of the NHS is becoming increasingly different in the four nations of the UK, often controlled by differing legislative frameworks. GMP must take this into account without leading to differential standards for doctors in individual countries.
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A further question is the extent to which GMP should include aspects which are ’taken as read’ by the vast majority of doctors. Some doctors say that some of the content is unnecessary or even patronising. The Working Group believes that it continues to be important to include such statements in core values for doctors, not least to discourage the small number of doctors who are tempted to breach them.
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Since the last revision of GMP a number of topics have assumed a higher profile in the minds of the profession and society. Discussions of some are included in this month's What do you want to see in GMP. Which, if any, of these and other suggested subjects should be added to GMP, bearing in mind the need to keep the document brief and high level?
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The review offers a great opportunity to ensure that what we say is more easily understood by members of the public. Should we address this in GMP or is a version designed for patients and the public preferable?
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In our initial scoping consultation earlier this year there was majority support for trying to reformat GMP around the four domains which will be used for Revalidation (1 Knowledge, skills and performance; 2 Safety and quality; 3 Communication, partnership and teamwork; 4 Maintaining trust). If this format is used it will be essential that all crucial elements are retained and that GMP remains easy to use for purposes other than Revalidation.
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Finally, and perhaps the biggest challenge of all, is how we can ensure that doctors actually incorporate the standards of GMP into their everyday practice. Recent scandals over poor standards of care or inadequate attention to patient safety and dignity have shown that doctors do not always feel able to draw attention to poor care or to carry out simple acts which can improve matters. The principles requiring such interventions are already in GMP. How can we encourage doctors to put them into action?
How your views help us
We want to hear your thoughts on the above or on any aspect of GMP. Your views will assist us in drafting a revised text, which we will release for formal consultation later this year. We aim to release the new edition of GMP in late summer/early autumn of 2012.
Jim McKillop
August 2011
The consultation on the new Good Medical Practice is now closed. Please sign up to our email updates to stay in touch with the review.
September 2012