Key Facts

Good Medical Practice (GMP) is the definitive ethical and professional guide issued by the General Medical Council. First published in 1995 and most recently updated in 2024, it sets the standard of competence and conduct expected of all doctors on the UK medical register. Breach of these standards may trigger fitness to practise proceedings.

The Four Domains

1. Knowledge, skills, and performance — maintain competence through CPD, recognise and work within limits of competence, keep accurate records
2. Safety and quality — contribute to and comply with systems to protect patients, take action if patient safety is compromised, respond to risks
3. Communication, partnership, and teamwork — communicate effectively, work collaboratively, treat patients as partners in care
4. Maintaining trust — treat patients and colleagues fairly, act with honesty and integrity, maintain public confidence in the profession

Regulatory Framework

• GMP is the benchmark used in fitness to practise investigations
• Linked to revalidation (introduced 2012): every licensed doctor must undergo annual appraisal mapped to GMP domains
• Supporting GMC guidance documents include: Consent, Confidentiality, 0-18 years, Leadership and Management, and Social Media

Historical Context

• Bristol Royal Infirmary Inquiry (2001): highlighted failures in professional self-regulation
• Shipman Inquiry (2005): led to reform of GMC processes and introduction of revalidation
• Francis Report (2013): emphasised culture of openness and duty of candour

Domains in Practice

Domain 1: Knowledge, Skills, and Performance

• Keep professional knowledge and skills up to date
• Recognise and work within limits of competence
• Keep clear, accurate, and legible records
• Prescribe drugs safely and within competence

Domain 2: Safety and Quality

• Take prompt action if patient safety, dignity, or comfort is compromised
• Protect patients and colleagues from any risk posed by your health
• Support a culture of openness — report adverse events via Datix or equivalent systems
• Comply with Never Events framework and contribute to Serious Incident investigations

Domain 3: Communication, Partnership, and Teamwork

• Listen to patients and respond to their concerns
• Share information with colleagues to support safe patient care
• Support colleagues who have problems affecting their ability to practise
• Work effectively within multidisciplinary teams

Domain 4: Maintaining Trust

• Treat every person with dignity and respect regardless of protected characteristics (Equality Act 2010)
• Be honest and trustworthy when writing reports and completing documents
• Act with integrity in financial and commercial dealings
• Use social media responsibly (GMC guidance on social media 2013)

Red Flags for Fitness to Practise

• Dishonesty or fraud — most serious category, often results in erasure
• Sexual misconduct — abuse of professional position
• Persistent failure to engage with GMC processes or appraisal
• Criminal convictions — must be reported to GMC within a defined timeframe
• Persistent poor performance despite support and retraining
• Health issues impacting patient safety where doctor refuses to seek help

Assessment and Monitoring

• Annual appraisal: structured reflection mapped to GMP domains; mandatory for revalidation
• Multi-source feedback (MSF): colleague feedback (minimum 15 responses) required once per revalidation cycle
• Patient feedback: patient questionnaires (minimum 34 responses) required once per revalidation cycle
• Significant event analysis: reflective review of clinical incidents

GMC Fitness to Practise Process

• Triage: initial assessment of complaint or referral
• Investigation: GMC case examiners review evidence
• Case examiner decision: no action, warning, undertakings, or referral to MPTS
• Medical Practitioners Tribunal Service (MPTS): independent tribunal hearing

Possible MPTS Sanctions

• No impairment found
• Warning: recorded for 5 years
• Conditions: placed on registration (e.g. supervision, retraining)
• Suspension: up to 12 months, can be extended
• Erasure: removal from the medical register (cannot apply for restoration for 5 years)

Special Tests of Professional Standards

• Performance assessment: workplace-based assessment by trained assessors
• Health assessment: occupational health evaluation if health concerns raised
• Language assessment: PLAB/IELTS if communication concerns identified

Non-pharmacological

• Reflective practice: maintain a portfolio of learning and reflection mapped to GMP
• Continuing Professional Development (CPD): minimum 50 credits/year recommended by most Royal Colleges
• Clinical governance participation: engage with audit, quality improvement, and morbidity/mortality meetings
• Peer review: participate in regular case discussion and peer observation

Professional Development

• Mentoring and coaching: seek support for professional development challenges
• Remediation programmes: structured support for doctors in difficulty (e.g. NHS Practitioner Health Programme)
• Balint groups: reflective groups for exploring doctor-patient relationships (particularly relevant for GPs)

Organisational Support

• Responsible Officer: senior doctor designated under the Medical Profession (Responsible Officers) Regulations 2010 to oversee revalidation
• Local medical director: provides clinical leadership and oversight of professional standards
• Occupational health services: support for doctors with health concerns

Referral Criteria

• Self-referral to GMC: encouraged when aware of own fitness to practise concerns
• Employer referral: when local remediation has failed or concerns are serious
• Mandatory referral: criminal charges, suspension from clinical duties, immediate risk to patients
• NHS Practitioner Health: self-referral service for doctors with mental health or addiction issues (0300 0303 300)

Outcomes and Statistics

• Approximately 8,000-10,000 complaints to GMC per year; only ~3-4% result in referral to MPTS
• Erasure occurs in approximately 0.1% of all registered doctors' cases investigated
• Doctors who engage with remediation programmes have >80% successful return to full practice
• Revalidation failure to engage: ~1-2% of doctors have revalidation deferred or licence withdrawn
• Doctors from BME backgrounds are statistically more likely to be referred to GMC — acknowledged as a concern and subject to ongoing review

Complications of Poor Practice

• Patient harm and potential litigation
• Criminal prosecution in severe cases (gross negligence manslaughter — R v Adomako 1995)
• Loss of livelihood and professional identity
• Psychological impact on doctor: depression, anxiety, suicide risk (doctors under investigation have increased suicide risk)
• Reputational damage to employing organisation

GMC Duties of a Doctor

Key Landmark Cases

Revalidation Cycle Summary