Today, the updated code of Good Medical Practice comes into force including new duties on sexual harassment– but without tackling the regulator’s culture, we will continue to see unfair referrals. Moves to bring associate professionals under the same code will blur distinctions and create safety issues. HCSA urges doctors to familiarise themselves fully with the code in line with professional obligations.

An updated version of Good Medical Practice, the code published by the General Medical Council to which doctors work, comes into effect today (30th January 2024). The new code has laudable intentions including new duties to prevent sexual harassment and promote speaking up, and the introduction of friendlier terminology such as ‘kindness’.

Medics should be concerned by the incorporation of associate professionals into the code, due following their regulation at the end of 2024. A footnote describes use of the terminology ‘medical professionals’ to allow for reference to both doctors and Physician and Anaesthesia Associates. In a submission to the consultation, HCSA described this move as ‘crossing a red line’.

Loss of distinction between the roles of doctors and associates makes it easier for stretched employers to inappropriately substitute associate professionals for doctors. Taking the perspective of an employer facing budgetary pressures, it is all too easy to imagine the appeal of using lower paid and lesser qualified associates to carry out work previously undertaken by doctors. Introduction of an umbrella term, ‘medical professionals’ also makes it more difficult for patients to understand who is treating them so their queries are not directed to the correct place. The effect on safety is extremely worrying.

On sexual harassment, HCSA is encouraged by the definition GMC provides, which instructs doctors not to “act in a sexual way towards colleagues with the effect or purpose of causing offence, embarrassment, humiliation or distress”. It goes on to further define that this applies to a range of behaviours, from physical contact to images and written messages. This robust definition makes it difficult for perpetrators to plead ignorance, while also recognising that sexual harassment continues outside of work in virtual spaces such as whatsapp.

A significant change that the medical profession should note is the removal of the ‘threshold statement’, which previously reassured “Only serious or persistent failure to follow our guidance that poses a risk to patient safety or public trust in doctors will put your registration at risk.” This line is replaced with ambiguity in the new code, which describes only ‘assessing the risk’ with a list of possible factors. The implication is that ‘serious or persistent’ are no longer guiding principles of whether an act will put registration at risk.  Other changes include new duties to manage resources with sustainability in mind and to take reasonable steps to meet patients’ language needs – as proportionate to factors such as circumstances and availability of resources.

Yet the elephant in the room is that without tackling the adversarial and discriminatory culture at the root of the GMC, new duties will inevitably provide further opportunities for unfair referral of doctors. This in turn will disproportionately affect ethnic minority doctors and those branded ‘trouble-makers’ for speaking up on safety issues. The medical community will recall the high profile case of Mr Omer Karim, who the GMC was found to have racially discriminated against in 2021. Yet since then, a steady stream of unfair fitness to practice referrals continues for offences as minor as requesting a laptop.

Nonetheless, all doctors must familiarise themselves with the Code and work to it. The new Good Medical Practice comes into force today. HCSA’s message to decision-makers is that it is not too late to backtrack on plans to bring associate professionals under the code. Instead, there should be a separate code of practice to support a separate profession, and language used that clearly differentiates.

Read HCSA’s submission to consultation on changes to Good Medical Practice

Read new Good Medical Practice as published by GMC