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Good Medical Practice: An update

The Medical Council of New Zealand recently launched a new, revised version of their Good Medical Practice guidance. Sara Williams shares a round-up of the most significant changes

We all have an opinion of what makes a good consultation with a professional, whether it is being listened to, respected or even compassionate, but what everyone would agree on is that, above all else, we expect professionals to be competent and up-to-date.

The Medical Council of New Zealand (MCNZ) have recently updated their seminal guidance Good Medical Practice (GMP), which outlines the professional duties of a good doctor and outlines the clinical standard against which their conduct and decision-making will be measured.

What it is not is an exhaustive code of ethics; it is a guide to assist doctors in understanding and complying with the requirements of legislation.

Why the revision?

GMP was reviewed and subsequently updated to summarise the duties of all doctors in a simple and clear manner. It is a document intended to help doctors monitor their own conduct and that of their colleagues.

Background

Under the Health Practitioners Competence Assurance Act (2003) the MCNZ is tasked with setting the standards, clinical competence, cultural competence and ethical conduct of all doctors. GMP was put out for consultation last year and is the result of feedback from patients, the public, stakeholders and doctors, detailing the standards a competent doctor is expected to meet.

GMP is used by the Health Practitioners Disciplinary Tribunal, the MCNZ’s Professional Conduct Committees, and the Health and Disability Commissioner in determining whether a doctor has acted inappropriately. The MCNZ says that the new guidance places more emphasis on explaining the key principles and standards in GMP. In this article we will look at the most significant changes to the guidance.

Professionalism

Previously, the section most overlooked was the initial foreword. Under a new heading, the ‘Professionalism’ section underlines the key duties and competencies that underpin all professional practice.

The MCNZ expects all doctors to be competent in:

  • Caring for patients
  • Respecting patients
  • Working in partnership with patients and colleagues
  • Acting honestly and ethically
  • Accepting the obligation to maintain and improve standards.

Personal data (par 7)

A new duty has been introduced that doctors take all reasonable steps to ensure that records containing personal data about patients, colleagues or others are kept securely.

A new duty has been introduced that doctors take all reasonable steps to ensure that records containing personal data about patients, colleagues or others are kept securely

Prescribing (par 10)

Prescribing guidance previously stated that before prescribing, a face-to-face consultation would “usually” be required; now, before prescribing any medicine, you “should” have a face-to-face consultation with the patient. In the absence of a face-to-face consultation, discuss the patient’s treatment with another health practitioner who can verify the patient’s physical data and identity.

If this is not practical:

  • Complete the prescription if providing cover for a colleague or discharging a patient from hospital, and review the patient’s notes
  • Renew a prescription of a patient you, or a colleague, have seen previously
  • Complete a prescription when you have a relevant history and there is an urgent clinical need to prescribe, providing you inform the patient’s doctor as soon as possible.

Adverse outcomes (par 24)

New duties have also been introduced with regards to managing adverse outcomes. Previously, if your patient had suffered serious harm or distress, you were required to act immediately to put it right “where possible”; the revised guidance expressly states that you “should” express regret and apologise if appropriate, then explain fully:

  • What has happened
  • The likely short-term and long-term effects
  • What you and your health service can do to alleviate the problem.

Informed consent (par 30-34)

Previous editions of GMP contained little on informed consent, so this section now advises that you familiarise yourselves with the Code of Health and Disability Services Consumers’ Rights and the Health Information Privacy Code.

With rare and specific exceptions you should not provide treatment unless:

  • The patient has received all the information that a reasonable patient would expect to receive about their condition and treatment options, including the expected risks, side-effects, costs and benefits of each option
  • You have determined that he or she has an adequate understanding of that information
  • You have provided the patient with an opportunity to consider and discuss the information with you
  • The patient has made an informed choice 
  • The patient consents to treatment. The guidance says that you should have a reasonable knowledge of the range of evidence-based treatments that are available, and of how patients can access those that you do not provide, and you must respect and support the patient’s right to seek a second opinion or to decline treatment, or to decline involvement in education or research.
Giving information to others for the protection of a patient may be a justifiable breach of confidentiality and, where a vulnerable adult is at risk of injury, is a legal duty

Working with colleagues (par 39)

The MCNZ says that working appropriately with colleagues should apply in all circumstances. A new duty requires you to respect the skills and contributions of your colleagues and recognise the impact of your conduct on other team members, and how it may affect quality care.

Sharing information in public (supplementary guidance) When sharing information in any public forum, eg, chatting in a hospital cafeteria or posting on a social networking site, the revised guidance says you should not disclose information about yourself that might undermine your relationship with patients. Similarly, do not disclose information that might identify and cause distress to colleagues, patients or their families.

Continuity of care (par 50-52)

Although the new guidance is not intended to impose a duty on doctors to assume responsibility for every patient, it does require them to ensure that someone is personally accountable for each patient’s care. It also requires that when you delegate care to a colleague, you must make sure they have the appropriate qualifications, skills and experience to provide care for the patient.

Raising concerns (par 62-69) 

New duties have also been introduced with regards to raising concerns. If you have concerns over the competency of a colleague, where previously doctors were required to raise concerns “where possible” you now “should”:

  • Raise your concerns with the doctor
  • Draw the matter to the attention of the doctor’s employer
  • Report your concerns to the registrar of the MCNZ or the Health and Disability Commissioner
  • If the matters relate to health information privacy and security, refer to the office of the Privacy Commissioner.
If you have a conflict of interest, you must be open about the conflict, declaring your interest

Summary

As mentioned, the revised Good Medical Practice is not an exhaustive code of ethics. There may be obligations or situations that are not specifically covered inGood Medical Practice; in such circumstances your first priority should always be the care of your patient.

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