Exclusive GPs are set to be required to encourage patients to go back to work as part of their responsibilities to the GMC, under changes to the regulator’s core ethical guidance drafted with input from the Department of Work and Pensions (DWP).
A draft revised version of Good Medical Practice, presented to GMC Council last week, included a new duty ‘to encourage patients with long-term conditions to stay in, or return to, employment’.
The GMC told Pulse a submission from the DWP had fed into the draft document, amid fears from GPs over ‘pressure from Government’ to enlist doctors in the coalition’s benefit crackdown.
The controversial requirement comes as part of a raft of proposed changes in the first major review of Good Medical Practice for five years. But it has prompted outrage among GPs and debate among GMC Council members, who have demanded clarification on the change.
GMC officials said the proposal will be reworded ahead of a public consultation later this month, with the redraft likely to substitute ‘employment’ for ‘meaningful activity’.
Niall Dickson, GMC chief executive, said the draft was based on ‘a lot of evidence that people having productive activity can be life-enhancing’.
He said: ‘We don’t want to suggest doctors become policemen of the state. It has to be where it is in the patient’s best interest that encouragement and support is given.’
But many GPs responded angrily to the proposal, claiming it ignored the complexities of getting patients into work and pressured doctors into putting the needs of the Government ahead of patients. Click here to join the debate in the Pulse forum.
Dr Rob Barnett, secretary of Liverpool LMC, said: ‘I’m a GP, not an employment adviser.’
‘GPs have a responsibility to get patients as fit as possible and if that helps get them into work then that’s great. However, I’m working in an area of high unemployment. It may be OK for the GMC in London to propose things like this but the reality here is that there are very few jobs around.’
Dr Margaret McCartney, a GP in Glasgow, said: ‘Work in general is good for people, but it is not right for everyone all the time. Doctors need to be quite clear on where our responsibilities are – it is patients first.’
‘The reality for people who have complex and multiple chronic illnesses is not well represented in the literature to date. The evidence base for the GMC proposal doesn’t really reflect the reality of frontline general practice.’
Dr John Hughes, secretary of Manchester LMC, said: ‘This has rather dubious wording. Work can be good for some patients but the GMC needs to recognise there is an appropriate time and an appropriate sort of work for some patients.
‘I’m wondering how much pressure the GMC has come under from the Government for this.’
The DWP said its submission had been drafted by Dame Carol Black, its work and health tsar, but was unable to provide a copy as Pulse went to press.
A DWP spokesperson said:
‘The Department of Work and Pensions is supportive in principal of helping people who can work, get back into work.’
Additional duties for doctors
New requirements included in draft Good Medical Practice guidance
• To encourage patients to stay in, or return to, work
• To consider patients’ religious, spiritual and cultural history
• To act as a mentor to less experienced colleagues
• To take ‘prompt action’ against basic failings in care
• To ensure you or a named colleague retains responsibility for patients’ continuity of care
• An explicit duty to be competent in providing care and performing other professional roles
A full draft for public consultation will be published on 17 October.
See also –
GMC guidance is not a political tool
The GMC’s Good Medical Practice guidance is designed to ‘set out the principles and values on which good practice is founded’ – or, in other words, to capture the timeless essence of what it means to be a doctor. The specifics of the guidance do change with time, of course, to reflect long-term shifts in our cultural appreciation of medicine, such as the increasing value now placed on patients playing an active role in decisions involving their health. But the guidance is almost as fundamental to modern-day medicine as the Hippocratic Oath, and needs to preserve a common strand – a universally agreed set of ethical standards – through each succeeding version.
So the GMC must be extremely careful when it releases new draft guidance that each fresh recommendation is seen to be founded in those universal principles.
The one thing the guidance must never become is a political tool, bent and morphed to fit the latest Government imperative. Yet that is exactly what appears to have happened with the release of the latest provisional version, and its hugely contentious suggestionthat GPs should have an ethical duty to persuade patients to return to work.
Under the current wording, doctors will be considered to have ‘a duty to encourage patients with long-term conditions to stay in, or return to, employment’. The GMC has apparently agreed to look again at that wording, but not at the principle it describes. Getting patients back to work is now to be considered a fundamental part of what being a doctor is about, alongside recommendations on confidentiality, patient consent, the doctor-patient relationship and the need to be ‘honest and trustworthy’.
There is a good range of evidence to suggest that in many patients who are out of work through illness – though not all – returning to work can be beneficial for their mental and physical health. Most GPs would accept it is good practice to play a role in aiding return to work, if it feels the right thing to do for that individual, and always provided there is some prospect of work for the patient to be encouraged into. But accepting that work is often a good thing is a chasm away from agreeing that to promote it should be a universal duty, and failure to do so a matter for the regulator. Can doctors who fail to chase their patients to the job centre or challenge requests to be signed off sick really expect a GMC letter on their doorstep?
It is on one level simply ridiculous for the GMC to make a recommendation on such a specific aspect of a patient’s care – akin to making it an ethical duty to control a patient’s blood glucose or apply new guidance on ambulatory blood pressure monitoring. And does the ethical duty lapse if the evidence changes?
But it is more sinister than that. The GMC may deny it expects doctors to become ‘policemen of the state’, but its new advice seems to be driven far more by the political obsessions of today than anything to do with the immutable principles of medicine.