Using Good Medical Practice: standards, judgement and accountability

How should a doctor interpret Good medical practice in real work, and how do GMC standards relate to law, local policy, revalidation and fitness-to-practise processes?

Conceptual foundation. This module does not teach the detail of every later duty; it teaches how to reason with professional standards and identify the source of an obligation.

• Identify the four domains and explain why they are equally important.
• Distinguish “you must” from “you should” and apply each appropriately.
• Explain the relationship between Good medical practice, more detailed GMC guidance, law, local policy, revalidation and fitness to practise.
• Use a simple professional-judgement framework to identify the relevant standard, context, action and rationale.
• Recognise that not every departure from guidance automatically establishes serious regulatory impairment, while maintaining respect for mandatory duties.

Good medical practice is divided into four equally important domains. The domains are navigation aids, not independent silos; a single event may engage competence, patient partnership, culture/safety and trust at the same time.

The GMC expressly says GMP is not a set of rules. Registrants are expected to use professional judgement to decide which standards are relevant and how to apply them to the circumstances. This permits contextual reasoning but does not turn standards into optional aspirations.

The distinction between “must” and “should” should be taught precisely. “Must” signals a legal or ethical duty expected to be met or justified if not. “Should” covers duties/principles that may not apply or may be impossible because of external constraints. Neither term should be converted into a point-scoring rubric.

GMP sits within a statutory regulatory architecture. The Medical Act gives the GMC functions concerning professional standards and fitness to practise. The professional standards do not themselves define every legal wrong or every regulatory sanction.

Not every departure from professional standards is serious or leads to fitness-to-practise action. Stage 3 should teach seriousness, context, insight/remediation and current public-protection considerations without trying to predict the outcome of an individual GMC case.

Appraisal and revalidation use professional standards as an organising framework for demonstrating ongoing practice, but appraisal is not a disciplinary hearing and revalidation is not a retrospective certificate that every individual clinical decision was correct.

Local policy may operationalise professional duties but may also contain employer-specific rules. A doctor should usually follow local policy, but policy cannot safely be taught as if it were itself a GMC paragraph or an Act of Parliament.

Professional accountability means being able to explain and justify decisions, including why a standard was applied in a particular way and what was done when resources, systems or competing duties constrained the ideal response.

1. Identify the decision or concern.
2. Name the source of each duty: GMC standard, law, national/provider regulation, employer policy or clinical governance.
3. Distinguish mandatory duties from context-sensitive expectations without treating either as optional.
4. Apply professional judgement to the actual circumstances and competing duties.
5. Act, communicate and document the reasoning proportionately.
6. Escalate or seek advice where authority, safety or legal position is uncertain.
7. Review the outcome and identify learning or system action.

Scenario 1. A senior doctor cannot follow a local pathway because the recommended test is unavailable overnight and must document an alternative safe plan.

Reasoning prompt: identify immediate risk; identify the professional source; check any separate legal/local framework; act, communicate, document and escalate proportionately.

Scenario 2. A doctor is told that any deviation from local policy is automatically a GMC breach.

Reasoning prompt: identify immediate risk; identify the professional source; check any separate legal/local framework; act, communicate, document and escalate proportionately.

Scenario 3. A complaint alleges poor communication but no patient harm; the learner must distinguish complaint handling, reflection and regulatory seriousness.

Reasoning prompt: identify immediate risk; identify the professional source; check any separate legal/local framework; act, communicate, document and escalate proportionately.

• GMP is the law.
• A must always means a criminal/statutory duty.
• A should is optional.
• Any breach of GMP means impaired fitness to practise.
• Following local policy automatically proves good professional practice.

• Which professional standard is engaged?
• What other legal, policy or local rules apply?
• Is the wording a GMC must, a should, or a separate legal/local requirement?
• What facts and constraints materially affect the decision?
• Can I explain why this action is defensible?
• Have I documented material departures, constraints and escalation?

Optional reflection

Do not enter identifiable patient, colleague or employer information.

• Where in your own workplace could local custom obscure the underlying professional standard?
• Think of a decision where more than one source of authority applied. What helped you distinguish them?

• The four GMP domains are equally important.
• Professional judgement is required to apply GMP in context.
• Must and should have distinct GMC meanings.
• Local policy and GMC standards are not interchangeable.
• A complaint does not by itself establish impaired fitness to practise.
• Context can explain non-compliance but does not automatically excuse it.
• Revalidation is not a guarantee that every past decision was correct.
• Doctors should be able to explain and justify decisions.
• A single case may engage several domains.
• Legal and regulatory consequences must be analysed separately.

These sources underpin the module. Check current versions for time-sensitive decisions.

• GMC-01 - General Medical Council / Good medical practiceOpen official sourceUK / Professional standards. Current framework; effective 30 Jan 2024 for doctors; updated 13 Dec 2024
• GMC-02 - General Medical Council / About Good medical practiceOpen official sourceUK / Interpretation of standards. Four domains; professional judgement; meaning of must/should
• GMC-07 - General Medical Council / Guidance on supporting information for revalidationOpen official sourceUK / Regulatory/revalidation. Whole-practice appraisal and six supporting-information types
• LAW-01 - UK Parliament / Medical Act 1983Open official sourceUK with statutory detail / Primary legislation. Statutory basis for medical regulation; use current amended text