Outcome of the initial engagement

To begin the review of Good Medical Practice (2006) we held an initial consultation (from February to April 2011) to seek comments on the scope and structure of the guidance and views on the issues that we should consider as part of the review.

We announced the consultation with a press release and sent out nearly 2000 emails to a wide variety of professional, public, patient and third sector organisations across the UK to invite them to participate.

Read the short questionnaire (pdf) which was the basis of the consultation, review the respondent data and response summary and find out what happens next.

Respondent data

230 people responded using our public consultation site; these are our 'registered' respondents. In addition, 1867 doctors responded to our anonymous survey, which asked the same questions but did not require registration; these are our 'anonymous' respondents.

Responding on behalf of an organisation	Responding as an individual
68 organisations (registered respondents) including: Bodies representing doctors. NHS/Health Service providers. An independent healthcare provider. Postgraduate medical institutions. Bodies representing patients. Government departments. Regulatory bodies.	2029 individuals: 1867 from doctors (anonymous respondents). 162 registered individual respondents.

Response summary

Keep it high level

82% of registered and 77% of anonymous respondents agreed that Good Medical Practice should continue to be based on high level principles rather than detailed guidance:

• “… replacing these principles with a set of 'must do' rules would lose the essence of the insight and responsibility to interpret these principles that is enshrined in Good Medical Practice.” (NHS organisation)

Some of those who disagreed or were unsure also provided comments including:

• “…do not think one should preclude the other. Whilst the high level principles are valuable, detailed guidance is also necessary in order to ensure that the principles can be applied as effectively as possible within the given range of contexts.” (Body representing patients)

Include additional principles…

47% of registered respondents felt there were values or principles missing from Good Medical Practice, while 53% of anonymous respondents did not. Many of the suggestions for additions were already covered in the 2006 guidance (for example the duty to raise concerns about patient safety or respecting patients). Other suggestions included adding a duty to act on climate change and specific advice on revalidation and appraisal.

Include advice for trainees

53% of registered and 51% of anonymous respondents felt that we should include advice specifically addressed to doctors in training grades in Good Medical Practice so no overwhelming majority. Comments revealed no clear consensus on how to do so in practice, but many respondents cited the qualities and behaviours which were particularly important for trainees and should therefore be emphasised in some way for example insight; acting within their competence; seeking advice where appropriate; raising concerns and working with colleagues.

Don’t shorten or remove content but…

55% of registered and 40% of anonymous respondents did not think that there were any sections or paragraphs in Good Medical Practice which could be shortened or removed. Many respondents made suggestions aimed at ensuring balance across the sections. There were also contradictory views where some see the current guidance as too long and complicated (a minority), or concise and clear (the majority):

• “Everything needs to be condensed and simplified into clear bullet points, so as to not read like a dry legal document.” (Individual doctor)
• “When it was first published I was delighted at its brevity but comprehensiveness and ease of reading - do not lose this!” (Individual doctor)

Keep the focus on the doctor/patient relationship

54% of registered and 64% of anonymous respondents did not agree that the current focus in Good Medical Practice on the doctor/patient partnership excludes doctors who do not routinely see patients. Most respondents felt we could make it clearer how the guidance was relevant to doctors in all areas of practice through supplementary guidance or learning materials rather than by adding anything to Good Medical Practice itself.

• “It's good that the doctor/patient partnership is at the heart of the document. I've attended numerous medical conference talks where patients are barely mentioned...” (Individual member of the public)
• “I would not say they are excluded, but that certain elements of GMP are simply less applicable.  If it is deemed that extra guidance would be appropriate to address the issues that these doctors face I would be supportive of that. The question I guess would be whether such guidance is necessary and/or justified?” (Individual)

Patients' needs and rights

59% of registered and 83% of anonymous respondents agreed that Good Medical Practice does give sufficient weight to patients’ needs and rights. Despite this, some respondents thought we should go further and reflect the patient as an ‘expert’ while a minority thought that this was not appropriate.

Replace the seven headings

61% of registered and 50% of anonymous respondents agreed that we should rearrange the guidance under the four headings of the framework for appraisal and assessment which is itself based on Good Medical Practice. However, there were differing views as to the advantages of having consistency across these documents versus losing the current seven headings which:

• “…are easily understood by the public and reflect immediate areas of natural interest/concern.” (Public organisation)

And finally…

We also asked an open question about the two things that we should bear in mind when conducting the review. Most common issues raised related to the style and length of the guidance: there was wide support from all categories for the guidance to be brief, clear and relevant to doctors’ practice.

What happened next?

We revised the 2006 guidance based on the detailed analysis which we conducted. The revised draft was used as the basis for a formal consultation which was held from October 2011 to January 2012. The new version of Good Medical Practice will be published at the end of 2012.

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