The BMA has warned that revisions to professional standards do not sufficiently take account of the pressures facing doctors in the NHS today.

The association has said that updates to the Good medical practice guidance coming into force in January 2024 but unveiled on 22 August by the GMC do not reflect ‘the current perilous state of the health service’, adding that urgent reform is still needed to address long-standing distrust of the regulator by the medical profession.

Reiterating calls for an independent and comprehensive review of the GMC’s regulatory processes ahead of legislative change, the BMA welcomed some key aspects of the new standards such as the greater clarity around tackling sexual harassment and bullying in the workplace.

BMA council chair Philip Banfield said that, while the new standards on inappropriate behaviour were to be welcomed, the overall emphasis of the updates risked setting unachievable expectations for doctors working within a chronically under-resourced and overstretched NHS.

BANFIELD: Scapegoat concerns

He said: ‘Good medical practice guidance is used as a benchmark to assess professional actions and behaviour. It is therefore crucial that it lays out robust and achievable standards rather than aspirational standards that doctors may fail to reach through no fault of their own.

‘While many of the updates are reasonable on an individual level, when placed in the context of an extremely challenging health service – navigating chronic under-resourcing and the biggest backlog in the history of the NHS – doctors are rightly concerned that this will simply extend opportunities for individuals to be scapegoated when services (and the systems behind them) fail to meet the needs of patients.

‘Doctors come to work to do the best job we can to care for our patients, and the GMC should not underestimate the impact that systemic pressures and failures have on doctors’ ability to provide safe care.’

The new standards, which the GMC describes as the first ‘major update’ to its professional guidance in a decade, echo many of the recommendations lobbied for by the BMA following the association’s own work into addressing unacceptable workplace behaviour.

More than 2,000 doctors shared their experiences of sexism with the BMA for its sexism in medicine survey, including cases of sexual harassment. Since then, it has been working to implement changes to address the environment some doctors and medical students are working in, including the launch of the Ending Sexism in Medicine Pledge.

The recognition of sexual harassment included in this guidance is necessary if sexual harassment in medicine is to be brought to an end, according to the BMA.

Under a section of the guidance headed ‘contributing to a positive working and training environment’, the standards note that doctors must not ‘act in a sexual way towards colleagues with the effect or purpose of causing offence, embarrassment, humiliation or distress’.

The guidance further makes clear that such behaviour includes, but is not limited to, ‘verbal or written comments, displaying or sharing images and unwanted physical contact’.

The standards also emphasise that bullying, harassing or discriminating against anyone based on personal characteristics such as appearance, lifestyle and cultural background is prohibited in the same way as it is for to existing legally defined protected characteristics such as race or sexual orientation.

Doctors who witness bullying or sexually inappropriate behaviour among their colleagues are encouraged by the new guidance to offer support to the person targeted or affected by harassment or bullying, verbally challenge those responsible and to consider reporting their behaviour.

Dr Banfield added that emphasising individual responsibility in reporting inappropriate workplace behaviour should not be a substitute for a deeper, ‘three-tier approach’ that sought to create a more supportive and inclusive workplace environment.

He said: ‘Encouraging individuals to speak up and report bullying and harassment … will not be effective if doctors do not trust those who they are complaining to or if complaints are not taken seriously when people do.

‘If we are to truly create a fair and equal place of work within the NHS, then a three-tier approach must be adopted with a focus on not just reporting unacceptable discriminatory or sexual behaviours, but also improving the resolution of problems and creating a more supportive and inclusive culture, including mediation and resourced remediation processes.’