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The General Medical Council (GMC) has published an update of Good medical practice, which details the principles, values and standards expected of doctors working in the UK.
It is the first major update to the guidance in ten years and includes guidance on sexual harassment of colleagues for the first time. The guidance says doctors ‘must not act in a sexual way towards colleagues with the effect or purpose of causing offence, embarrassment, humiliation or distress’.
The standards make clear this includes verbal or written comments and displaying or sharing images, as well as physical contact. This adds to existing guidance that doctors must not act in a sexual way towards patients or use their professional position to ‘pursue a sexual or improper emotional relationship’.
Professor Dame Carrie MacEwen, Chair of the GMC and a consultant ophthalmologist working in the NHS, said: “Sexual harassment, bullying and discrimination are entirely unacceptable. Where workplace cultures of this kind of behaviour go unchecked, they are detrimental to wellbeing, performance and patient safety. Doctors are increasingly, and bravely, speaking out about it, and as a regulator, it is important we leave no doubt that such behaviour has no place in our health services.
“Those who experience harassment or discrimination must feel supported to speak out, by employers, peers, managers and leaders. We heard from thousands of doctors, patients and members of the public during this consultation. We hope that by addressing this issue so clearly in the standards, this will spark discussion on making meaningful cultural change throughout medicine.”
Good medical practice should not include aspirational standards
The British Medical Association (BMA) welcomed the updated standards, but said that it had significant concerns about the expectations placed on individual doctors given the current perilous state of the health service.
Professor Phil Banfield, BMA council chair, said: “Good medical practice guidance is used as a benchmark to assess professional actions and behaviour. It is therefore crucial that it lays out robust and achievable standards rather than aspirational standards that doctors may fail to reach through no fault of their own.
“While many of the updates are reasonable on an individual level, when placed in the context of an extremely challenging health service – navigating chronic under-resourcing and the biggest backlog in the history of the NHS – doctors are rightly concerned that this will simply extend opportunities for individuals to be scapegoated when services (and the systems behind them) fail to meet the needs of patients. Doctors come to work to do the best job we can to care for our patients, and the GMC should not underestimate the impact that systemic pressures and failures have on doctors’ ability to provide safe care.
“If we are to truly create a fair and equal place of work within the NHS, then a three-tier approach must be adopted with a focus on not just reporting unacceptable discriminatory or sexual behaviours, but also improving the resolution of problems and creating a more supportive and inclusive culture, including mediation and resourced remediation processes. Encouraging individuals to speak up and report bullying and harassment, for example, will not be effective if doctors do not trust those who they are complaining to or if complaints are not taken seriously when people do.”
The updated Good medical practice, which comes into effect at the end of January following a five-month familiarisation period for doctors, includes an entire section devoted to ‘contributing to a positive working and training environment’.
It says doctors must behave in ways that create ‘a culture that is respectful, fair, supportive and compassionate’, and should be aware of how their behaviour may influence others.
Doctors who witness unacceptable behaviour, including any form of bullying, discrimination or harassment, should do something about it. The guidance suggests that, depending on circumstances, this could include:
- offering support to the victim, including letting them know the behaviour witnessed is unacceptable
- challenging the behaviour by speaking to the person responsible, either at the time, if safe to do so, or at an appropriate time and place
- reporting the behaviour in line with workplace policies, making sure the person targeted is aware of and supports that intention.
It also makes clear the supportive role those in positions of formal leadership and management must play in making sure behaviours are addressed, dealt with promptly and escalated if necessary.
The publication of the updated Good medical practice follows last year’s public consultation, the largest ever conducted by the GMC, on a draft version. It comes into effect from Tuesday 30 January 2024 and will apply to all doctors on the UK medical register.
Doctors need to have confidence their concerns will be heard
The Medical and Dental Defence Union of Scotland (MDDUS) also had some concerns about the update and said as current events demonstrate, doctors will only feel empowered to speak out when they witness wrongdoing if they can have confidence their concerns will be heard and acted on by senior clinical leaders, NHS managers and the GMC itself.
Dr John Holden, chief medical officer at MDDUS, added “The GMC is clear it wants the revised version of GMP to be seen by doctors as a supportive document. It – quite rightly – goes as far as to state that doctors who witness unacceptable behaviour, including any form of bullying, discrimination or harassment, should do something about it.
“This is welcome, but of course GMP will be used in the real world. That has to mean that whenever the GMC believes a Trust is failing to support doctors voicing serious concerns it calls this out publicly and involves the Care Quality Commission.”