Good Medical Practice

By Taruna Chauhan / 01 Apr 2014

Taruna Chauhan explains how you can successfully incorporate the General Medical Council’s four domains of Good Medical Practice into your business processes

All General Medical Council (GMC) registered medical practitioners are expected to meet the Good medical practice (GMP) guidelines, which were updated in 2013.
“Patients must be able to trust doctors with their lives and health. To justify that trust you must show respect for human life and make sure your practice meets the standards expected of you in four domains.”1
Even for clinics that are not required to be registered by the Care Quality Commission (CQC), incorporating the four domains of GMP into their daily processes can help them meet the guidelines. Using them will reflect well on your clinic and will also help with revalidation and appraisal. Ultimately, and most importantly, this will also be for the benefit of your patients.

The four domains of Good medical practice

1. Knowledge, skills and performance

  • DEVELOP AND MAINTAIN YOUR PROFESSIONAL PERFORMANCE:

Practitioners should be making sure that they keep up-to-date with new techniques. When performing new techniques however, you should look at areas for development through training before administering the treatment. Development is personal to each practitioner, and you should plan how you will meet targets. Continuing Professional Development (CPD) should be related to both a practitioner’s professional development and also what improvements are required within the services that their particular practice provides. Keeping up-to-date with competence does not necessarily always mean going on a course and can also be achieved by reading relevant articles from established journals.

  • APPLY KNOWLEDGE AND EXPERIENCE TO PRACTICE:

A medical practitioner should work within their areas of expertise and competence. If you decide to expand your practice, then this will have implications in terms of the service you offer and developments that need to be made. For example if you have previously just done facial treatments and wish to start offering body contouring treatments then you need to ensure you have been on a relevant and accredited training course. Additionally, you might be experienced in treating the face but would like to start offering a new procedure for facial rejuvenation, in which case you should attend the appropriate training course.

  • RECORDING WORK CLEARLY, ACCURATELY AND LEGIBLY: 

Practitioners should also understand what the patient requires by gathering a thorough medical history such as allergies, current medication and any treatments they may have had in the past. Having a proper process in place for you or your clinic staff to record this information ensures that this always happens. It is vital that all people involved in the care of the patient can read and understand what has been written about a patient’s medical history and treatment.

 2. Safety and Quality

  • CONTRIBUTE TO AND COMPLY WITH SYSTEMS TO PROTECT PATIENTS:

It is important to contribute to, and comply with, quality assurance and quality improvement systems such as adverse event reporting. Ensure staff and patient safety in terms of equipment, infection control and the environment.

  • RESPOND TO RISKS TO SAFETY:

In every practice, there will be a time when something goes wrong or complications arise. There should be a clear and simple procedure in place for you and your staff to follow in this instance. For example if you are using a piece of equipment and something is not working properly, you would stop the procedure (and use another piece of equipment if possible), apologise to the patient, make all staff aware that the piece of equipment is un-useable, and log the time and date of the incident along with details of what has happened. Records
of the incident should be kept both in the patient file and in the adverse event recording file. How much investigation follows depends on the severity of incident. If something major happens, obviously there needs to be a thorough investigation. You can learn from these events and improve your practice by taking action to negate risks wherever possible. Risk assessments should be carried out regularly, either by yourself or an external provider.

  • PROTECT PATIENTS AND COLLEAGUES FROM RISKS

Even if you are doing a simple procedure in clinic then you need to be sure that you are not putting your patient at risk if you have a health condition. Decide whether you should ask your colleague to see your patients instead if you believe they might be at risk.

3. Communication, partnership and teamwork 

  • COMMUNICATE EFFECTIVELY:

Ensure that you and your colleagues are communicating clearly and effectively both with each other and with patients. Lack of information or clarity can lead to misinterpretation, which can cause problems.

  • WORK COLLABORATIVELY WITH COLLEAGUES TO MAINTAIN OR IMPROVE PATIENT CARE:

Working collaboratively with colleagues to provide the best patient care will develop partnership and teamwork in your practice. Staff with the appropriate knowledge and skills should work together to provide the best treatment. This domain is about understanding that everybody’s role is important. I’ve worked at big trusts, and the porter is just as important as the consultant. In clinic the first person the new patient will see is the receptionist, and they may well have already spent consid- erable time speaking with front of house staff on the phone. Look at the service holistically; don’t look at it in small segments. Try to get away from the hierarchical structure and instead employ a matrix structure to promote good teamwork. We all have different knowledge and skills to bring to the table, and it is about utilising this within your practice. 

  • TEACHING, TRAINING, SUPPORTING AND ASSESSING:

Partnership and teamwork also covers training of staff, and senior members mentoring junior members of staff. Regular assessment of staff is crucial in order to identify areas for both encouragement and development.

  • CONTINUITY AND COORDINATION OF CARE:

In this time of integration of care, when multiple providers are involved, the patient should feel that their care has been seamless, and this is possible when patient information is shared appropriately. In a clinic this would apply if a practitioner is on leave and another colleague will be taking care of the patient in their absence.

  • ESTABLISH AND MAINTAIN PARTNERSHIPS WITH PATIENTS: 

Check that patients have fully understood the procedure that you have explained to them and that they are aware of any potential risks. Due to the nature of non-surgical aesthetic procedures, you will most probably see the same individual on a fairly frequent basis, thus enabling you to build a strong patient-practitioner relationship. 

4. Maintaining Trust

  • SHOW RESPECT FOR PATIENTS
  • TREAT PATIENTS AND COLLEAGUES FAIRLY AND WITHOUT DISCRIMINATION
  • ACT WITH HONESTY AND INTEGRITY

This is a broad domain revolving around confidentiality, consent, respecting the patient, and being open when things go wrong. Showing respect includes not using your position as a professional to pursue an improper emotional relationship with a patient, and not expressing your own personal views and beliefs in a way that could take advantage of their vulnerability or could distress or upset them. Ensure you provide the appropriate treatment for the patient without prejudice, and be honest about financial dealings; honesty and integrity are vital. If your care has caused a patient to suffer distress or harm,, be sure to put things right if possible, apologise to them and explain to them in detail what has happened, as well as the short and long-term effects. By following the Good Medical Practice guidelines of the GMC, you can help to assure safety and peace of mind for yourself, your colleagues and your patients. For examples of case studies which highlight the consequences of not following the guidelines, visit the GMC website.4

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