The General Council of Medical Education & Registration in the UK was established as a statutory body by the Medical Act of 1858. All the functions of this General Medical Council emerge from a statutory requirement for establishing and maintaining a register of doctors who are registered medical practitioners within Britain. Further General Medical Council also monitors and controls entry to the medical register. The medical register is known as the List of Registered Medical Practitioners. The Medical Act further notes the main aim of the GMC is to exercise functions to promote, protect and maintain the safety and health of the public.
The GMC also regulates and establishes the standard for UK’s medical schools and liaise with other medical and university regulatory bodies across medical schools internationally. This leads to qualifications accorded mutual recognition. Since the year 2010, the GMC is also involved in regulating postgraduate medical courses and degrees. The GMC is also responsible for revalidation and licensing system for doctors in the UK, separate from registration systems. This was given a legal effect by the Privy Council’s order in December 2012.
The GMC grants numerous legal benefits and responsibilities to medical practitioners registered with it. Registration brings a lot of privileges with it. This is in accordance with the UK government’s strategy for simplifying and reforming the system for regulation of healthcare, social workers and social care workers in England. Registration with the GMC can be provisional or even full. Provisional registration is offered to those completing medical school and entering their first year of medical training. This is transformed into complete registration upon effective completion of the first year of postgraduate training. The GMC administers the Professional and Linguistic Assessment Board test for non-EU overseas doctors before they practice medicine in the UK as a registered doctor.
The GMC is empowered to license and revalidate medical practice in the UK, as well.
Setting Standards of Professional Conduct
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The GMC set standards of ethical and professional conduct that UK doctors are required to follow. Main guidance that GMC provides for doctors is known as Good Medical Practice. This outlines standards of professional conduct the public expects from doctors and provides principles underpinning the GMC’s fitness to practice decisions. A revised version came into force from April 2013. The content of Good Medical Practice has been rearranged into 4 duty domains. The GMC also helps in taking prompt action if patient comfort, safety, dignity is being compromised. There is a range of explanatory guidelines, including social media use. The council also provides additional medical guidance on specific topics like treating patients under age 18, conflicts of interest and end-of-life/palliative care.
The GMC regulates medical training and education in the UK. It also runs quality assurance and UK medical school programs as well as postgraduate deaneries to ensure necessary outcomes and standards are achieved. In April 2010, the Postgraduate Medical Education and Training Board is assimilated into the GMC. Further, registered medical practitioners can be referred to the GMC in case there are doubts about fitness to practice in the UK. These are further divided into concerns about health, ability, and behavior. In the past, issues were dealt with differently and separately but now pass through single fitness for practicing the process. GMC has powers to issue warnings or advice to doctors accepting undertakings from them or refer them to fitness to practice panels.
The GMC’s fitness for practicing panels can take in undertakings from doctors, issue warnings, impose conditions on medical practice, or suspend or erase them from the medical register. The GMC is concerned with ensuring safety in medical practice.
Since 2001, the General Medical Council’s fitness to practice decisions have been subject to review by the Council for Healthcare Regulatory Excellence. GMC is also accountable to the UK Parliament through the Health Select Committee. The GMC also is a high-performing regulatory authority under the aegis of professional standards of medical conduct in the UK.
Protecting the Public
Good medical practice describes what it means to be an excellent doctor. The GMC stipulates that making the care of patients their first concern is important for doctors. Doctors are also advised to be competent and keep professional skills and knowledge updated. The GMC states that prompt action needs to be taken if patient safety is compromised. The council also holds the need to maintain and establish good partnerships with colleagues and patients. Doctors are also encouraged to maintain trust in the profession by being open, honest and working with integrity. The GMC guidance on this describes the professional behaviors and values expected from doctors registered with them. It also encourages doctors to use expertise and professional judgment to apply principles in the guidance to the situations faced.
The Importance of Confidentiality
Confidentiality focuses on good practice in handling patient information. It is an important ethical
and legal duty, though not absolute. The General Medical Council has also shared 8 principles in relation to confidentiality that one applies to the practice. It also provides a framework for deciding when information can be shared. It also helps in thinking about why the information is shared. This is essential for the protection or direct care of the patient, or caregivers. The guidance on confidentiality includes a section on protecting and managing information, which yields important advice on personal responsibilities for protecting patient information.
This also provides advice on whether information can be shared after a patient ceases to live. This guidance was further updated to reflect requirements of the GDPR/General Data Protection Regulation and Data Protection Act, 2018. So, whether it involves information disclosure for education and training, employment, insurance, and similar purposes or even information about communicable diseases that are serious or a person’s fitness to drive or knife/gunshot wounds cases. Working in partnership with patients help to make good clinical decisions to add to the value of the good medical practice. Decisions about treatment and care of patients also come into play. Informed consent and conditions for disclosure to caregivers and significant others are also covered here. There are guidelines on what the patient should be told about taking risks, what to do if the patient does not want to hear data one thinks is relevant when there should be written consent and what should be recorded. This helps in deciding when patients lack capacity, including helpful things considered and advice on dealing with disagreements.
Duty of Candour
It is also important to consider what to do if things go wrong. Being open and honest about mistakes in practice is also important. Whose responsibility it is to explain and record the procedures when things go wrong. The General Medical Council when and whom to apologize to, what to include in apologies and how to say sorry. Doctors are also encouraged to report errors, not only with patients but at the place of work to promote a learning culture. Prompt action needs to be taken if patient welfare is at stake. It also covers how to raise concerns and how to overcome barriers preventing you. There is also a section on handling concerns brought to one.
One is also responsible for prescriptions signed. Doctors are instructed to prescribe drugs only when there is adequate knowledge of patient health. Be satisfied that drugs serve patient needs. Following the guidance ensures safe prescriptions. It reminds one that where possible, doctors should avoid prescribing for oneself or those close to one. This goes through what should be considered when repeat prescriptions or sharing patient responsibility with colleagues are focused on.
Technology moves on and so does the way doctors prescribe. This is why one has a section on remote prescriptions. Things to consider while prescribing unlicensed medicines and patients overseas are also to be taken into account.
Protecting Young People and Children
Protecting children as well as younger people is the key duty of all doctors. Child protection is an important area of practice. This includes guiding principles. It explores how to ensure young people as well as children receive the support and care needed. This guidance helps to identify courses of action when identifying children at risk or suffering neglect and abuse. It encourages individuals to work in partnership with parents as well as others and provides a comprehensive framework for sharing information.
The GMC also gives advice on carrying out child protection exams and advice if one needs to give court evidence.
End of Life/Palliative Care
When it comes to protecting the public, GMC also specifies conditions for the end of life or palliative care. Patients need high-quality treatment and care coming to the end of their lives. Providing care involves making emotionally challenging and difficult decisions. This guidance provides a framework to meet patient needs as they reach the end of their life. This includes advice on topics like making decisions with patients who have the capacity, possible courses of action when patients don’t have the capacity, assessing overall treatment benefits, advanced care planning, meeting hydration and nutrition needs, focusing on cardiopulmonary resuscitation and the role of caregivers and significant others. Organ donation and care post-death also form a part of this guidance. The General Medical Council also has a useful section on young people, children, and neonates. It creates an understanding in doctors that decisions regarding treatment should always be in their best interests. It also provides advice about remaining sensitive to patient concerns and resolve conflicts.
All patients must be respectfully treated and not discriminated against. This explores how one can balance personal beliefs with decisions about patient care. It also explains what to do if one does not carry out specific procedures on account of own beliefs. If patients are requesting or refusing procedures on account of beliefs, the guidance has considerable advice on male circumcision. The GCM guidelines include how to assess the child’s best interest and who you need consent from.
Additionally, research is also vital for protecting population health. Apply principles of good medical practice to research using GMC’s guidelines, whether it involves actual individuals, human tissues or is record-based.
Following such guidance ensures participants are not harmed. Additionally, how one conducts research is also important as is looking at principles of confidentiality and consent.
The Council also helps doctors to make decisions and choices about how to effectively support plus protect adult patients in partnership with them and focus on empowering patients to make decisions that support their own interests. Support and encouragement for patients are forthcoming and doctors are also guided regarding the legal requirement to disclose information about adults who are known or considered to be at risk of neglect or abuse. Doctors need to be clear that disclosure is required by law and disclosure of information should be relevant to the request and required by law. Also, the patients need to be told of the disclosure unless it would undermine the disclosure to carry this out.
One must disclose personal data about adults at serious risk of harm if required by law. If a patient lacking capacity to consent is at the risk of abuse or any harm, doctors must report the condition to a responsible person or authority, unless it is not in the interests of the patient. As a principle, GMC holds that adult individuals with a capability are entitled to make decisions in their own interests, even if others consider it to be unwise or irrational. Ask for consent before disclosure of personal information about patients, if the disclosure is not required by law and it is practicable to do so.
In case adult patients with the capacity to make the decision reduce to consent to information being disclosed that one should consider necessary for their protection, reasons for this must be explored by doctors. It is also appropriate to encourage patients to consent to the disclosure and warn them regarding refusal to consent.
It is equally important to abide by a patient’s refusal to consent to the disclosure, even if this leaves them at serious risk of death or harm. Doctors are encouraged by the GMC to make decisions in their best interests in serious cases like domestic violence. Doctors have a duty of confidentiality for patients, but also a wider duty to promote and protect the health of patients and the public. As far as disclosing information for public protection is considered, some laws require disclosure of patient information such as notification of infectious diseases and terrorism prevention. If the information is required by law, it must be disclosed.
Ask for the patient’s consent to disclose information for protecting others, unless the information is required legally or it is not safe, suited and not practicable to do so. Consider reasons given for refusal, as well. Confidential medical care is regarded in law as being in public interest. People are encouraged to seek advice and treatment on the whole as because it benefits society, not just the individual. Public interest in disclosing information is also there, to protect society or individuals from the risk of serious harm, whether in terms of serious crimes or communicable diseases.
If it is not practicable or suitable to seek consent and in exceptional cases, where patients refuse consent, disclosing personal information may be justified in public interest if failure to do so exposes others to serious harm or death. The benefits to individuals or society as a whole regarding the disclosure must outweigh the patient and public interest in keeping the information confidential.
Such a situation may take place if the disclosure is essential for the prevention, prosecution or detection of serious crimes. When violence survivors or abuse victims may refuse police help, complete disclosure may be still allowed if others remain in danger from someone who is violent or abusive towards adults or children.
Other examples of cases where failure to disclose information exposes others to risk of serious harm or death include when a person cannot drive or is diagnosed with serious communicable diseases or poses a risk to others while being unfit for work.
Before deciding if the disclosure is justified in public interest, it is important to consider the question of consent. Patients should be told about the intention to disclose personal information unless it is not practicable or safe to do so. If patients refuse consent, you should consider their reasons. In keeping the information confidential, consider the potential harm or distress to patients from disclosure in terms of future treatment and overall health.
Another matter of concern is the potential harm to doctors in general for instance if it is widely perceived that doctors will disclose information about patients without their consent. Finally, doctors should also consider the benefits or harms that can arise if the information is not disclosed and whether the harms or benefits can be considered without breaching patient privacy and through minimum intrusion. If one considers the failure to disclose information leaving individuals or societies exposed to serious risks, that outweigh the patient and public interest in maintaining confidentiality, doctors must disclose relevant information promptly to specific persons or authorities.
The reasons for disclosing information with or sans consent must be documented in the patient’s record. Documenting steps taken to seek patient consent and inform regarding disclosure or failure to disclose must also be considered. Decisions about whether or not disclosure sans consent can be justified in public interest are complex. Doctors should also seek advice from Caldicott or expert advisors or data guardian not connected with the use for which disclosure is being considered. If possible, this should be carried out without revealing patient identity.
Relevant information about patients who pose serious harm to others is essential to be disclosed. Doctors need to protect the public from violent criminals and sex offenders, which involves keeping MAPPA/Multi-agency public protection arrangements in England, Wales and Scotland and public protection arrangements in North Ireland informed. Seriously consider all requests for information needed for formal reviews, such as inquiries and inquests, significant and serious case reviews, case management reviews and domestic homicide reviews established to learn lessons and improve services and systems.
Genetic and other data about patients must be informed about others with whom the individual shares genetic or other links. Diagnosis of patient illness may point to the likelihood of the same diseases in blood relatives. Many patients readily share information about health with children and relatives if this helps relatives to get preventative treatments, intervention or prophylaxis. It could also help in increased surveillance, investigations and preparing for potential health issues.
Taking care of the patient and the public is every doctor’s first concern. Work to provide an excellent standard of care and practice. Doctors registered with the General Medical Council also keep professional skills and knowledge up to date, besides recognizing and working within competence limits. Additionally, doctors are advised to take prompt action if patient comfort, safety or dignity is being compromised. Promoting and protecting the health of public and patients is important, too. When it comes to partnership, teamwork, and communication, patients need to be treated as individuals and their dignity must be respected. The patient’s right to confidentiality may be respected subject to public welfare.
Doctors should also work with patients in a partnership, listening to and responding to concerns and preferences. Patients need to give information wanted and needed in a way understood. Respecting patients right to reach decisions offers a choice about care and treatment. Patients also must be supported in caring for themselves and improving as well as maintaining their health.
Maintaining trust, honesty and openness are important while acting with integrity. It is also important not to discriminate against patients or colleagues unfairly. Doctors are personally accountable for protecting their patients as well as the public and the GMC reiterates this.