What do you want to see in GMP?

Dame Carol Black is the National Director for Health and Work for the Department of Health.

Supporting patients to enter, remain in, or return to work

Good clinical care includes helping to restore function and independence, including the capability to work. 

A doctor should where appropriate draw patients’ attention to the generally positive relationship between work and heath, and the dangers of long-term worklessness. Generally the right work – work that is appropriate to an individual’s knowledge, skills and circumstances, and undertaken in a safe, healthy and supportive working environment – promotes good physical and mental health, can help to prevent ill-health, and can also aid recovery from illness or injury. The view that people must be wholly fit and well before resuming work is incorrect and potentially harmful. Good work can bring a greater sense of self-worth and help social functioning, and worklessness can adversely affect a patient and the patient’s family.  

When issuing a Statement of Fitness for Work (a ‘Fit Note’) a doctor can include advice to patient and employer on the effects of the patient’s condition upon function. The doctor can suggest measures or adaptations that an employee can agree with their employer to facilitate return to work. The Fit Note gives emphasis to what a patient can do rather than merely saying that they are unfit for work. 

Entering, remaining in, or returning to work is a desirable outcome of clinical care for patients of working age. The necessary decisions and actions are for the patient to take, usually with the support of an employer and often with the advice of a doctor.

Hazel Thornton is an Independent Advocate for Quality in Research and Healthcare.

'We are all in this together': resolving uncertainty through research

Although we all have a responsibility to protect and promote our own health as patients, and as citizens for the wider public, Good Medical Practice must contain a stronger duty for doctors to:

• Contribute to research activity, and
• Encourage their patients to be partners in this endeavour.

The doctor must act at the centre of research activity to encourage patients to work together with clinicians, health professionals and researchers so as to produce clear, evidence-based, up-to-date information about the effects of treatments. But this can only happen when doctors embrace the ideal of 'shared decision-making'.

We have moved a long way from the `doctor knows best` model of healthcare towards a partnership between doctor and patient. Alongside the responsibility of the doctor to involve patients in decisions about their health, we, as patients, must also recognise our responsibility to improve healthcare, not only for ourselves as individuals, but for our shared society.

We must move to a model of healthcare where everyone can play their part in contributing to reducing uncertainties about treatments effects. Doctors have a key role in enabling patients to be involved in research either as active co-researchers or as research participants.

That 'we are all in this together' can affect both face-to-face consultations and wider public health matters – such as early detection of disease. But it is important to remember where we have come from. There is often a power imbalance between doctors and patients. Doctors should stimulate a two-way flow of information by encouraging their patients to ask questions; listen properly to what they have to say; and be receptive to the specific expertise that patients hold.

After all, who knows their own health better than the person sitting alongside the doctor?

Bharti Mepani is the Children and Young People’s Participation & Advocacy Manager at the Royal College of Paediatrics and Child Health.

Good Medical Practice should address the needs of children and young people

Children and young people make up 22% of the UK population, but their needs and rights often get overlooked in healthcare. High profile cases bring the issues to prominence, but all too quickly we fall back into old patterns of behaviour and fall to learn lessons. Although there is a section in Good Medical Practice which deals with children and young people, this could be strengthened in the new edition.

From talking to children, and involving them in our work, we know that children want to:

• Be treated with respect – the same respect that adults get
• Be listened to, and taken seriously
• Have things explained to them in a way they can understand.
• Be treated with kindness and consideration.

These issues can be given more prominence in the guidance.

The needs and rights of children should be referenced throughout Good Medical Practice, not just in a few paragraphs. This could be achieved, for example, by integrating the UN Convention on the Rights of the Child into the guidance.

The Royal College of Paediatrics and Child Health would also like to see new or more prominent guidance on:

• The obligation on all doctors to ensure that child protection concerns are always investigated and further action taken when children are being harmed or are at risk of harm.
• The need to balance confidentiality and information sharing in child protection cases included to the section on confidentiality
• The duty to ensure effective and timely communications with children and young people
• The importance of multi-agency working and good record-keeping and documentation in protecting children

Finally, the GMC should make sure that the views and experiences of children and young people are heard during the consultation.

The new edition of Good Medical Practice provides a great opportunity to highlight all doctors’ responsibilities toward this vulnerable group of patients. We hope the GMC will grasp it.