GMC report: Medical professionalism matters
In December 2016 the General Medical Council (GMC) published ‘Medical professionalism matters’, the culmination of an 18-month consultation with doctors, trusts, royal colleges and training providers into the challenges faced by the modern medical profession.
Time and support
Predictably, both the time and support available to doctors at all levels of practice came in for substantial criticism.
Doctors considered that the pressures of day-to-day practice were increased by unrealistic patient expectations and frequent conflicts between those demands and those of their employers. Those observations call to mind the comments of the Supreme Court in Montgomery that the requirement for healthcare staff to ‘pause and engage in the discussions which the law requires’ might not be welcomed by some healthcare providers but that ‘respect for the dignity of patients requires no less.’ Many participants suggested that they simply did not have time to engage in ‘reflective practice’.
Doctors also cited problems around professional isolation and support. Only one in five of the doctors surveyed described their working environment as supportive and eighteen percent dismissed the idea as a ‘pipedream’.
It was generally felt that many organisations failed to show compassion and were increasingly business-like, perhaps a reflection of the increasing financial strain under which the sector operates. Hospital trainees were noted as being particularly vulnerable to professional isolation, as rotations made it difficult to feel part of a team. Locums, GPs and community doctors were also identified as lacking support networks.
Continuity and communication
Many doctors raised concerns about a lack of continuity in patient care both within and between services. Large practices, and even larger patient lists, mean that patients rarely have a single point of contact. It was noted that there is a ‘yawning communication gap’ between primary and secondary care, which has worsened over the last two decades. There was also a feeling that medical professionals had less of an understanding of each other’s roles than previously.
The GMC also came in for criticism, in particular in respect of its approach to fitness to practise proceedings and the impact they can have on a doctor’s mental health. It was suggested that the GMC was failing to show compassion to its registrants, particularly to those under investigation. Some participants suggested that increased regulation and guidelines led to defensive, rather than innovative, medicine.
Doctors also raised concerns about the GMC’s response to whistleblowers, with many stating that they would hesitate to raise concerns out of fear that they would be labelled a ‘trouble-maker’.
The report sets out a range of ‘key’ recommendations to support doctors and deal with the concerns highlighted through the consultation, including:
- Working with medical schools to ensure a greater focus on medical professionalism within the undergraduate curriculum to assist with preparing students for the transition to practice.
- Recognising the intense pressures on the profession, promote a culture of openness, and making it acceptable to ask for help. The GMC has committed to continue implementing its programme of reforms to take account of doctors’ mental health when facing fitness to practise proceedings.
- A greater emphasis on appraisal, personal development and reflective practice on the doctor’s contribution to quality improvement. Greater focus on leadership development for doctors.
- Closer working between the medical royal colleges and the GMC to reinvigorate CPD with a focus on reflection.
- Greater focus on communication with patients and consent in medical training. The GMC has committed to reviewing its guidance on consent and enhancing the materials available to help doctors make decisions in partnership with patients.
Most importantly, in concluding the launch Professor Terence Stephenson, Chair of the GMC, expressed hope that the report would provide not only a starting point to work for positive change but also to celebrate a profession that is too often taken for granted.
A copy of the report is available here:
For any further information, please contact:
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 Montgomery v Lanarkshire Health Board  AC 1430
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