What does the Good Medical Practice say about Honesty & Doctors?

What is dishonesty?

The GMC’s fitness to practise data shows that the highest number of allegations received by it relates to doctors not acting with honesty and integrity.  This has consistently been the highest category of GMC complaints for several years.

Alleged dishonesty can take many forms and could relate to clinical and/or private circumstances.

In common law, dishonesty is defined as:

“… a jury must first of all decide whether according to the ordinary standards of reasonable and honest people what was done was dishonest … If it was dishonest … then the jury must consider whether the defendant himself must have realised that what he was doing was by those standards dishonest.”

The test for dishonesty therefore is subjective and objective:

• Was the act one that an ordinary, decent person would consider to be dishonest (the objective test)? If so:
• Must the accused have realised that what he was doing was, by those standards, dishonest (the subjective test)?

Dishonesty & Good medical practice

According to GMC guidance:

“Dishonest behaviour can include a wide range of actions or omissions which may arise inside or outside a doctor’s working life. When dishonesty arises in a doctor’s working life, their behaviour may be directed towards patients, former patients, relatives of patients, colleagues, the organisation the doctor is working for or their professional regulator(s). Outside a doctor’s working life, dishonesty may be directed at any person or organisation.”

The Good medical practice states:

• Doctors must make sure their conduct justifies their patients’ trust in them and the public’s trust in the profession [i].
• They must follow the law [ii] and always be honest about their experience, qualifications and current role [iii].
• Good doctors are open and honest with patients if things have gone wrong. Doctors must respond promptly, fully and honestly to complaints and apologise when appropriate [iv].
• Documents made by doctors to formally record their work (including patients’ medical records) must be clear, accurate, contemporaneous and legible [v].
• When writing references and when appraising or assessing the performance of colleagues, doctors must be accurate, fair and objective [vi].
• Doctors must be honest and trustworthy when writing reports; completing or signing forms, reports and other documents; and when giving evidence to courts and tribunals. They must make sure that any information they communicate is not false or misleading. Doctors must take reasonable steps to check the information is correct, must not deliberately leave out relevant information or present opinion as established fact [vii].
• When communicating publicly as a doctor, they must be honest and trustworthy, not exploit people’s lack of medical knowledge and declare any conflicts of interest [viii].
• Conflicts of interest may arise in a range of situations. They are not confined to financial interests and may also include other personal or professional interests. Doctors must not allow any interests they have to affect, or be seen to affect, the way they propose, provide or prescribe treatments, refer patients or commission services [ix]. Nor must they ask for, accept or offer an incentive which may affect, or be seen to affect, these things [x].
• When designing, organising or carrying out research, doctors must put the interests of participants first, act with honesty, follow national research governance guidelines and GMC guidance [xi].

Good medical practice

• “Good Medical Practice is the most important”- High Court
• Good Medical Practice – when was the last time you actually read it?

It is worth pointing out that the extent to which a doctor has departed from the Good medical practice is a relevant (aggravating) consideration by the GMC (or a tribunal) when considering the appropriate sanction.

Continued below ↓

Unique and practical courses focusing on impairment, reflection, insight, and remediation at highly competitive prices.

Legal Advice & Representation in cases of dishonest doctors

Dishonesty is particularly problematic for the GMC because it points to character flaws that are difficult to remediate and doctors are at high risk of erasure or facing a lengthy suspension.

Engagement with the GMC in cases where dishonesty is alleged is key because it gives the doctor opportunities to respond to allegations and, where appropriate, offer a defence and challenge evidence.  However, key to all the aforementioned is specialist legal advice and representation.

Reflecting on such cases, fitness to practise defence barrister, Catherine Stock, comments:

“In cases of dishonesty before any healthcare regulator, a sanction of erasure is nearly always an option for the GMC or a tribunal. However, any fitness to practise hearing whether it be a substantive hearing, a review or restoration, being able to demonstrate insight and remediation is tantamount and something that is not easy to achieve without specialist advice.”

The importance of engagement was further reinforced in Parkinson v Nursing and Midwifery Council [2010] EWHC 1898 (Admin), where Mitting J said:

“A [registrant] found to have acted dishonestly is always going to be at severe risk of having his or her name erased from the register. A [registrant] who has acted dishonestly, who does not appear before the Panel either personally or by solicitors or counsel to demonstrate remorse, a realisation the conduct criticised was dishonest, and an undertaking that there will be no repetition, effectively forfeits the small chance of persuading the Panel to adopt a lenient or merciful outcome and to suspend for a period rather than to direct erasure.”

Although an NMC case, what Mitting J said applies equally in GMC cases.

Specifically on the topic of insight and remediation, the lack of clear and robust evidence of insight and remorse will be seen as a lack of understanding of the significance of a doctor’s behaviour that will almost certainly lead to the GMC or a tribunal concluding that there is a real risk of repetition.

That said, remediation, and evidence thereof, is not impossible, but it will most likely be a very long process that forms part of a clear defence strategy.  Legal advice and a clear working strategy are both key to good outcomes for doctors facing allegations of dishonesty. 

[i] Good medical practice 2024 paragraph 81

[ii] Good medical practice 2024 paragraph 4

[iii] Good medical practice 2024 paragraph 82

[iv] Good medical practice 2024 paragraph 46

[v] Good medical practice 2024 paragraph 69

[vi] Good medical practice 2024 paragraph 62

[vii] Good medical practice 2024 paragraph 89

[viii] Good medical practice2024 paragraph 90

[ix] Good medical practice 2024 paragraph 94

[x] Good medical practice 2024 paragraph 95

[xi] Good medical practice 2024 paragraph 85

Is legal representation the answer?

It is widely accepted and proven that legal representation makes a real difference to the outcome of investigations and results in lesser sanctions for doctors.

What is also unquestionably clear is that GMC investigations and MPTS hearings are complex, daunting, prolonged and legalistic leaving doctors stressed and anxious.  Where legal advice and representation can have the biggest impact on this, is helping doctors understand the process, what to expect and how to engage with the GMC during an investigation and hearing.

Research has shown that registrant’s engagement and legal representation can impact on decisions about seriousness, and that the lack of legal representation has been identified as being associated with more severe sanctions outcomes in fitness to practise cases, stating:

“Legal representation was seen as important by participants because legal advice could support and guide registrants through the FtP process, which is complex and legalistic. Legal advice was seen as important in aiding registrants to understand regulators’ expectations, especially in terms of the need for registrants to demonstrate insight and perhaps to show evidence of remediation activities. Lack of legal representation was, therefore, seen to potentially have an impact in terms of the seriousness of the outcome for registrants who are perhaps unaware of how to present their case to best effect.”

 A compassionate approach to legal representation

The right legal advice and representation is not just about the legalities and technicalities of a case.  Our barristers fully understand the stress and anxiety that doctors experience during prolonged GMC investigations.

We also understand that we are working with people who are anxious and worried about what investigations might mean for them, their professions and the reputations.

We never lose sight of the human aspects of FtP investigations and hearings.  We will always give an open and honest assessment of cases, but we will marry that with an approach that also supports health and care professionals through the duration of a case.

“I was not optimistic about the case, I felt that it is a lost case that we couldn’t do much about and especially just before the start of the trial I lost my confidence and was very nervous. Mr McCaffrey was there to prove me wrong. He turned everything around in a victorious , panegyric manner. I was stunned.” – CL

Catherine is professional, empathic and very knowledgeable. She provided all the necessary assistance throughout the long thorough investigation. – AR

A colleague recommended me to Catherine. She was very experienced , professional, empathetic , non-judgemental and listened to me. – Mel

I found myself consumed with dark thoughts, isolated and afraid. Stephen worked with me and slowly but surely formulated a plan not to just to fight my case and win, but to build me back up bit by bit so as to prepare me to face external scrutiny and present with confidence to panels where this was necessary. – FJ

What you can Expect when Instructing Kings View

All clients are entitled to an initial, no obligation and free telephone consultation about their case.  During this consultation, we will outline the stages and next steps, including indicative timeframes and fixed price quotations for preparation and representation and confirmed in writing at each and every stage.

We understand that timescales are entirely dependent on the stage you are at in proceedings, what work needs to be done and dictated by internal investigations or hearing dates.  We always meet those timescales however should more time be needed, then we will apply for such on your behalf and with your permission.

Contact us today for a no obligation and free telephone consultation about your case in the knowledge that you are speaking to one of the best in the business.

Disclaimer: This article is for guidance purposes only. Kings View Chambers accepts no responsibility or liability whatsoever for any action taken, or not taken, in relation to this article. You should seek the appropriate legal advice having regard to your own particular circumstances.