5 May 2016
Dear Mr Fryer,
Thanks for your enquiry
You raise a number of questions about interpretation of the guidance in Good Medical Practice (GMP) in relation to doctors taking up training posts and filling employment rotas.
I think it’s important to note that GMP sets out a high level framework to guide the actions and decisions of UK doctors. It is not a rule book, nor do we try to cover every possible situation that a doctor might encounter in practice. Doctors are expected to exercise professional judgment about how to apply the principles and standards in their day to day their practice.
Taking up appointments
Bearing in mind the variety of organisations with which doctors may contract to provide services; what may be a ‘reasonable’ period of notice for withdrawing from a post in one situation may be unreasonable in another. We do not therefore state a minimum or required period of notice within our guidance.
We expect individual doctors to make their own judgement about what might be seen as reasonable notice in their particular circumstances. This is likely to depend on the nature of the post and the recruitment process, the contractual period of notice and any accommodation that the doctor can agree with the current and prospective employer. You may find it helpful to consult the code of practice (http://www.bma.org.uk/support-at-work/contracts/juniors-contracts/accepting-jobs/code-of-practice) agreed between the BMA, NHS Employers and others, to govern the recruitment of doctors into training posts. According to the BMA website, the code lays out the agreed set of information that recruiting organisations and employers should provide to doctors in training at each stage of the recruitment process, the first post and subsequent rotations to better support doctors to make these important decisions.
Unsafe working hours
It is not part of our role to provide advice on what might be safe working hours in particular fields of practice, types of healthcare service, or individual roles within an organisation. However, we recently issued a statement and list of questions and answers (http://www.gmc-uk.org/news/28653.asp) to set our views about the importance of safe rota design. We say that:
The design of rotas must be safe for doctors in training and safe for the patients they care for. Our new standards for medical education and training – Promoting excellence (http://www.gmc-uk.org/Promoting_excellence_standards_for_medical_education_and_training_0715.pdf_61939165.pdf) – require organisations to design rotas that make sure doctors in training have appropriate clinical supervision and minimise the adverse effects of fatigue and workload. We monitor whether that requirement is being met in various ways, such as the regular reports that we receive from postgraduate deans and through our quality assurance visits. Where there are issues, we expect postgraduate deans to manage these with the NHS Trusts and surgeries who provide medical education.
We recognise the current pressures in the service and understand that doctors may find themselves in difficult positions. We make clear that if doctors feel under pressure to cover a gap, they should carefully consider their own health and welfare and the impact on their practice if they are exhausted. They need also to consider the risks to patients from any refusal to cover a shift, and wherever possible work collaboratively with colleagues to find a solution to the situation.
Emergencies
We have not defined ‘emergencies’ as what is seen as an emergency in a particular setting is a matter for professional judgement. We would expect any differences of view about emergency cover for rota gaps to be discussed and resolved locally with the aim of ensuring safe, effective care for patients.
We say in our published Q&A:
I am being put under pressure to cover a rota gap. I don’t think it is safe. What should I do?
Follow our guidance in Raising and Acting on Concerns about Patient Safety (http://www.gmc-uk.org/guidance/ethical_guidance/11863.asp). Work with colleagues and your organisation constructively to put the matter right if you can, raising your concerns as summarised in this flowchart (http://www.gmc-uk.org/guidance/ethical_guidance/decision_tool.asp) and keeping a record of the steps you take. If you think you are too exhausted to cover a shift safely, you should not do so.
I don’t think this contract is safe. If I sign it, will I be responsible for any harm to my patients because of it?
You should work with your organisation to seek a resolution of your safety concerns, for example in improving rota design. If you are making the care of your patient your first concern, following our guidance and keeping a record of your decisions and actions, it is highly unlikely you will face a situation where there would be GMC action taken against you.
I hope that this advice is helpful to you and your colleagues in considering how best to respond to any current issues and concerns.
Yours sincerely,
Education and Standards Directorate
General Medical Council