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Flashcards in GMC guidance Deck (32):
1

4 domains

1. Knowledge, skills and performance

2. Safety and quality

3. Communication, partnership and teamwork.

4. Maintaining trust

2

Domain 1: Knowledge, skills and performance

■ Make the care of your patient your first concern.

● Provide a good standard of practice and care.
● Keep your knowledge and skills up to date.
● Recognise and work within the limits of your competence.
● Regularly take part in activities that maintain and develop your competence and performance

3

Domain 2: Safety and quality

■ Take prompt action if you think that patient safety, dignity or comfort is being compromised.
■ Protect and promote the health of patients and the public.

"Make the care of your patient your first concern"

4

Domain 3: Communication, partnership and teamwork.

● Treat patients as individuals and respect their dignity.
● Treat patients politely and considerately.
● Respect patients’ right to confidentiality.
● Work in partnership with patients.
● Listen to, and respond to, their concerns and preferences.
● Give patients the information they want or need in a way they can understand.
● Respect patients’ right to reach decisions with you about their treatment and care.
● Support patients in caring for themselves to improve and maintain their health.
● Work with colleagues in the ways that best serve patients’ interests.

5

Domain 4: Maintaining trust

■ Be honest and open and act with integrity.
■ Never discriminate unfairly against patients or colleagues.
■ Never abuse your patients’ trust in you or the public’s trust in the profession.

Note:
You are personally accountable for your professional practice and must always be prepared to justify your decisions and actions.

6

‘You must’ - usage

‘You must’ is used for an overriding duty or principle.

7

'You should' - usage

‘You should’ is used:
- when providing an explanation of how you will meet the overriding duty
- where the duty or principle will not apply in all situations or circumstances (due to external factors)

8

Examining patients

"where necessary, examine the patient"

9

English language requirement

"You must have the necessary knowledge of the English language to provide a good standard of practice and care in the UK"

10

Referring to other healthcare professionals
a) patient choice of HCP
b) second opinions
c) your own conscientious objections

a) "Refer a patient to another practitioner when this serves the patient’s needs"
(e.g if there is capacity, patients should be able to see a female doctor if they so wish)

b) "Respect the patient’s right to seek a second opinion"

c) - Explain to patient your objection
- Do not express disapproval/judgement at their decision
- Explain their right to see another doctor
- Support the arrangement to see a colleague if the patient cannot practicably do this themselves

11

Prescribing treatments (without assessing the patient)

"Prescribe drugs or treatment, including repeat prescriptions, only when you have adequate knowledge of the patient’s health and are satisfied that the drugs or treatment serve the patient’s needs"

"Provide effective treatments based on the best available evidence"

12

Treating yourself/people you are close to

You must.... "wherever possible, avoid providing medical care to yourself or anyone with whom you have a close personal relationship"

13

Mentoring and support - is it a 'you must' or 'you should' recommendation?

"You SHOULD be willing to find and take part in structured support opportunities offered by your employer or contracting body (for example, mentoring)"

14

Consent before examination, investigations, treatments, teaching or research

"You must be satisfied that you have consent or other valid authority before:
- you carry out any examination or investigation, or
- provide treatment, or
- involve patients or volunteers in teaching or research".

15

Written records.
a) must be...?
b) when to document?

a) "work must be clear, accurate and legible.

b) "You should make records at the same time as the events you are recording or as soon as possible afterwards"

16

Clinical records: what to include

1. Relevant clinical findings
2. Decisions made and actions agreed, (and who is making the decisions and agreeing the actions)
3. Information given to patients
4. Drugs prescribed, or other investigation or treatment
5. Who is making the record, and when (date and sign)

17

Reviews and auditing

"You must take part in systems of quality assurance and improvement to promote patient safety, including:

a) regular REVIEWS and AUDITS of your work and that of your team, responding constructively to the outcomes, taking steps to address any problems and carrying out further training where necessary

b) regularly REFLECTING on your standards of practice and the care you provide

c) reviewing PATIENT FEEDBACK where it is available

18

Safety reporting.
a) Types of safety reporting/ responding to requests
b) Patient confidentiality

a) - contribute to confidential inquiries
- contribute to adverse event recognition
- report adverse incidents that put or have the potential to put the safety of a patient, or another person, at risk
- report suspected adverse drug reactions
- respond to requests from organisations monitoring public health.

b) "When providing information for these purposes you SHOULD still respect patients’ confidentiality"

19

Breaking confidentiality
a) General principle
b) Adults at risk of harming themselves
c) Requested by law (3 points to follow)
d) Adults who lack capacity
e) Risk of harming others
f) Whose advice may be sought to determine if it is in the public interest to disclose confidential information?
g) After a patient has died

a) Duty of confidentiality must be weighed against duty of care to the patient and others. If confidentiality is to be broken:
-Use the minimum necessary personal information.
-Comply with the law
-Tell patients about disclosure, attempt to gain their consent
- Involve seniors (it is beyond FY1 role)

b) - Support and encourage patients to be involved, as far as they want and are able, in decisions about disclosing their personal information
- If they have capacity and want information to remain confidential that is THEIR RIGHT, even if it puts THEM at risk of harm
- If non-disclosure would but OTHERS at risk of harm, you can break confidentiality
- If practicable, you should not disclose the patient’s identity in contacting and advising others about the risks they face

c) - satisfy yourself that the disclosure is required by law
- only disclose information relevant to the request, and only in the way required by the law
- tell patients about such disclosures whenever practicable, unless it would undermine the purpose of the disclosure to do so

d) If of OVERALL BENEFIT, you can break confidentiality to protect adults who lack capacity from abuse; if you don't believe it to be overall benefit, speak to a senior colleague and document your reasons

e) - domestic abuse victim - if the perpetrator is at large and poses a risk to others
- when a patient is not fit to drive
- they have a serious communicable disease
- pose a serious risk to others by being unfit for work

f) Caldicott, data guardian, similar expert adviser (not directly connected to the patient case)

g) Cannot break, unless risk to others, required by law, etc.

20

Colleague not fit to practise
- raising concerns

"If you have concerns that a colleague may not be fit to practise and may be putting patients at risk, you must ask for advice from:
- a colleague,
- your defence body, or
- GMC

21

Good Samaritan Law.
a) When should you act?
b) What must you also remember to do?
c) When should you NOT act?

a) "You must offer help if emergencies arise in clinical settings or in the community, taking account of your own safety, your competence and the availability of other options for care"

b) - Obtain the patient's consent for any treatment you provide and maintain confidentiality.
- Keep detailed notes of any incidents and the medical care you provide, even in an emergency

c) - It would endanger your safety
- It is outside of your competence
- You are under the influence of alcohol
- When more qualified or able people are available to help

22

Illness/disability.
a) If you have an illness/disability that could affect patient safety or quality?
b) If a colleague has the above

a) "You must consult a suitably qualified colleague. You must follow their advice about any changes to
your practice they consider necessary"

b) - You must support colleagues who have problems with their performance or health.
- But you must put PATIENT SAFETY FIRST at all times

23

Immunisations

"You should be immunised against common serious communicable diseases (unless contraindicated)"

24

Teaching
a) self
b) others

a) "Regularly take part in activities that maintain and develop your competence and performance"

b) "You should be prepared to contribute to teaching and training doctors and students."

25

Handovers.
a) sharing information
b) duty of care

- "Share all relevant information with colleagues involved in your patients’ care within and outside the team (including handovers), and when you delegate care or refer patients to other health or social care providers"

- "When you are off duty, or you delegate the care of a patient to a colleague, you must be satisfied that the person providing care has the appropriate qualifications, skills and experience to provide safe care for the patient"

26

Duty of candour.
a) Explain
b) if someone has suffered harm or distress, you should do what 3 things?

a) "You must be open and honest with patients if things go wrong.

b) If a patient under your care has suffered harm or distress, you should:
1. put matters right (if that is possible)
2. offer an apology
3. explain fully and promptly what has happened and the likely short-term and long-term effects.

27

Prioritising patients

"You must give priority to patients on the basis of their clinical need if these decisions are within your power"

28

If patient has a condition that puts you at risk, should you still treat them?

"You must not deny treatment to patients because their medical condition may put you at risk.
- You should take all available steps to minimise the risk before providing treatment or making other suitable alternative arrangements for providing treatment

29

If a patient has a disability, should you change your practice to accommodate them?

"You must consider and respond to the needs of disabled patients and should make reasonable adjustments to your practice so they can receive care to meet their needs"

30

Patients making complaints against you.
a) How to respond
b) How it affects the care you provide
c) If and when you should end your professional relationship with them
d) If someone you care for or work with asks for your name and GMC number, what must you do?

a) "You must respond promptly, fully and honestly to complaints and apologise when appropriate."

b) "You must not allow a patient’s complaint to adversely affect the care or treatment you provide or arrange"

c) "You should end a professional relationship with a patient only when the breakdown of trust between you and the patient means you cannot provide good clinical care to the patient."

d) "You must give them your registered name and/or GMC reference number"

31

If faced with a conflict of interest, what should you do?

"If you are faced with a conflict of interest:
- you must be open about the conflict,
- declaring your interest formally,
- be prepared to exclude yourself from decision making

32

Accepting gifts

- "You must not ask for or accept – from patients, colleagues or others – any inducement, gift or hospitality that may affect or be seen to affect the way you prescribe for, treat or refer patients or commission services for patients.
- You must not offer these inducements