Exploring patient and public views to inform the Good medical practice review
Why did we commission this research?
In spring 2022, we ran a public consultation on a draft, updated version of Good medical practice, the professional standards for all doctors in the UK. We proposed changes in a range of areas, including new duties to encourage positive professional behaviours between colleagues, updates to support fair and inclusive leadership, as well as new duties to promote patient centred care.
To make sure we heard from groups of patients with shared characteristics, particularly those who may not be able or want to complete online surveys, we commissioned a research agency called ICE Creates to conduct qualitative research. They focused on the key areas we were seeking views on in the consultation (phase one).
Following the consultation, a second phase of qualitative research explored some of the themes that had emerged through the consultation, as well as how the standards could be put into practice once they’re published.
What were the key findings?
Eight themes were explored relating to areas of Good medical practice where changes were proposed. Indicative findings summarising participants views are provided against each theme – please refer to the full report to place these in context:
1. Meeting patient’s language and communication needs
Most participants said professional interpretation will help meet many patients’ language and communication needs. Some also said it is reasonable to use technology to access remote interpretation services.
2. Meeting the needs of patients with a disability
Participants said they would expect medical teams to first understand the patient’s specific support needs, and then make reasonable adjustments to meet them.
3. Receiving care from multiple professionals
Good communication between professionals is crucial to ensure appropriate care.
4. When patients pose a risk to medical professionals
Most participants think it is reasonable for a medical professional to refuse to treat a patient posing a risk to their health and safety if they have taken steps to try to minimise the risk.
5. Considering economic factors
Nearly all participants said they want medical professionals to take account of patients’ socioeconomic background, as these factors can influence a patient’s health, ability to access care and ability to take action for their health.
6. Conflict of interests
View differed on whether medical professionals needed to disclose financial and non-financial interests.
7. Communication in public and private
It was viewed as unacceptable for a medical professional to make a discriminatory remark about a patient at work, in public or in private.
8. Disclosing conscientious objection
Many participants believe there is no reason for a medical professional to disclose their personal beliefs because it does not impede the patient’s ability to receive treatment.
Five themes were explored with participants relating to areas of Good medical practice which had been present in consultation responses. Indicative findings summarising participants views are provided against each:
1. What is important to patients in short, medical consultations
Among other areas, it is important that doctors have reviewed the patient’s medical record and can demonstrate that they know why the patient is there in context of their medical history.
2. Consideration of environmental impact in medical decisions
Doctors should consider the environmental impact of the decisions they make, however, it should not be to the detriment of patients’ health and safety
3. Patient and professional boundaries
Most participants think that it is not appropriate for a doctor and a patient to pursue a romantic and/or sexual relationship as it crosses professional boundaries. This is especially true if it is with a current patient and the patient is vulnerable.
4. Ending relationships with patients
It would be reasonable for a doctor to end the relationship if the patient displays verbal or physical abuse, bullying, harassment or discrimination.
5. Use of chaperones
Most participants agreed that it is reasonable for doctors to refuse to proceed without a chaperone where they believe having a chaperone is appropriate, as long as it is not a serious situation where the examination needs to happen quickly. In which case, they should proceed without a chaperone as the patient’s clinical needs must take precedence.
What did the research involve?
Phase one involved a mix of virtual and face-to-face focus groups. The researchers interviewed 40 members of the general public, from all four UK countries, and 119 people from 22 specific groups with shared characteristics (eg a woman only group; a group with people with a learning disability).
Phase two involved 44 respondents participating in qualitative focus groups. Respondents were selected on the basis of the issues to be discussed or gaps in consultation responses (for instance fewer men responding to the consultation).