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Increasing pressures holding back professional practice of doctors, warns GMC

Doctors are struggling to make time for reflective and professional practice because of pressures on medical services, according to a new report from the General Medical Council (GMC).

The ‘Medical professionalism matters’ report follows 18 months of consultations with GPs, consultants, trainees, royal colleges, training providers and employers, with many respondents describing the current environment as the most challenging of their careers.

The unprecedented discontent among doctors was also recently highlighted in the GMC’s annual report.

In addition to lack of time and support, doctors said it was harder to introduce reflective practice because of professional isolation, fragmented care and poor communication with others.

Many felt the gap between primary and secondary care was widening, despite national efforts to introduce more integrated care systems through the Five Year Forward View.

The report, which is due to be presented at the GMC Conference today, makes a number of recommendations to deal with the problems.

It says that medical schools should implement a stronger focus on understanding medical professionalism, while foundation and postgraduate medical education should stress the doctor’s role in leadership and quality improvement.

It also recommends medical training which stresses the importance of patient involvement, and new guidance on consent to make it easier for doctors to make decisions with patients.

The Royal College of Surgeons has already prepared new guidance to help doctors understand the impact of last year’s Montgomery v. Lanarkshire Health Board ruling on consent guidance and the associated increased risk of litigation.

Professor Jane Dacre, president of the Royal College of Physicians (RCP), said that the report’s findings echoed the RCP’s report ‘Underfunded, underdoctored, overstretched’ in showing doctors were suffering from “excessive stress, low morale and unmanageable workloads”.

She called for employers and education supervisors to provide protected time for doctors to reflect on their practice.

Furthermore, ‘Medical professionalism matters’ urges the GMC to work with the royal medical colleges to reinvigorate continuing professional development, with an emphasis on reflection and changing practice.

However, it argues that responsibility for nurturing a culture of openness, learning and candour should go beyond the GMC.

Instead, it says all healthcare regulators and bodies should promote a more transparent culture, which recognises that the doctor may be the ‘second victim’ when things go wrong. NHS Employers and the GMC should also work together to provide advice on how doctors can contribute to organisation leadership.

Professor Terence Stephenson, GMC chair, said: “I hope this report will provide us with the start of an important conversation about how we can work together to achieve positive change.

“In taking findings forward we also need to celebrate everything that is astounding and transformational about the profession. World class scholarship, an extraordinary commitment to delivering the best for patients even under immense pressure and the teamwork and mutual support and the day-to-day human and scientific miracles that too often we take for granted.”

The GMC is currently implementing reforms to take account of doctors’ mental health when facing fitness to practice procedures and to minimise their negative impact.

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