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Good Medical Practice for General Practitioners competency basedStarting from the General Medical Council’s Good Medical Practice (2001 edition), the document describes why each particular aspect of care is important for GPs. They are described under seven broad headings:
Royal College of General Practitioners and General Practitioners Committee. Good Medical Practice for General Practitioners. London: RCGP/GPC, 2002
Good Medical Practice for General Practitioners
In more detail: Good Medical Practice for General PractitionersGood clinical care1. Clinical careThe excellent GPq maintains his or her knowledge and skills, and is aware of his or her limits of competence q takes time to listen to patients, and allows them to express their own concerns q considers relevant psychological and social factors as well as physical ones q uses clear language appropriate for the patient q is selective but systematic when examining patients q performs appropriate skilled examinations with consideration for the patient q has access to necessary equipment and is skilled in its use q uses investigations when they will help management of the condition q knows about the nature and reliability of investigations requested and understands the results q makes sound management decisions which are based on good practice and evidence q has a structured approach for managing long-term health problems and preventive care The unacceptable GPq has limited competence, and is unaware of where his or her limits of competence lie q consistently ignores, interrupts, or contradicts his or her patients q fails to elicit important parts of the history q is unable to discuss sensitive and personal matters with patients q fails to use the medical records as a source of information about past events q fails to examine patients when needed q undertakes inappropriate, cursory, or inadequate examinations q does not explain clearly what he or she is going to do or why q does not possess or fails to use appropriate diagnostic and treatment equipment q consistently undertakes inappropriate investigations q shows little evidence of a coherent or rational approach to diagnosis q draws illogical conclusions from the information available q gives treatments that are inconsistent with best practice or evidence q has no way of organising care for long-term problems or for prevention 2. Keeping records, writing reports and keeping your colleagues informedThe excellent GPq records appropriate information for all contacts including telephone consultations q respects the patient’s right to confidentiality and provides information to colleagues in a manner appropriate to their level of involvement in the patient’s care q ensures that letters are legible and copies kept on file q files GP notes, hospital letters, and investigation reports in date order The unacceptable GPq keeps records which are incomplete or illegible, and contain inaccurate details or gratuitously derogatory remarks q does not keep records confidential q does not take account of colleagues’ legitimate need for information q keeps records that cannot readily be followed by another doctor q consistently consults without records q omits important information from a report which he or she has agreed to provide, or includes untruthful information in such a report 3. Access, availability and providing care out of hours.The excellent GPq has opening hours which meet the needs of the patient population and are clearly stated q monitors how the appointments system works q has a system for receiving or returning phone calls from patients q has an effective system to identify and respond to emergencies, and a system to deal with requests for same-day appointments q can always be contacted when on duty and arranges immediate action in an emergency situation q only uses out-of-hours cover arrangements where high standards of care are provided q checks the registration of locums with the GMC and only employs a locum who has provided a JCPTGP certificate (or a curriculum vitae if he or she entered practice before such certificates were issued) and two references from previous employers, and who has attained a high standard of practice (e.g. possession of the MRCGP) q can demonstrate an effective system for transferring and acting on information from other doctors about patients The unacceptable GPq has very restricted opening hours q does not have adequate arrangements for patients to contact the practice by phone q provides no opportunity for patients to talk to a doctor or a nurse on the phone q cannot be contacted when on duty, takes a long time to respond to calls, or does not take rapid action in an emergency situation q has no knowledge of the qualifications of locums employed in the practice or ignores doubts about their ability q has no system for transferring information about out-of-hours consultations to the patient’s usual doctor q does not follow up relevant information about his or her patients that has been provided by another health professional 4. Treatment in emergenciesThe excellent GPq responds rapidly to emergencies q has policies that all team members are familiar with for the organisation and management of medical emergencies q arranges appropriate training for practice staff in managing emergencies q has up-to-date emergency equipment and drugs and ensures that they are available for any doctor, e.g. a locum, working in the practice q works effectively with the emergency services q gives consideration to the broader implications of a medical emergency for the patient’s family and friends q reviews the care of emergency cases as part of clinical meetings, using techniques such as significant event auditing The unacceptable GPq cannot be contacted in an emergency or does not respond quickly q provides ineffective or erratic care in emergencies q provides no support to practice staff in managing emergencies q has insufficient emergency drugs or equipment, or has drugs which are out of date q does not maintain his or her resuscitation skills q does not appropriately follow up patients who have experienced a medical emergency 5. Making effective use of resourcesThe excellent GPq only prescribes treatments which make an effective contribution to the patient’s overall management q takes resources into account when choosing between treatments of similar effectiveness The unacceptable GPq consistently prescribes unnecessary or ineffective treatments q takes no note of resources when choosing between similar treatments q refuses to register patients whose treatment may be costly
Maintaining good medical practice6. Keeping up to date, and maintaining your performanceThe excellent GPq is up to date with developments in clinical practice and regularly reviews his or her knowledge and performance q uses these reviews to develop personal and practice development plans q uses a range of methods to monitor different aspects of care and to meet his or her educational needs q has information available on laws relating to general practice q has a named person in the practice who is responsible for Health and Safety at work and employment matters, and ensures compliance with them The unacceptable GPq has little knowledge of developments in clinical practice q has limited insight into the current state of his or her knowledge or performance q selects educational opportunities which do not reflect his or her learning needs q does not audit care in his or her practice, or does not feed the results back into practice q is hostile to external audit or advice q does not understand or respond to the law relating to general practice q where employing staff, neither understands nor meets his or her responsibilities as an employer q has unsafe premises, e.g. hazardous chemicals or sharp instruments are inadequately protected
Relationships with patients7. Providing information about your servicesThe excellent GPq has a clear, accurate and up-to-date practice leaflet, containing information about services provided q leaves clear messages if an answerphone is used The unacceptable GPq does not have a practice leaflet, or has one which is untrue or self-promoting q uses vague or incomplete messages on the answerphone q visits or phones prospective patients to encourage them to join the practice 8. Relationships with patients – maintaining trustThe excellent GPq treats patients politely and with consideration q takes care for the patient’s privacy and dignity, especially during physical examinations q obtains informed consent to treatment q respects the right of patients to refuse treatments or tests q gives patients the information they need about their problem, in a way they can understand q involves patients in decisions about their care q keeps patients’ information confidential – including consulting in private to make sure that confidential information is not overheard q is aware of the possibility of personal advantage accruing from a close clinical relationship, and avoids situations where personal and professional interests might be in conflict q does not seek or accept financial rewards from patients outside the normal framework of professional fees The unacceptable GPq exploits relationships with patients to his or her own advantage q ignores the patient’s best interests when deciding about treatment or referral q consistently ignores, interrupts, or contradicts his or her patients q is careless of the patient’s dignity, and assumes his or her willingness to submit to examination without seeking permission q makes little effort to ensure that the patient has understood his or her condition, its treatment, and prognosis q is careless with confidential information q fails to obtain patients’ consent to treatment q has inappropriate financial or personal relationships with patients
9. Avoiding discrimination and prejudice against patientsThe excellent GPq treats all patients equally and ensures that some groups are not favoured at the expense of others q discusses racism and promotes equal opportunities within the practice team q is aware of how his or her personal beliefs could affect the care offered to the patient, and takes care not to impose his or her own beliefs and values q takes measures to protect the practice team from patients who might pose a threat The unacceptable GPq provides better care to some patients than others as a result of his or her own prejudices q pressurises patients to act in line with his or her own beliefs and values q refuses to register certain categories of patients, such as the homeless, the severely mentally ill, or those with problems of substance or alcohol misuse q refuses to make appropriate arrangements to see patients who pose a threat, or carelessly puts at risk members of the practice who are seeing such patients 10. If things go wrongThe excellent GPq contacts the patient soon after it is apparent that a mistake has occurred q apologises for himself or herself or for the practice staff q tells the patient what has happened and how it can be put right q co-operates with any investigation arising from a complaint q tries to maintain a relationship with the patient or family when a mistake has occurred The unacceptable GPq does not acknowledge or attempt to rectify any mistakes that occur q does not make appropriate apologies q has no procedure for dealing with complaints q hinders or obstructs a complaint or investigation q allows a complaint to influence his or her care of the patient adversely q removes a patient from the practice list solely because a complaint has been made or is likely
Working with colleagues11. Working with colleagues and working in teamsThe excellent GPq has effective systems for communication within the practice q holds regular meetings with members of the practice team q knows how to contact individual primary care team members outside meetings q understands the health needs of the local population, and tries to ensure that the primary care team has the skills to meet those needs q aims to develop an organisation which offers personal and professional development opportunities to its staff The unacceptable GPq does not attempt to meet members of the primary care team (e.g. district nurses or health visitors), or even know who they are q does not know how to contact primary care team members q does not know what skills team members have q delegates tasks to other members of the team for which they do not have appropriate skills q does not encourage staff to develop new skills and responsibilities. q bullies or harasses his or her colleagues
12. Referring patientsThe excellent GPq provides, within his or her team, the types of care usually provided by GPs q makes appropriate judgements about patients who need referral q chooses specialists to meet the needs of individual patients q accompanies referrals with the information needed by the specialist to make an appropriate and efficient evaluation of the patient’s problem q where appropriate, feeds back to specialists views on the quality of their care The unacceptable GPq does not refer patients when specialist care is necessary q consistently dismisses patients’ requests for a second opinion q consistently refers patients for care which would normally be regarded as part of general practice q does not provide information in a referral that enables the specialist to give appropriate care 13. Accepting postsThe excellent GPq provides the care that he or she has agreed to provide The unacceptable GPq holds no personal responsibility for care that he or she has agreed to provide
Teaching and training, appraisal and assessment14. Teaching and training, appraisal and assessmentThe excellent GP teacherq has a personal commitment to teaching and learning q shows a willingness to develop both him or herself and other doctors or students, through education, audit, and peer review q ensures that patients are not put at risk when seeing students or doctors in training q understands the principles and theory of education, and uses teaching methods appropriate to the educational objectives q uses formative assessment and constructs educational plans q assists in making honest assessments of learners The unacceptable GP teacherq puts patients at risk by allowing the learner to practise beyond the limits of his or her competence q does not take teaching responsibilities seriously q offers no personal and educational support to the learner, and does not have appropriate teaching skills q uses inappropriate teaching methods and does not use formative assessment to identify learning needs q makes biased or prejudiced judgements when assessing learners q fails to take appropriate action when the performance of a learner is inadequate
Probity15. ResearchThe excellent GPq ensures that research carried out in his or her practice is done to a high standard q protects patients’ rights, and makes sure that they are not disadvantaged by taking part in research q provides accurate data q preserves patients’ confidentiality The unacceptable GPq ignores his or her responsibility to protect patients during research studies q does not obtain consent from patients before entering them in research studies q provides inaccurate or false data q is motivated primarily by personal gain when deciding whether to take part in research q requests payments for participating in research which have not been approved by a research ethics committee 16. Financial and commercial dealingsThe excellent GPq is an example of financial probity in society q ensures that his or her financial affairs are capable of withstanding searching outside audit q never seeks inappropriate personal gain in the pursuit of practice q provides truthful and honest information on certificates and other documents The unacceptable GPq seeks personal financial gain from his or her patients other than the normal remuneration expected from his or her job q carelessly attaches his or her name to documents or certificates q knowingly provides false information on such documents 17. Providing referencesThe excellent GPq takes care with references, bearing in mind his or her responsibility to future partners or employers and, most importantly, to a doctor’s future patients q is honest and objective in comments made in references, and does not miss out important information The unacceptable GPq gives dishonest, untrue, or biased references q omits important information from references q includes comments in references (favourable or unfavourable) which are based largely on personal prejudice
Health and the performance of other doctors18. Protecting patients when your own health or the health, conduct, or performance of other doctors puts patients at riskThe excellent GPq is aware when a colleague’s performance, conduct, or health might be putting patients at risk q quickly, and discreetly, ascertains the facts of the case, takes advice from colleagues, and, if appropriate, refers the colleague for medical advice or local remedial action q provides positive support to colleagues who have made mistakes or whose performance gives cause for concern q realises when his or her own performance is unsafe, e.g. through illness q seeks advice from a suitable colleague and follows that advice, taking any action required to reduce patient risk The unacceptable GPq ignores his or her own or a colleague’s unsafe behaviour q takes no advice, nor offers any to the colleague concerned q denies or actively conceals his or her own ill health
GMC - Duties of a Doctor
Source:
Good Medical Practice for General Practitioners
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