Tackling toxic health service cultures at heart of new GMC guidance

NEW duties could be placed on doctors to call out bullying and to tackle toxic workplace cultures.

The General Medical Council has placed supportive and inclusive working environments at the heart of proposals to update its core guidance.

The regulator launched a 12-week consultation on the content of Good medical practice. The guidance, last updated in 2013, outlines the professional values, knowledge and behaviours expected of doctors working in the UK.

Included for the first time is a duty for doctors to act, or support others to act, if they become aware of workplace bullying, harassment or discrimination, as well as zero tolerance of sexual harassment.

The draft guidance also provides greater clarity on the use of social media. A new duty makes clear that doctors must not use digital communications channels to mislead, and they should "make reasonable checks" to avoid doing so.

For the first time the guidance – which will also apply to physician associates and anaesthesia associates when they come under GMC regulation – proposes 12 commitments, including:

• Make the care of patients my first concern.
• Demonstrate leadership within my role, and work with others to make healthcare environments more supportive, inclusive and fair.
• Provide a good standard of practice and care, and be honest and open when things go wrong.
• Ensure my conduct justifies my patients’ trust in me and the public’s trust in my profession.

Running at 16 pages long, the draft guidance covers areas such as “working with colleagues”, “working with patients”, “professional capabilities” and “maintaining trust”.

GMC chief executive Charlie Massey said: "There is a lot of evidence of the damage bad workplace cultures can do to patient safety and, ultimately, to the UK’s ability to retain the healthcare professionals it needs. Toxic cultures can also spread online, undermining public trust in the medical profession.

"It is important our guidance reflects the reality of what doctors face and the cultures many are working in, and that it supports them to be able to do the best for their patients and for their colleagues."

The consultation closed on July 20 and MDDUS has submitted a response.

Dr John Holden, Chief Medical Officer at MDDUS, commented: “There are encouraging recommendations in the revised GMP consultation draft. MDDUS have identified areas where resource pressures, such as inadequate staffing levels or funding, may make these difficult for medical professionals to deliver.

“It's imperative that the GMC communicate throughout the guidance that registrants can only be expected to deliver their responsibilities with support from trusts, employers, and commissioners. The GMC must make it clear that exceptional circumstances may require exceptional judgments and actions.

“This assurance must be at the front and centre of the revised GMP document. Clarity around this would provide support and reassurance to registrants.

“Doctors must be able to take assurance from the guidance if they are to regard it as a supportive guide rather than a rule book.”

MDDUS has identified several areas in the revised GMP where we are asking the GMC to reconsider or review the proposed wording. Some of these revisions include:

Kindness

We recognise that ‘kindness’ is an attribute to which all members of society, not least health professionals, should aspire to and strive towards. ‘Kindness’ is a subjective term and concept. The kindness of the doctor, when addressing a patient’s best interests, may be perceived by the patient as an act of unkindness. As such, we do not agree that ‘kindness’ should be included as a professional duty.

Action against bullying, harassment and discrimination

It must be recognised by GMC that it may be difficult for an individual in oppressive circumstances to take action if they witness bullying, harassment or unfair discrimination. Registrants must feel supported by the GMC rather than judged. Trusts, commissioners and employers must fulfil their responsibilities by producing appropriate in-house guidance and policies to support health professionals.

Language and inclusion needs

We agree that medical professionals must take all reasonable steps to meet language and communication needs of patients. However, this requirement must be mindful of the availability of resources, such as interpreters, as well as funding. The duties of trusts and commissioners must again be communicated to registrants for their assurance that the full context of their work and the attendant constraints are being met.