Overview of consultation

Between March and June 2026, the General Medical Council called for submissions on its updated draft Personal beliefs and medical practice guidance

MPS response

Section 1 - structure and terminology

Question 1: To what extent do you agree or disagree with the following statement:The updated guidance structure is accessible. 

• Agree

Question 2: To what extent do you agree or disagree with the following statement: The updated guidance accurately reflects the range of personal beliefs and values that might influence the practice of doctors, PAs, and AAs and inform patient's' decision making.

• Agree

Question 3: Do you agree or disagree with this statement: It would be helpful if there was a description of the relationship between personal beliefs and clinical opinion in the guidance. 

• No

Question 4: Is there anything else we should consider when defining the range of personal beliefs that can fall within the scope of this guidance?

It is important that the approach to this guidance remains principles-based rather than overly prescriptive. Personal beliefs are inherently broad, context-specific and evolving, and any attempt to provide an exhaustive or rigid definition risks either excluding relevant scenarios or creating unintended ambiguity. A flexible framework, underpinned by clear professional standards, is therefore more appropriate than a fixed list of beliefs or categories.

The guidance should include practical examples to support greater understanding and consistent application. In particular, illustrative case studies could help clarify how the guidance applies in real-world scenarios, including where doctors may have fallen short of expected standards. This would provide clearer boundaries and help doctors better understand how personal beliefs may interact with their professional responsibilities in practice.

It would be particularly helpful for such examples to extend beyond strictly defined workplace settings. In an increasingly digital and interconnected environment, the distinction between professional and personal spheres is not always clear. For example, the use of social media can raise complex questions about how and when personal beliefs are expressed, and how these expressions may be perceived in a professional context. While the draft guidance references existing social media guidance, more explicit integration – supported by concrete examples – would improve clarity and accessibility for doctors.

Expanding on these areas would help ensure that the guidance is both sufficiently flexible to accommodate the wide range of personal beliefs doctors may hold, while also providing the practical clarity needed to support safe, professional and consistent decision-making.

Question 5: Is there anything else we should consider in terms of the guidance structure and the terminology we use?

Overall, the revised structure of the guidance is an improvement. The clearer separation between patient-focused and doctor-focused considerations makes the document easier to navigate and more comprehensive than the previous version.

However, there are some areas where the terminology used could benefit from greater clarity to reduce ambiguity and unintended risk.

For example, the use of terms such as “distress” (for example, at paragraphs 10 and 17) introduces a level of subjectivity that may be difficult for doctors to interpret and apply consistently. As currently framed, this risks creating uncertainty about the threshold at which conduct may fall below expected standards, potentially exposing doctors to disproportionate regulatory risk. Existing principles within Good Medical Practice – such as requirements to treat patients with respect, communicate sensitively, and avoid causing harm – already provide a robust and more established framework for assessing behaviour. Consideration could therefore be given to aligning terminology more closely with these established standards, or providing further clarification on how “distress” should be understood in the context of the guidance.

Similarly, phrases such as “may affect practice” (paragraph 12) are very broad and could be interpreted in a wide range of ways. Without further definition or explanation, this risks overextending the scope of the guidance and making it more difficult for doctors to determine when they are required to declare or act on their beliefs. Greater clarity around the intended threshold for impact on practice would improve consistency and confidence in applying the guidance.

More generally, while a degree of flexibility is appropriate, there are parts of the document where the language remains high-level and could benefit from additional practical clarity. As with other GMC guidance, the inclusion of illustrative examples – potentially as an annex – would help demonstrate how key terms and expectations could be applied in practice.

Finally, we note that some changes in terminology compared to the previous version of the guidance may have substantive implications (for example, in how conscientious objection is framed in relation to life-sustaining treatment). While this is more a matter of content than structure, it will be important to ensure that any such changes are clearly explained and justified, given their potential impact on interpretation and practice.

Section 2 - personal beliefs of doctors, PAs, and AAs

Question 6: To what extent do you agree or disagree with the following statements?

A - The updated draft guidance on doctors, PAs, and AAs being open with their employers, partners or colleagues where personal beliefs may affect their practice is clear.

• Agree

B - The updated draft guidance on doctors, PAs, and AAs being open with their employers, partners or colleagues where personal beliefs may affect their practice is helpful.

• Agree

C - The updated draft guidance on doctors, PAs, and AAs being open with their employers, partners or colleagues where personal beliefs may affect their practice is achievable in practice.

• Neither agree nor disagree

Question 7: To what extent do you agree or disagree with the following statements?

A - The updated draft guidance on doctors', PAs', and AAs' responsibilities in contributing to a respectful, fair, supportive and compassionate workplace is clear.

• Disagree

B - The updated draft guidance on doctors', PAs', and AAs' responsibilities in contributing to a respectful, fair, supportive and compassionate workplace is helpful.

• Agree

C - The updated draft guidance on doctors', PAs', and AAs' responsibilities in contributing to a respectful, fair, supportive and compassionate workplace is achievable in practice.

• Neither agree nor disagree

Question 8: To what extent do you agree or disagree with the following statements?

A - The updated draft guidance on how, when appropriate, doctors, PAs, and AAs should talk to patients about their beliefs is clear. 

• Disagree

B - The updated draft guidance on how, when appropriate, doctors, PAs, and AAs should talk to patients about their beliefs is helpful.

• Disagree

C -  The updated draft guidance on how, when appropriate, doctors, PAs, and AAs should talk to patients about their beliefs is achievable in practice.

• Disagree

Question 9: To what extent do you agree or disagree with the following statements?

A - The updated draft guidance on how doctors, PAs, and AAs should manage discussing conscientious objections with patients is clear.

• Agree

B - The updated draft guidance on how doctors, PAs, and AAs should manage discussing conscientious objections with patients is helpful.

• Disagree

C - The updated draft guidance on how doctors, PAs, and AAs should manage discussing conscientious objections with patients is achievable in practice.

• Disagree

Question 10: To what extent do you agree or disagree with the following statements?

A - The updated draft guidance on how doctors, PAs, and AAs should manage any conscientious objections they have that are not legal rights is clear.

• Agree

B - The updated draft guidance on how doctors, PAs, and AAs should manage any conscientious objections they have that are not legal rights is helpful.

• Agree

C - The updated draft guidance on how doctors, PAs, and AAs should manage any conscientious objections they have that are not legal rights is achievable in practice.

• Neither agree nor disagree

Question 11: Is there anything else we should consider in relation to paragraphs 10-26 on the personal beliefs of doctors, PAs, and AAs?

In relation to paragraphs 10–26, we support the overall intent to balance doctors’ rights to hold personal beliefs with the need to ensure patient access to care and maintain professional standards. However, there are several areas where greater clarity and proportionality could strengthen the guidance.

First, the expectations around disclosure of personal beliefs to employers and patients (paragraphs 12 and 21) may be difficult to apply consistently in practice. The requirement to be “open” where beliefs “may affect your practice”, and to take steps to make patients aware of conscientious objections in advance, risks being interpreted too broadly. This could lead to over-disclosure, with doctors feeling obliged to declare beliefs even where there is no meaningful impact on patient care. Greater clarity on the threshold for disclosure would help ensure a proportionate approach and avoid unnecessary or inappropriate sharing of personal information.

Related to this, the expectation that doctors should communicate conscientious objections through printed or online materials may not be practical or appropriate in all settings. In many contexts, it may be more reasonable for such discussions to take place at the point of care, where they can be handled sensitively and in a way that is tailored to the individual patient’s circumstances. Clarifying that advance disclosure is not always required, and that flexibility is appropriate depending on context, would improve the guidance’s applicability.

Second, the guidance would benefit from clearer delineation between professional regulatory standards and matters more appropriately managed at an employment or organisational level. For example, expectations around workplace culture, interpersonal dynamics, and how concerns are addressed may depend heavily on local policies and employer responsibilities. While it is appropriate for the guidance to reinforce core professional values, care should be taken not to extend regulatory expectations into areas that are more appropriately addressed through local governance or internal human resources frameworks.

Third, in relation to interactions with patients (paragraph 17), there is a need for greater clarity on when, if ever, it is appropriate for doctors to share their own beliefs. While the prohibition on imposing beliefs is clear, the additional framing around “inappropriate or insensitive expression” and causing distress is more subjective and may be difficult to interpret in practice. Consideration could be given to providing clearer guidance on the limited circumstances in which disclosure may be appropriate, alongside a stronger emphasis on maintaining professional boundaries.

Finally, while the section on conscientious objection is broadly comprehensive, some of the expectations may be challenging to operationalise consistently across different roles and settings. Ensuring that the guidance remains flexible and proportionate, and is supported by practical examples, would help doctors apply these principles in a way that prioritises patient care without creating unnecessary regulatory risk.

Section 3 - personal beliefs of patients

Question 12: To what extent do you agree or disagree with the following statements?

A - The updated draft guidance on considering patients' personal beliefs when providing care and exploring suitable treatment options is clear.

• Neither agree nor disagree

B - The updated draft guidance on considering patients' personal beliefs when providing care and exploring suitable treatment options is helpful.

• Agree

C - The updated draft guidance on considering patients' personal beliefs when providing care and exploring suitable treatment options is achievable in practice.

• Neither agree nor disagree

Question 13: Is there anything else we should consider in relation to paragraphs 32-33 on providing care in line with patients' personal beliefs?

The guidance could more clearly emphasise that conversations about personal beliefs should be relevant to the patient’s care and circumstances. In many routine clinical interactions, a patient’s personal beliefs may not be relevant, and doctors should not feel expected to explore them unnecessarily. A clearer statement on proportionality would help doctors understand when such conversations are appropriate.

The guidance should also more explicitly caution against assumptions. While paragraph 28 advises doctors not to make generalisations about people who share a belief, paragraphs 32–33 could be strengthened by making clear that doctors should not assume a patient’s beliefs, values or preferences based on their name, appearance, background, ethnicity, religion, culture, sex, gender, sexuality or any other personal characteristic. Even where a patient does identify with a particular belief system or cultural background, there may be a wide range of views and practices within that group.

This would help reinforce the importance of treating each patient as an individual, rather than approaching care based on perceived or assumed beliefs. It would also support better, more patient-centred conversations, where beliefs are explored only where relevant and in a way that is sensitive, respectful and clinically appropriate.

Finally, paragraph 33 is a useful addition in recognising that doctors also have the right to work in an environment free from abuse and discrimination. However, it may be helpful to provide further clarity on how doctors should respond in practice where a patient’s request or stated belief is discriminatory or abusive, while still ensuring that urgent or necessary care is not compromised.

Question 14: To what extent do you agree or disagree with the following statements?

A - The updated draft guidance on how doctors, PAs, and AAs should respond when a patient expresses abusive or discriminatory views based on their beliefs, or makes a request based on these views is clear.

• Agree

B - The updated draft guidance on how doctors, PAs, and AAs should respond when a patient expresses abusive or discriminatory views based on their beliefs, or makes a request based on these views is helpful.

• Agree

C - The updated draft guidance on how doctors, PAs, and AAs should respond when a patient expresses abusive or discriminatory views based on their beliefs, or makes a request based on these views is achievable in practice.

• Disagree

Question 15: To what extent do you agree or disagree with the following statements?

A - The updated draft guidance on how doctors, PAs, and AAs should manage patient requests for procedures or treatments that are against the law is clear.

• Agree

B - The updated draft guidance on how doctors, PAs, and AAs should manage patient requests for procedures or treatments that are against the law is helpful.

• Agree

C - The updated draft guidance on how doctors, PAs, and AAs should manage patient requests for procedures or treatments that are against the law is achievable in practice.

• Neither agree nor disagree

Question 16: To what extent do you agree or disagree with the following statements?

A - The updated draft guidance on providing care for children and young people, where the personal beliefs of the child or young person and their family may affect their preferences and decision-making, is clear.

• Agree

B - The updated draft guidance on providing care for children and young people, where the personal beliefs of the child or young person and their family may affect their preferences and decision-making, is helpful.

• Agree

C - The updated draft guidance on providing care for children and young people, where the personal beliefs of the child or young person and their family may affect their preferences and decision-making, is achievable in practice.

• Agree

Question 17: Is there anything else we should consider in relation to paragraphs 47-53 on providing care where patients are children and young people.

Overall, these paragraphs provide a clear and structured framework for managing care involving children and young people, particularly in relation to consent, parental responsibility and escalation where disagreements arise. The emphasis on best interests, involvement appropriate to age and maturity, and clear routes to court where agreement cannot be reached is helpful and aligns with established practice. 

However, there are areas where the guidance could be strengthened.

First, while the legal and procedural framework is clear, the practical application may be more challenging in real-world settings. Situations involving disagreement between parents, or between parents and clinicians, are often complex, time-sensitive and emotionally charged. The guidance could more explicitly acknowledge these practical challenges and provide additional support or examples to help clinicians navigate them in practice.

Second, the distinction between safeguarding concerns involving children and those involving adults is implicit but not fully explored. In practice, clinicians may find it more straightforward to escalate concerns involving children due to clearer safeguarding frameworks, whereas similar concerns involving adults may be more difficult to manage. While this is not solely within the scope of these paragraphs, recognising this difference would better reflect the realities clinicians face.

Finally, while the guidance appropriately sets out when legal routes should be considered, further clarity on early-stage conflict resolution (for example, informal mediation or multidisciplinary discussion) could help support proportionate decision-making before escalation to court.

Question 18: Is there anything else we should consider in relation to paragraphs 27-53 on patients' personal beliefs?

Paragraphs 27–53 provide a comprehensive overview of how doctors should take account of patients’ personal beliefs in clinical care, including assessment, communication, decision-making and managing requests or refusals of treatment. The emphasis on respecting patient autonomy, avoiding discrimination, and supporting informed decision-making is appropriate.

However, there are several areas where the guidance could be strengthened to improve clarity and applicability.

First, the guidance would benefit from a clearer emphasis on relevance and proportionality. While it is important to recognise that patients’ beliefs can influence care, this will vary significantly depending on the clinical context. In some settings (for example, end-of-life care), exploring beliefs may be central to decision-making, whereas in more routine or time-limited interactions it may be less relevant. Making this distinction more explicit would help clinicians apply the guidance appropriately in practice.

Second, the guidance should more explicitly caution against assumptions. Although paragraph 28 advises against generalisations, there is a strong case for reinforcing that doctors should not infer a patient’s beliefs based on factors such as their name, appearance or background. The discussion highlighted that individuals within the same belief system may hold a wide range of views, and clearer wording would help ensure patients are treated as individuals rather than through perceived group characteristics.

Third, while paragraph 33 appropriately recognises that patients may express beliefs in ways that are discriminatory or abusive towards doctors, the response set out is limited. The guidance risks appearing overly reliant on local employer policies and does not fully engage with the realities clinicians face in these situations. There is a need for a more developed framework that supports doctors in responding appropriately to discriminatory or abusive behaviour while maintaining patient care, including clearer expectations on when and how it is appropriate to challenge or escalate such behaviour.

Finally, there is a broader issue that the guidance does not always fully reflect the constraints of real-world practice. Time pressures, resource limitations and complex patient dynamics can affect how these principles are applied. A more explicit acknowledgement of these factors would strengthen the credibility and usability of the guidance.

Question 19: To what extent do you agree or disagree with the following statement?

The guidance should acknowledge that a range of belief systems coexist and frame these neutrally.

• Strongly agree

Question 20: To what extent do you agree or disagree with the following statement?

The updated draft guidance frames personal beliefs neutrally.

• Agree

Question 21: Thinking about the proposed change in how explanatory examples are presented, which approach do you prefer?

• Keep example in the main text of the guidance

Question 22: Can you see any risks in removing examples from the main text and instead using them to develop supporting materials?

• Yes

Question 23: Please tell us about the risks.

The most significant risk is reduced accessibility and engagement. If examples are not embedded within the guidance itself, there is a real possibility that users will not access them, particularly where this requires navigating multiple links or separate documents. This is especially relevant given the number of cross-references already included in the draft, which can make the guidance feel fragmented and harder to follow. Removing examples from the main text risks compounding this issue and reducing the practical usability of the guidance.

A related risk is loss of clarity. Examples play an important role in illustrating how principles should be applied in practice, particularly in areas that are inherently nuanced or context-specific. Without them, the guidance may appear more abstract and open to interpretation, increasing the likelihood of inconsistent application by doctors.

There is also a risk that separating examples from the core text weakens their impact. When examples are integrated alongside the relevant principles, they help to anchor interpretation and provide immediate, practical context. If they are instead located elsewhere, this connection may be lost, and users may not readily link the examples back to the relevant sections of the guidance.

That said, there are potential benefits to developing supporting materials, including the ability to provide more detailed, realistic and varied case studies. However, this should complement rather than replace examples within the main guidance.

Question 24: Can you suggest any scenarios where case studies or supporting materials would help explain how the principles in Personal beliefs and medical practice can be applied in practice?

It would be beneficial to include case studies that reflect the full range of personal beliefs covered by the guidance. There is a tendency to associate personal beliefs primarily with religious views, but in practice these may also include political, moral or philosophical beliefs. Broadening the range of examples would help reinforce that the guidance applies across this wider spectrum and avoid an overly narrow interpretation.

Case studies exploring the expression of personal beliefs outside the workplace would also be particularly valuable. In modern practice, the distinction between personal and professional contexts is less clear-cut, especially given the prominence of social media. Examples could cover scenarios where doctors express personal views publicly (for instance on social media or in public settings) while clearly identifiable as medical professionals. This would help clarify how professional standards apply beyond the immediate clinical environment, and what constitutes acceptable versus unacceptable expression of personal beliefs in these contexts.

Related to this, case studies could also illustrate how the guidance applies where a doctor’s conduct outside the workplace may nonetheless have implications for public confidence in the profession. This would support clearer understanding of the boundaries between private belief and professional responsibility.

More broadly, there would be value in including practical, realistic scenarios that reflect the complexities of day-to-day practice, including where competing considerations arise (for example, balancing personal beliefs with patient expectations, or managing situations where beliefs are expressed in ways that may cause concern).

Question 25: What impact, if any, do you think the draft updates to Personal beliefs and medical practice guidance could have on patients and the professionals we regulate who share protected characteristics under the Equality Act 2010 (the protected characteristics are race, disability, age, sex, gender reassignment, sexual orientation, religion and belief, pregnancy and maternity, and marriage and civil partnership)?

• Somewhat positive

Question 26: If you think the draft guidance could be interpreted or applied in ways that lead to biased or unfair judgements, please explain how.

One key risk is inconsistent or overly expansive interpretation by employers. For example, requirements around being "open" about beliefs that may affect practice, or making patients aware of conscientious objections in advance (paragraphs 12 and 20), could be misinterpreted as requiring doctors to formally declare or document their personal beliefs more broadly than intended. This could lead to inappropriate practices, such as employers requesting or maintaining records of doctors’ personal beliefs or conscientious objections, which would go beyond the purpose of the guidance and raise concerns around privacy and proportionality.

Related to this, there is a risk that the guidance could be used in a punitive or disproportionate way within local disciplinary processes. In particular, broadly framed or subjective elements of the guidance may be relied upon as a basis for criticism or sanction, even where doctors are acting professionally and in good faith. This could create uncertainty and contribute to a perception that the guidance is being used as a “tool” against doctors rather than as a framework to support professional practice.

There is also a potential risk to perception and confidence. Some doctors may interpret the guidance as unduly restricting their ability to hold or express personal beliefs, particularly outside the workplace. While the draft seeks to strike an appropriate balance, without clear communication and careful implementation there is a risk that it could be perceived as curtailing personal freedoms, which may in turn affect engagement with the guidance.

Finally, there is a broader risk that the guidance does not fully reflect the realities of how it will be applied in practice, particularly given variation in local policies, workplace cultures, and leadership approaches. Without sufficient clarity and safeguards, this could lead to uneven application and unintended bias in how concerns are raised, assessed and acted upon.

To mitigate these risks, it will be important to ensure that the guidance is clearly framed as supporting proportionate, professional behaviour, and that its implementation is accompanied by appropriate support and oversight to avoid misinterpretation.

Question 27: Is there anything else we should consider in relation to the guidance?

Overall, the guidance is clear and comprehensive, but there are a small number of additional considerations that may strengthen its impact.

Consideration could be given to tone and style. While the use of plain English is welcome, elements of the drafting – including the use of contraction apostrophes – risk creating an overly informal or conversational tone. Given this is formal regulatory guidance, a more consistent and formal style may help reinforce its authority and ensure it is taken seriously by all audiences.

There would also be value in including clearer signposting to sources of support for doctors, particularly those who may experience discrimination, harassment or abuse in the course of their work. This would complement the recognition within the guidance that such issues can arise and provide more practical support for those affected.

Finally, the guidance would benefit from greater acknowledgement of the practical context in which it will be applied. Factors such as organisational policies, resource constraints and workplace culture may influence how the guidance is implemented in practice, and clearer recognition of these enablers and barriers would support more consistent and realistic application.

Addressing these points would further strengthen the clarity, authority and practical usability of the guidance.

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Contact

Should you require further information about any aspects of our response to this consultation, please do not hesitate to contact us.

Michael East
Policy and Public Affairs Manager
michael.east@medicalprotection.org