Updated 'Good Medical Practice' from 30 January - what's changing?

As well giving the standards a re-structure, the updated 'Good Medical Practice' reflects key changes in the legal, regulatory and cultural landscape over the last decade.

In this briefing, we look at the headline changes and what they may mean in practice for doctors and their fitness to practise.

What are the key changes?

Structure and what's included

The updated 'Good Medical Practice' has been significantly re-structured. Whilst the standards continue to be split into 4 'domains' as before, the titles of those domains have been changed to reflect the updated content, as follows:

The 2024 version also includes clearer explanations of what is meant in the standards by 'must' and 'should'.

There are also new sections, which do not appear in the 2013 version, on how the standards relate to revalidation and to the GMC's fitness to practise procedures.

These additions perhaps reflect the GMC's move towards a more proactive approach to regulation and building more supportive programmes for doctors.

In terms of the 'Good Medical Practice' standards themselves, for anyone who needs to see a detailed comparison between the 2013 and 2024 versions, the GMC has produced a useful table which sets out exactly what's new and what is staying the same. We have picked out some of the headline changes below.

Domain 1: Knowledge, skills and development

Each domain in the 2024 version of 'Good Medical Practice' has a pre-amble which sets the scene for the standards within that domain. For example, the first domain begins: "Medical practice is a lifelong journey. Keeping pace with rapidly changing social, legal and technological developments means learning new skills while maintaining others."

The need for doctors to be competent in all aspects of their work has been expanded to include express reference to competency in formal leadership roles, reflecting a greater focus in the 2024 version generally on leadership. These changes could potentially broaden the opportunity for the GMC to take fitness to practise action against board members in addition to any action the CQC may take.

There is also a greater focus in the 2024 version on development - both in the personal sense and also in terms of wider improvements in healthcare. Examples include a new provision that doctors should reflect on the risk of unconscious bias by considering how their life experience, culture and beliefs may impact on their decision-making, plus an expectation that doctors will contribute to discussions and decisions about improving the quality of services and outcomes. Doctors should also tell patients about opportunities for them to participate in appropriate research, which is also new. These will be likely discussion points for annual appraisals and revalidation.

Reflecting a post-pandemic world, the 2024 version addresses the issue of offering remote consultations: "You must provide safe and effective clinical care whether face to face, or through remote consultations via telephone, video link, or other online services. If you can’t provide safe care through the mode of consultation you’re using, you should offer an alternative if available, or signpost to other services."  It is envisaged that medical professionals will see more challenges in cases where they have opted to see patients remotely in a post-pandemic world.

Another new feature of the 2024 version covered as part of this first domain relates to sustainability. Specifically, doctors should  "…choose sustainable solutions when you’re able to" and should "consider supporting initiatives to reduce the environmental impact of healthcare". This reflects the behaviours the GMC expects doctors to be adopting in recognition of the risk to public health from climate change.

Domain 2: Patients, partnership and communication

As part of the consultation process on updating 'Good Medical Practice', the GMC received feedback that there needed to be a greater focus on patients’ needs, rights and expectations. This is reflected in the 2024 version's emphasis on the importance of a patient-centred approach, as highlighted in the pre-amble to the second domain: "Good medical professionals recognise that patients are individuals with diverse needs, and don’t make assumptions about the options or outcomes a patient will prefer".

Whilst the core principles from the 2013 version in terms of working in partnership with patients remain, there is more detail about this in the 2024 version, including the key elements of a lawful consent process as established by case law, notably Montgomery, such as giving patients information about treatment options, including the option of doing nothing. Also relevant here is the newly added standard about doctors needing to be aware of their legal and ethical duties relating to consent and mental capacity.

Like its predecessor, the 2024 version covers what happens when things go wrong and states that, if a patient has suffered harm or distress, the doctor should offer an apology, although the 2024 version expands on this by explaining that apologising does not, of itself, mean that you are admitting legal liability for what has happened. Also new is the requirement on doctors to report the incident in line with their organisation’s policy "so … lessons can be learnt and patients protected from harm in the future".

Domain 3: Colleagues, culture and safety

Whilst there was very little about culture in the 2013 version of 'Good Medical Practice', this is by contrast a major focus for the 2024 version. As stated in the pre-amble to the third domain: "Culture is determined by the shared values and behaviours of a group of people. Everyone has the right to work and train in an environment which is fair, free from discrimination, and where they’re respected and valued as an individual". There is also a new 'must' paragraph requiring doctors to "help to create a culture that is respectful, fair, supportive, and compassionate by role modelling behaviours consistent with these values".

There is also much more in the 2024 version about what's expected of those in leadership roles, including in terms of safety culture. For example, there is a new ‘must’ paragraph for doctors with formal leadership or management roles requiring them to "take active steps to create an environment in which people can talk about errors and concerns safely", including making sure that any concerns raised with them are "dealt with promptly and adequately". This is in line with the CQC's focus on the importance of avoiding 'closed cultures' and promotes a collective approach to patient safety, which may make it more difficult for doctors to seek to hide behind an unsafe service if they themselves have done nothing to raise or address concerns about that service.

Also new in the 2024 version are standards around tackling discrimination, abuse, bullying, harassment or sexually inappropriate behaviour. If a doctor witnesses such behaviour, the need to take action in response (e.g. to make sure the concerns are appropriately escalated and dealt with) will be a 'should' for all doctors and a 'must' for those in leadership roles. Rather than this necessarily becoming a fitness to practise issue for those failing to act in the way they 'should' when witnessing such behaviours, we suspect these provisions are aimed at empowering doctors to 'call out' unacceptable behaviour so this can be addressed through local processes, helping ensure that poor cultures are stamped out quickly and not perpetuated through careers, departments, hospitals or more widely throughout the health sector.

Domain 4: Trust and professionalism

The fourth domain focuses on doctors being honest and trustworthy, knowing the limits of their knowledge and maintaining patient confidentiality. As the pre-amble to this domain in the 2024 version states: "Patients must be able to trust medical professionals with their lives and health, and medical professionals must be able to trust each other."  There are relatively few changes on these issues compared with the 2013 version.

New to the 2024 version however is information relating to social media and instant messaging platforms, with a reminder to doctors that, whilst they may consider messages have been sent privately, they may not stay that way. Doctors are also signposted in the 2024 version to the GMC's specific guidance on using social media.

It is also worth noting that the section about insurance in the 2013 version will be slightly amended. Instead of stating that doctors must ensure they have adequate insurance and indemnity cover "so that your patients will not be disadvantaged if they make a claim", the 2024 version states: “You must ensure that you have insurance and indemnity that covers the full scope of your practice" (with 'full scope of your practice' intended to cover all activities, wherever they take place) and adds a new requirement to "keep your level of cover under regular review”. Some claimant clinical negligence firms have expressed concern about the lack of reference to the issue of discretionary indemnity cover and indemnifiers not providing cover in certain circumstances (such as a failure of notification by the indemnified doctor), which can leave some injured patients without redress, and have suggested that this is perhaps a missed opportunity to tackle that issue. 

Comment

Whilst the core principles of 'Good Medical Practice' remain, the 2024 version is the product of various significant developments over the last decade, including changes in the law on consent, the impact of the pandemic and remote working, the drive towards a more patient-centred approach to care and the overall cultural shift towards more open and supportive working environments, all of which are reflective of the ever-changing landscape to which doctors are having to adapt.  

We will have to wait and see what the new 'Good Medical Practice' means for fitness to practise investigations going forward. However, given the GMC’s focus on culture and development in the 2024 version, we may start seeing more investigations and/or allegations focusing on concerns arising from those areas.

How we can help

Our specialist team of professional regulatory lawyers have extensive experience of advising doctors in fitness to practise proceedings under their insurer or defence organisation cover and can help achieve the best outcomes at every stage of the process, including advising on the applicability and practical effect of 'Good Medical Practice' in the context of fitness to practise matters.