Doctors are being told to do more to keep patients with long-term illnesses in work and adopt healthy lifestyles.
New draft guidance from the General Medical Council (GMC) says doctors “must support patients in caring for themselves to empower them to improve and maintain their health”. The move is politically sensitive given the government’s drive to cut the number of people on incapacity benefits.
The guidance adds: “This may include encouraging patients, including those with long-term conditions, to stay in or return to employment or other purposeful activity. You may also advise patients on the effects of their life choices on their health and wellbeing and the possible outcomes of their treatments.”
Although it is common for doctors to check patients’ drinking and smoking habits, this is the first time the GMC has been so explicit in its guidance on good medical practice. The guidance is currently being updated, with the final version due next year.
Serious or persistent failure to follow the guidance could count against doctors facing fitness to practise investigations and endanger their registration. The word “must” is used for an overriding duty or principle doctors are compelled to obey, although the use of the word “may” with regard to encouraging patients back into employment or their life choices allows for flexibility in supporting patients.
No new claims for incapacity benefit have been accepted since January – people have to claim for employment and support allowance instead – but all those on the benefit are having their entitlement reviewed, a process not due for completion until 2014.
Although the guidance is not a statutory code and leaves room for doctors’ professional judgment, both the government and Labour are wary of “nanny state” approaches. The intervention of the GMC, which regulates all doctors including those in the NHS, comes at a sensitive time.
Guidance is also being toughened in other areas, including the protection of vulnerable patients in the wake of repeated concerns, including from the Care Quality Commission, that hospitals are not providing good care for older people. The new draft guidance says doctors must take a lead role in making sure a patient’s safety, comfort and dignity are always maintained.
Richard Vautrey, deputy chair of the BMA’s GPs’ committee, said the draft guidance fitted in with what doctors already did. “Doctors would see work as being beneficial for patients in the vast majority of cases … Clearly in cases where work was impossible or making patients unwell, that is when doctors would use certification to enable them to be away from work. You want to get people active,” he said whether through unpaid voluntary work or employment.
“Doctors’ first and foremost priority is the patient in front of them and not the Benefits Agency or the Department of Work and Pensions.”
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