Good medical practice and care coordination

The new GMC guidance requires doctors to assure continuity of care, but where are the systems to do this?

At the end of January, the UK General Medical Council (GMC), the august body charged with regulating doctors for the last 150 years, published a new version of Good Medical Practice. This is a set of guidance (not rules) which governs how doctors should behave towards their patients, other health professionals and the wider public.

The first edition was published in 2013, soon after the introduction of revalidation. It’s well written in unambiguous and straightforward prose, which makes it light enough to digest in one sitting.

Every doctor should read it, not just because it determines the structure of your appraisal, nor because its lightness of style belies the sharp (if slow moving) teeth of the fitness-to-practice process, but largely because it’s very sensible.

Here are some nuggets.

My favourite, if I’m allowed one is …

You must treat patients with kindness, courtesy and respect (paragraph 23)

Also necessary, important and sometimes difficult is …

You must keep up to date with guidelines and developments that affect your work (Paragraph 3)

And for those with enough insight ….

You should try to take care of your own health and wellbeing, recognising if you may not be fit for work (Paragraph 78)

And one particularly relevant in the times of increasing tele-health, video and telephone consultations:

In providing clinical care you must carry out a physical examination where necessary (Paragraph 7(b))

As an aside, this instruction (notice the “must”) reminds me of a middle-aged patient who I treated in an emergency department many years ago. She had globus hystericus (her term, not mine) and was lying in a cubicle in her dressing gown, curlers, and an excess of poorly-applied make up, talking erratically and manically about the contents of her handbag. She was also complaining amid her eye-rolling and glottle-stopping that she couldn’t move her legs. She was the epitome of what – in uncharitable terms – might have been described as a mad old bat. And her complaints could easily have been dismissed. Thankfully I did examine her. She had bilateral up-going plantar and no sensation below the knees. A CT revealed an osto-sarcoma of her spine. Always, always examine!

Good Medical Practice, also has lots of good stuff about research, consent, holistic care, leadership, end of life and there is some sensible discussion in Paragraph 75(b) of what to do if you see or experience problems with care delivery.

But most of all, my interest was piqued by paragraph 65 – continuity of care which says:

Continuity of care is important for all patients, but especially those who may struggle to navigate their healthcare journey or advocate for themselves. Continuity is particularly important when care is shared between teams, between different members of the same team, or when patients are transferred between care providers. 

How right. How sensible.

It then says:

You must promptly share all relevant information about patients with others involved in their care, within and across teams, as required.

and …

You must be confident that information necessary for ongoing care has been shared … before you delegate care or refer the patient to another health or social care provider.

No one would disagree.

Note again the “must” in that sentence. It means that it is an “ethical or legal obligation”. It’s not a should it’s a must.

But sadly, the reality for most clinicians – not just in the UK but worldwide – is a dearth of the necessary clinical systems to make this a reality.

Demos provided evidence of the lack of communication in the UK. PWC wrote a report on the subject.

Better communication and coordination across boundaries is not just required.

It’s a ‘must‘.