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GMC statement and advice to doctors on industrial action

GMC Statement

05 Sep 2016

A statement from the GMC after the British Medical Association agreed to a further rolling programme of industrial action.

We therefore do not believe that the scale of action planned at such short notice can be justified and we are now calling on every doctor in training to pause and consider the implications for patients.

Professor Terence Stephenson, Chair of the GMC

A statement from Professor Terence Stephenson, Chair of the General Medical Council:

‘We recognise the frustration and alienation of doctors in training and indeed their legal right to take industrial action. However, we are extremely concerned about the impact which this prolonged campaign of industrial action will have on patients’ care and on the public’s trust in doctors. The further action announced by the BMA will inevitably add to the cumulative impact of past industrial action on patients’ care. Further, the BMA’s announcement marks a substantial escalation of the previous industrial action in that it involves: the removal of emergency care (as well as routine appointments); a rolling programme of action of indefinite duration; the removal of junior doctors’ services for five days of each month (rather than one-off days of action); and much shorter notice to NHS employers of the first bout of action which leaves little time to prepare.

‘The health service is under huge pressure. During previous industrial action all doctors went to considerable lengths to make sure that patients continued to receive a good and safe level of care. We know that doctors will again want to do their utmost to reduce the risk of harm and suffering to patients. However, for the reasons given above, it is hard to see how this can be avoided this time around. To suggest otherwise would be a disservice to the enormous contribution made by doctors in training to the care and treatment of NHS patients every day. We therefore do not believe that the scale of action planned at such short notice can be justified and we are now calling on every doctor in training to pause and consider the implications for patients.

‘The GMC has no role in contract negotiations between the doctors' trade union and NHS Employers but we do know that many doctors in training feel alienated, undervalued and deeply frustrated about many aspects of their professional lives. We are committed to playing our part in addressing these wider issues. Over the past few months, progress has been made on several non-contractual issues, including Health Education England’s recent announcement that it will strengthen its whistleblowing protection for doctors in training. The GMC agreed in April this year to take forward a review that will explore how we can make postgraduate training more flexible and we have already started discussing the scope of that review with representatives of doctors in training.

‘As the regulator responsible for doctors’ postgraduate education, we are committed to protecting the quality of their training. We will do so with the aid of our new education standards which we published earlier this year and, if we feel issues with training are not being addressed at a local level, we will act through our enhanced monitoring process as we have done on behalf of trainee doctors successfully in the past.

‘For every doctor affected, these are difficult and worrying times and feelings are understandably running high. The advice we have issued today is based on the GMC's guidance, Good medical practice. It is important that we make clear doctors' continuing professional obligations and set out the various challenges facing doctors with leadership responsibilities, employers, doctors in training and senior doctors as well as those in non-training roles.

‘We understand that the government and the BMA have held talks about the small number of remaining issues and we hope that talks can resume in order to avoid plunging the health service into a further crisis which is in no-one's interests.’

Advice from the General Medical Council

Today (Monday), Niall Dickson, Chief Executive and Registrar, has set out the latest GMC advice for doctors. It covers those contemplating industrial action as well as doctors in leadership roles, senior doctors and those not in training.

Niall Dickson said:

‘The duties of a doctor are set out in Good medical practice, which says that doctors must make the care of their patient their first concern.

‘At this difficult time, everyone in the profession must remember their responsibilities – to each other and to their patients – respecting each other’s views and decisions in person, in print and online.

‘Parliament has not fettered the right of doctors to take industrial action, unlike some other professions and occupations. Doctors therefore have a right to strike and take industrial action. The question each doctor must ask, however, before taking action is whether what they are proposing to do is likely to cause significant harm to patients under his or her care or who otherwise would have come under his or her care. This is a matter of professional duty and we expect each doctor to comply with it.

‘This advice is issued under the authority of the 1983 Medical Act which governs the behaviour of all doctors practising in the UK. The Act and the accompanying guidance require doctors to exercise their professional responsibilities in the interests of their patients, to put their patients first and protect them from harm. The GMC has powers under the Act to investigate and apply sanctions to any doctor whose behaviour has fallen consistently or seriously below the standards required. Where we are presented with evidence that a doctor’s actions may have directly led to a patient or patients coming to significant harm, we would be obliged to investigate and if necessary take appropriate action.'

Advice for doctors contemplating industrial action

We ask every doctor contemplating further and escalated industrial action to pause and consider the possible implications for patients. Not only in terms of the immediate action but also in terms of the cumulative impact on patients, the additional risk posed by the withdrawal of emergency cover and the effect of removing all doctors in training every day for five days every month.

This will mean the cancellation of tens of thousands of operations and procedures, outpatient appointments and tests. The GMC cannot second guess the situation facing each doctor in training in England – that must be a matter for individual judgement. But given the scale and repeated nature of what is proposed, we believe that, despite everyone’s best efforts, patients will suffer. In light of this, the right option may be not to take action that results in the withdrawal of services for patients.

Any doctor who does decide to take action must take reasonable steps to satisfy themselves about the arrangements being made during the period when they are withdrawing their labour. This means making sure that senior doctors and managers have enough time to make alternative arrangements - action without warning or with inadequate warning is not acceptable. They should engage constructively and at an early stage with those planning for the care of patients during industrial action to make sure that patients are protected. They have a responsibility for continuity and co-ordination of care, and for the safe transfer of patients between different teams.

If, during the industrial action, it becomes clear that patients are at risk in a local area because of inadequate medical cover, and doctors in training are asked in good faith to return to work by employers, we expect they would fulfil this request. In the event of an emergency, we know doctors in training will always come forward. Where contingency plans are overwhelmed, it is vital that doctors taking action can be contacted and are available to help.

Advice for doctors in leadership roles

Doctors in leadership positions should do everything possible to organise services during the industrial action to make sure that patients are protected, as they have done during the action to date. They should assist employers, who will have been preparing for this action and putting in place other options for emergency care.

Although hospitals will inevitably face increased pressure during any period of industrial action, doctors in leadership positions should only call doctors in training back to work where there are genuine and significant concerns about the ability of the hospital to provide safe care to patients.

Doctors who have a management role or responsibility must support their organisations in acting immediately on any patient safety concerns.

Doctors in leadership roles should encourage an open, respectful culture and take action about any concerns about bullying raised with them, including online harassment.

Advice for senior doctors and those not in training

Senior doctors and those not involved in the dispute should continue to provide medical care during the industrial action and, as far as is possible, make sure that patients are protected, where necessary providing cover in place of those taking action. They should assist employers and clinical managers who will have been preparing for this action and putting in place other options for emergency care.

Advice for employers

The GMC does not regulate employers but we would expect them to engage with their medical workforce to develop robust plans that protect emergency services and minimise the impact on patients. Where there are concerns about the capacity of the organisation to cope, these concerns should be raised at the earliest opportunity with doctors, including those taking action.

Employers are required to meet our standards in relation to doctors in training. In particular, they should make sure that doctors are supported in the learning environment and given appropriate clinical supervision, including during a period of industrial action.

During the industrial action, concerns have been expressed about the design of rotas for doctors in training. We would therefore remind employers, who will be working hard to make sure patients continue to receive safe, high quality care during the action, that our new standards for medical education and training – Promoting Excellence – require organisations to design rotas that make sure doctors in training have appropriate clinical supervision and minimise the adverse effects of fatigue and workload. Where there are concerns, we expect postgraduate deans to address these with their local NHS Trusts or GP surgeries.

Read our FAQs on industrial action.

Notes to editors

The General Medical Council (GMC) is an independent organisation that helps to protect patients and improve medical education and practice across the UK.

  • We decide which doctors are qualified to work here and we oversee UK medical education and training.
  • We set the standards that doctors need to follow, and make sure that they continue to meet these standards throughout their careers.
  • We take action when we believe a doctor may be putting the safety of patients, or the public's confidence in doctors, at risk.

We are not here to protect doctors - their interests are protected by others. Our job is to protect the public.

We are independent of government and the medical profession and accountable to Parliament. Our powers are given to us by Parliament through the Medical Act 1983.

We are a registered charity (number 1089278 with the Charity Commission for England and Wales, and number SC037750 with the Office of the Scottish Charity Regulator), we have to show that our aims are for public benefit.

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