GMC proposes new duties for doctors to improve and police quality of care
Authors: Helen Jaques
Publication date: Nov 2011 in British Medical Journal
“Doctors should be responsible for ensuring consistency and continuity of care and have a duty to act when basic care is compromised, the General Medical Council has suggested in the new draft of its guidance on professional conduct.
The updated version of Good Medical Practice, which is out to consultation until 10 February 2012, also includes new guidance on encouraging patients back into employment or “other purposeful activity” and reiterates doctors’ responsibility to maintain the profession’s reputation even outside medicine.
In the new draft the GMC says that doctors should take a lead role in maintaining the quality and continuity of care to prevent patients “falling through the gaps.” The “safety and quality” section of the guidance states that doctors, or a named person when a doctor isn’t acting as the lead clinician, should be personally responsible for the care provided for each patient.
In addition, doctors must take “prompt action” when problems with basic care arise—in particular, in the care of patients who are unable to drink, feed, or clean themselves—and when a colleague, premises, equipment, policies, or systems might be putting patients at risk.
A doctor’s responsibilities do not begin and end with providing clinical treatment but include acting to improve standards of basic care, said Niall Dickson, chief executive of the GMC. “Good Medical Practice is about more than setting a minimum ‘bar’ below which standards of practice must not fall or against which disciplinary action is taken,” he said. “It must be a means of promoting excellent care and fostering the leadership and commitment that lie at the heart of medical professionalism.”
The new draft is a pared-down, shorter version of the 2006 guidance, written in a less “discursive” style after feedback said that the document should be clear and concise. The guidance is structured under four broad sections that align with the four domains against which doctors will be judged at revalidation. As well as quality and safety these cover communication, knowledge, and trust.
The “communication, partnership, and teamwork” portion of the draft suggests that doctors should encourage patients, including those with long term conditions, to stay in or return to employment or “other purposeful activity.” This proposal reflects evidence that having productive activity is beneficial for patients, in particular those with mental health problems, and builds on guidance in the 2006 version of Good Medical Practice stating that doctors should empower patients to improve and maintain their health, said Mr Dickson. Doctors should not act as “policemen of the state” in this responsibility, however, but in the patient’s best interest, he added.
The “knowledge, skills, and performance” section includes new duties for doctors to be competent in all the professional roles they undertake—including management, research, and teaching—and to ensure that records containing personal data are kept in accordance with data protection requirements.
The final “maintaining trust” section re-emphasises guidance in the 2006 version that doctors’ conduct “at all times” should justify trust in the profession, despite nearly all respondents (94%) to a poll held by the GMC agreeing that the organisation should not regulate doctors’ lives outside medicine (BMJ Careers, 20 Oct, http://careers.bmj.com/careers/advice/view-article.html?id=20005083).
The GMC said, “We think that if a doctors’ conduct undermines trust in the profession it should, in some cases, lead to action on their right to practise medicine.”
This section also warns doctors about the possibility of their information on social networking sites intended for friends or family becoming more widely available. The GMC will be publishing detailed guidance on doctors’ use of social networking in 2012.
