good psychiatric practice

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Good

PsychiatricPractice

Royal College ofPsychiatristsCollege Report CR154

ContentsThe duties o a doctor registered with the GMC

Core attributes good psychiatrists

Good clinical care

Maintaining good practice

Teaching, training, appraising and assessing

Relationships with patients

Consent

Confdentiality

Working with colleagues

Working with management

Research

Probity

3rd edition


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Good

PsychiatricPractice

3rd edition

College Report CR154


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First edition published as Good Psychiatric Practice 2000. The Royal College o Psychiatrists 2000.

Second edition The Royal College o Psychiatrists 2004.

Third edition The Royal College o Psychiatrists 2009.

All rights reserved. No part o this book may be reprinted or reproduced or utilised in any orm or byany electronic, mechanical or other means, now known or hereater invented, including photocopyingand recording, or in any inormation storage or retrieval system, without permission in writing rom thepublishers.

British Library Cataloguing-in-Publication Data

A catalogue record or this book is available rom the British Library.ISBN 978-1-904671-76-3

This report has been approved by a meeting o the Central Policy Coordination Committee and constitutesofcial College policy until revised or withdrawn. For ull details o reports available and how to obtainthem, contact Book Sales at the Royal College o Psychiatrists, 17 Belgrave Square, London SW1X 8PG(tel: 020 7235 2351; ax: 020 7245 1231; http://www.rcpsych.ac.uk).

The Royal College o Psychiatrists is a charity registered in England and Wales (228636) and in Scotland(SC038369).

Printed in Great Britain by Henry Ling Ltd, The Dorset Press, Dorchester.

Approved by the Central Policy Coordination Committee: February 2009

Due or review: 2014


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Contents

4 Introduction

5 The duties o a doctor registered with the GMC

6 Core attributes good psychiatrists

Good clinical care

7 GMC standards

9 RCPsych standards

Maintaining good practice

13 GMC standards

14 RCPsych standards

Teaching, training, appraising and assessing16 GMC standards


Relationships with patients

18 GMC standards


Consent

23 GMC standards

24 RCPsych standardsConfdentiality

25 GMC standards


Working with colleagues

27 GMC standards


Working with management

33 GMC standards34 RCPsych standards

Research

35 GMC standards


Probity

37 GMC standards



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RCPsych Good PsychiatricPracticeIntroduction

Good Psychiatric Practice sets out standards o practice or psychiatrists. It

is aligned to the General Medical Councils (GMCs) Good Medical Practice(2006), the standards or all medical practitioners. In this edition, the GMCstandards or Good Medical Practice (2006) are ollowed by the additional

standards required or good psychiatric practice. Repetition o standards isavoided where possible. Good Medical Practice (2006) is not reproduced inull in this document and is available at www.gmc-uk.org/guidance/good_

medical_practice/index.asp.

CR154 replaces the second edition oGood Psychiatric Practice (CR125). The

document has been revised with the GMCs approach to revalidation in mind.

The standards set out in Good Psychiatric Practice are those psychiatristswill need to meet or recertication in the UK. Reerence is also made to legal

principles relevant to the UK. The standards o practice do, however, apply tomembers o the Royal College o Psychiatrists, or other psychiatrists, whatevertheir grade, whatever the clinical setting and wherever they are practising.

Good Psychiatric Practice does not set out the competencies o psychiatricpractice, nor those o the practice o subspecialties. Competencies are detailedin the competency based curriculum available on the College website (www.

rcpsych.ac.uk/training/curriculum.aspx)

For ease o reerence and continuity, the ramework o the document has beenrevised to ollow that oGood Medical Practice (2006).

Good Psychiatric Practice should be read in conjunction with the ollowing

guidance documents published by the College in the Good Psychiatric Practiceseries. The dates and reerences o these documents will change over time.

Good Psychiatric Practice: Confdentiality and Inormation Sharing (CR133)(2006)

Vulnerable Patients, Sae Doctors: Good Practice in our Clinical

Relationships (CR146) (2007)

Sexual Boundary Issues in Psychiatric Settings (CR145) (2007)

Good Psychiatric Practice: Continuing Proessional Development (CR90)(2001)

Good Psychiatric Practice: Relationships with Pharmaceutical and Other

Commercial Organisations (CR148) (2008)

Court Work (CR147) (2008)

The above reports, and many others, are available in PDF ormat on the

Colleges website at www.rcpsych.ac.uk/publications/collegereports/college

reports.aspx. Some reports have been printed, and hard copies o these areavailable or purchase rom the Colleges Book Sales Oce.


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GMC Good MedicalPractice 2006 The duties o a doctor registered with the GMC

Patients must be able to trust doctors with their lives and health. To justiy that trust, you

must show respect or human lie and you must:make the care o the patient your rst concern

protect and promote the health o patients and the public

provide a good standard o practice and care

keep your proessional knowledge and skills up to date

recognise and work within the limits o your competence

work with colleagues in the ways that best serve patients interests

treat patients as individuals and respect their dignity

treat patients politely and considerately

respect patients right to condentiality

work in partnership with patients

listen to patients and respond to their concerns and preerences

give patients the inormation 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 or themselves to improve and maintain their health

be honest and open and act with integrity

act without delay i you have good reason to believe that you or a colleague may

be putting patients at risk

never discriminate unairly against patients or colleagues

never abuse your patients trust in you or the publics trust in the proession.

You are personally accountable or your proessional practice and must always be

prepared to justiy your decisions and actions.

Gooddoctors

Patients need good doctors. Good doctors make the care o their patients their rst1

concern: they are competent, keep their knowledge and skills up to date, establish

and maintain good relationships with patients and colleagues, are honest and

trustworthy, and act with integrity.


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RCPsych Good PsychiatricPractice

6

Core attributes good psychiatrists

Patients, their carers, their amilies and the public need good psychiatrists.

Good psychiatrists make the care o their patients their rst concern: they arecompetent; keep their knowledge up to date; are able and willing to use newresearch evidence to inorm practice; establish and maintain good relationshipswith patients, carers, amilies and colleagues; are honest and trustworthy, and

act with integrity. Good psychiatrists have good communication skills, respector others and are sensitive to the views o their patients, carers and amilies.

A good psychiatrist must be able to consider the ethical implications otreatment and clinical management regimes. The principles o airness, respect,

equality, dignity and autonomy are considered undamental to good ethical

psychiatric practice. A good psychiatrist will take these issues into accountwhen making decisions, and will need to pay particular attention to issues

concerning boundaries and the vulnerability o individual patients. A goodpsychiatrist will not enter into a relationship with a patient or with someonewho has been a patient.

Unacceptable psychiatric practice will include ailure to adhere to the standards

set in this document.


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GMC Good MedicalPractice 2006 Good clinical care

ProvidinGGoodclinicalcare

Good clinical care must include:2

adequately assessing the patients conditions, taking account o the history(a)

(including the symptoms, and psychological and social actors), the patients

views and where necessary examining the patient

providing or arranging advice, investigations or treatment where necessary(b)

reerring a patient to another practitioner, when this is in the patients best(c)

interests.

In providing care you must:3

recognise and work within the limits o your competence(a)prescribe drugs or treatment, including repeat prescriptions, only when you have(b)

adequate knowledge o the patients health, and are satised that the drugs or

treatment serve the patients needs

provide eective treatments based on the best available evidence(c)

take steps to alleviate pain and distress, whether or not a cure may be(d)

possible

respect the patients right to seek a second opinion(e)

keep clear, accurate and legible records, reporting the relevant clinical ndings,()

the decisions made, the inormation given to patients, and any drugs prescribedor other investigations or treatment

make records at the same time as the events you are recording or as soon as(g)

possible aterwards

be readily accessible when you are on duty(h)

consult and take advice rom colleagues, when appropriate(i)

make good use o the resources available to you.(j)

suPPortinGself-care

You should encourage patients and the public to take an interest in their health and4to take action to improve and maintain it. This may include advising patients on the

eects o their lie choices on their health and well-being and the possible outcomes

o their treatments.

avoidtreatinGthoseclosetoyou

Wherever possible, you should avoid providing medical care to anyone with whom5

you have a close personal relationship.


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GMC Good MedicalPractice 2006

raisinGconcernsaboutPatients safety

I you have good reason to think that patient saety is or may be seriously6

compromised by inadequate premises, equipment or other resources, policies or

systems, you should put the matter right i that is possible. In all other cases you

should draw the matter to the attention o your employing or contracting body. Ithey do not take adequate action, you should take independent advice on how to

take the matter urther. You must record your concerns and the steps taken to try

to resolve them.

decisionsaboutaccesstomedicalcare

The investigations or treatment you provide or arrange must be based on the7

assessment you and the patient make o their needs and priorities, and on your

clinical judgement about the likely eectiveness o the treatment options. You must

not reuse or delay treatment because you believe that a patients actions havecontributed to their condition. You must treat your patients with respect whatever

their lie choices and belies. You must not unairly discriminate against them by

allowing your personal views to aect adversely your proessional relationship with

them or the treatment you provide or arrange. You should challenge colleagues i

their behaviour does not comply with this guidance.

I carrying out a procedure or giving advice about it conficts with your religious or8

moral belies, and this confict might aect the treatment or advice you provide,

you must explain this to the patient and tell them they have the right to see another

doctor. You must be satised that the patient has sucient inormation to enable

them to exercise that right. I it is not practical or a patient to arrange to see anotherdoctor, you must ensure that arrangements are made or another suitably qualied

colleague to take over your role.

You must give priority to the investigation and treatment o patients on the basis o9

clinical need, when such decisions are in your power. I inadequate resources, policies

or systems prevent you rom doing this, and patient saety is or may be seriously

compromised, you must ollow the guidance in paragraph 6.

All patients are ent itled to care and treatment to meet their clinical needs. You10

must not reuse to treat a patient because their medical condition may put you at

risk. I a patient poses a risk to your health or saety, you should take all availablesteps to minimise the risk beore providing treatment or making suitable alternative

arrangements or treatment.

treatmentinemerGencies

In an emergency, wherever it arises, you must oer assistance, taking account o your11

own saety, your competence and the availability o other options or care.


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RCPsych Good PsychiatricPractice Good clinical care

Good psychiatric practice involves providing the best level o clinical care that is

commensurate with training, experience and the resources available. It involvesthe ability to ormulate a diagnosis and management plan based on otencomplex evidence rom a variety o sources. Good psychiatric practice involvesthe particular skills o being a good listener and good communicator.

ensurinGGoodclinicalcare

A psychiatrist must undertake competent assessments o patients with1mental health problems and must:

be competent in obtaining a ull and relevant history that incorporates(a)developmental, psychological, social, cultural and physical actors,

and:

be able to gather this inormation in diicult or complicatedi

situations

in situations o urgency, prioritise what inormation is needed toiiachieve a sae and eective outcome or the patient

seek and listen to the views and knowledge o the patient, theiriiicarers and amily members and other proessionals involved in

the care o the patient

have knowledge o:(b)

human development and developmental psychopathology, and theiinfuence o social actors and lie experiences

gender and age dierences in the presentation and managementii

o psychiatric disorders

biological and organic actors present in many psychiatric disordersiii

the impact o alcohol and substance misuse on physical andiv

mental healthbe competent in undertaking a comprehensive mental state(c)

examination

be competent in evaluating and documenting an assessment o clinical(d)

risk, considering harm to sel, harm to others, harm rom others, sel-neglect and vulnerability

be competent in determining the necessary physical examination and(e)investigations required or a thorough assessment

ensure that they are competent and trained, where appropriate,()in the use o any assessment or rating tools used as part o the

assessment.


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A psychiatr ist must demonstra te a consul tat ion sty le that osters a2therapeutic alliance with the patient and, where appropriate, their carersand amilies, and must:

endeavour to maximise patient participation in assessment and(a)

treatment planningcommunicate eectively with patients, carers and amilies using(b)

verbal, non-verbal and written skills as appropriate, taking into accountwhatever additional support may be required to meet any languageor communication needs.

In making the diagnosis and dierential diagnosis, a psychiatrist should3use a widely accepted diagnostic system.

A psychiatrist must appropriately assess situations where the level o4disturbance is severe and risk o adverse events, such as injury to sel or

others, or harm rom others, may be high, and take appropriate clinicalaction.

A psychiatrist must work with patients, carers and the multidisciplinary5team to make management decisions that balance risks to the patient or

the public with the desire to acilitate patient independence. This shouldinvolve consideration o positive therapeutic risk-taking.

A psychiatr ist must ensure that treatment is planned and delivered6eectively, and must:

ormulate a care plan that relates to the patients goals, symptoms,(a)

diagnosis, risk, outcome o investigations and psychosocial context;this should be carried out in conjunction with, and agreed with, thepatient, unless this is not easible

i the treatment proposed is outside existing clinical guidelines or(b)the product license o medication, discuss and obtain the patients

agreement, and where appropriate, the agreement o carers andamily members

involve detained patients in treatment decisions as much as possible,(c)taking into account their mental health and the need to provide

treatment in their best interests

recognise the importance o amily and carers in the care o patients,(d)

share inormation and seek to ully involve them in the planning andimplementation o care and treatment, having discussed this with andconsidered the views o the patient.

A psychiatrist must have specialist knowledge o treatment options in the7clinical areas within which they are working and, more generally, knowledge

o treatment options within mental health. The psychiatrist must:


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ensure that treatments take account o clinical guidance available rom(a)relevant bodies/the College/scientic literature, and be able to justiyclinical decisions outside accepted guidance

have knowledge or, when needed, seek specialist advice in the(b)

prescribing o psychotropic medication; in so doing, the psychiatristmust have an understanding o the eects o prescription drugs, bothbenecial and adverse

have knowledge o the basic principles o the major models o psycho-(c)logical treatments, and only undertake psychological interventions

within their competence

understand the range o clinical interventions available within mental(d)

health services and arrange reerrals where appropriate to the needso the patient

have sucient knowledge and skills o psychiatric specialties other(e)than their own in order to be able to provide emergency assessment,

care and advice in situations where specialist cover is not immediatelyavailable.

A psychiatrist must reer patients to other services or colleagues as8indicated by clinical need and local protocols:

the psychiatrist should acilitate the smooth transer o care between(a)

services, and provide a comprehensive summary o the clinical caseto the receiving doctor/proessional to enable them to take over thesae management and treatment o the patient

when discharging rom care, the psychiatrist should inorm the patient,(b)the reerrer and the primary care team about the possible indications

or uture treatment and how to access help in uture

i there are disagreements or diculties about transer arrangements,(c)the psychiatrist must ensure that the saety o the patient and othersremains the rst concern and must acilitate the swit resolution o

any diculties.

A psychiatrist must recognise the limits o their own competence, and9 value and utilise the contribution o peers, multidisciplinary colleagues

and others as appropriate.

A psychiatrist should seek and careully consider advice, assistance or a10second opinion i there are uncertainties in diagnosis and management,or i there is confict between the clinical team and the patient or their

carer and amily.

A psychiatrist should be readily accessible to patients and colleagues11

when on duty.


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A psychiatrist must maintain knowledge o current mental health and other12legislation as it applies to psychiatric practice, ensuring that it is appliedappropriately in clinical practice.

A psychiatrist must provide care that does not discriminate and is sensitive13

to issues o gender, ethnicity, colour, culture, liestyle, belies, sexualorientation, age and disability.

A psychiatrist must maintain a high standard o record-keeping:14

good psychiatric practice involves keeping complete and under-(a)standable records and adhering to the ollowing:

handwritten notes must be legible, dated and signed with theidoctors name and title printed

electronic records must be detailed, accurate and veriedii

a record must be kept o all assessments and signicant clinicaliiidecisions

the reasoning behind clinical decisions must be explained andiv

understandable in the record and, i appropriate, an accounto alternative plans considered but not implemented must berecorded

the record should include inormation shared with or received romvcarers, amily members or other proessionals

notes must not be tampered with, changed or added to once theyvi

have been signed or veried, without identiying the changes, andsigning and dating them.

the psychiatrist should ensure that a process is in place to obtain(b)and record in the clinical record patients consent to share clinicalinormation, and that this is completed or patients with whom they

have direct contact and or whom the have clinical responsibility

i the psychiatrist has agreed to provide a report, this must be(c)completed in a timely ashion so that the patient is not disadvantagedby delay

letters with details o the treatment plan should be provided to patients(d)ollowing a consultation.

A psychiatrist must communicate treatment decisions, changes in treatment15plans and other necessary inormation to all relevant proessionals and

agencies, with due regard to condentiality.


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GMC Good MedicalPractice 2006 Maintaining good medical practice

Keepinguptodate

You must keep your knowledge and skills up to date throughout your working lie.12You should be amiliar with relevant guidelines and developments that aect your

work. You should regularly take part in educational activities that maintain and urther

develop your competence and perormance.

You must keep up to date with, and adhere to, the laws and codes o practice13

relevant to your work.

MaintainingandiMprovingyourperforMance

You must work with colleagues and patients to maintain and improve the quality o14

your work and promote patient saety. In particular, you must:

maintain a older o inormation and evidence, drawn rom your medical(a)

practice.

refect regularly on your standards o medical practice in accordance with GMC(b)

guidance on licensing and revalidation.

take part in regular and systematic audit.(c)

take part in systems o quality assurance and quality improvement.(d)

respond constructively to the outcome o audit, appraisals and perormance(e)

reviews, undertaking urther training where necessary.help to resolve uncertainties about the eects o treatments.()

contribute to condential inquiries and adverse event recognition and reporting,(g)

to help reduce risk to patients.

report suspected adverse drug reactions in accordance with the relevant reporting(h)

scheme.

Co-operate with legitimate requests or inormation rom organisations monitoring(i)

public health when doing so you must ollow the guidance in Confdentiality:

Protecting and Providing Inormation.


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RCPsych Good PsychiatricPracticeMaintaining good psychiatric practice

Lielong learning is expected o all doctors. Patients rightly expect the

knowledge and skills o a psychiatrist to be up to date. The process oremaining up to date is not only the demonstrable acquisition o inormationbut also the establishment o a process o personal learning that enables apsychiatrist to maintain development, learning, competence and perormance

over the course o their proessional career. As most psychiatrists work inteams, learning may be team based as well as individual. Psychiatrists shouldrecognise that learning comes rom a variety o methods. These include

listening to the experiences o their patients and colleagues, reading journals,attending conerences, and learning rom complaints and adverse incidents,rom clinical audit and rom the review o outcome measures.

maintaininGlifelonGlearninG

A psychiatrist must ensure that their continuing proessional development16(CPD) activities are at least equivalent to those that will allow them to bein good standing or CPD within the College. In particular, the psychiatrist

should:

undertake CPD activities that refect the needs o their current and(a)planned proessional activities

keep up to date with clinical advances relevant to their practice(b)

take advice rom colleagues and rom the appraisal process when(c)determining their CPD activities

be able to provide evidence o learning rom private study and(d)meetings attended, or example by documented refection on the keylearning points, and demonstrate that new knowledge is incorporated

into clinical practice.

A psychiatrist must take part in and, where appropriate, lead on processes17

that aim to monitor and maintain the quality o clinical care and patientsaety. In particular, the psychiatrist:

should take part in quality monitoring programmes such as clinical(a)

audit, national audits, condential inquiries, use o outcome measures,benchmarking and accreditation schemes

should be knowledgeable about audit methodology and participate(b)in clinical audit to measure and improve clinical care provided bythemselves and their team

should, where possible, work with colleagues to determine and(c)

monitor meaningul measures o clinical outcome


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must approach adverse incidents and complaints that involve both(d)themselves and their team as learning opportunities, refecting onlessons to be learned and lessons to be shared

must respond to the results o audit, quality monitoring programmes(e)

and investigations to improve practise, undertaking urther training orproessional development as appropriate.

A psychiatrist must participate in regular appraisal o their work in an18open manner, using the appraisal process to guide their proessionaldevelopment.

A psychiatrist must be up-to-date with the relevant law, codes o practice19

and statutory body regulations that govern medical practice, includingHuman Rights legislation, and legislation covering equality and diversity,and capacity.

A psychiatrist must accept and actively par ticipate in appropriate20

supervision o their clinical and other work.


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GMC Good MedicalPractice 2006Teaching, training, appraising and assessing

Teaching, training, appraising and assessing doctors and students are important15

or the care o patients now and in the uture. You should be willing to contribute to

these activities.

I you are involved in teaching you must develop the skills, attitudes and practices16

o a competent teacher.

You must make sure that all sta or whom you are responsible, including locums17

and students, are properly supervised.

You must be honest and objective when appraising or assessing the perormance18

o colleagues, including locums and students. Patients will be put at risk i you

describe as competent someone who has not reached or maintained a satisactory

standard o practice.You must provide only honest, justiable and accurate comments when giving19

reerences or, or writing reports about, colleagues. When providing reerences you

must do so promptly and include all inormation that is relevant to your colleagues

competence, perormance or conduct.


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RCPsych Good PsychiatricPractice Teaching, training, appraising and assessing

Teaching and training are an important aspect o the role o a psychiatrist.

They involve teaching not only doctors and medical students but also otherproessionals and, where appropriate, members o the public.

standardsforPsychiatristsinvolvedinteachinG, traininG, aPPraisinGandassessinG

The content o teaching must provide an accurate representation o current21

knowledge in the area.

Inormation must be provided in a orm suitable or the audience and be22

based on an understanding o the principles o education and learning.Patients must be asked to consent beore they are involved in teaching23and training.

Written inormed consent must be obtained beore a patients personal data24

are used or the purposes o public teaching, training or presentations.

Written inormed consent must be obtained beore the recording, including25video recording, o patient interviews. Consent or any subsequent use ordisclosure o the recording must be obtained.

Constructive criticism must be provided, when necessary, to improve26perormance and clinical skills.

As an appraiser, a psychiatrist must maintain high proessional standards.27In particular, the psychiatrist must ensure that:

the appraisal is conducted in a way that acilitates the development(a)o their colleague

appropriate aspects o the appraisal process remain condential, while(b)

at the same time raising concerns with others where this is necessary

to ensure patient saety.


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GMC Good MedicalPractice 2006Relationships with patients

thedoctorPatientPartnershiP

Relationships based on openness, trust and good communication will enable you to20work in partnership with your patients to address their individual needs.

To ull your role in the doctorpatient partnership you must:21

be polite, considerate and honest(a)

treat patients with dignity(b)

treat each patient as an individual(c)

respect patients privacy and right to condentiality(d)

support patients in caring or themselves to improve and maintain their health(e)

encourage patients who have knowledge about their condition to use this when()

they are making decisions about their care.

Goodcommunication

To communicate eectively you must:22

listen to patients, ask or and respect their views about their health, and respond(a)

to their concerns and preerences

share with patients, in a way they can understand, the inormation they want(b)

or need to know about their condition, its likely progression, and the treatmentoptions available to them, including associated risks and uncertainties

respond to patients questions and keep them inormed about the progress o(c)

their care

make sure that patients are inormed about how inormation is shared within(d)

teams and among those who will be providing their care.

You must make sure, wherever pract ical, that arrangements are made to meet23

patients language and communication needs.

childrenandyounGPeoPle

The guidance that ollows in paragraphs 2527 is relevant whether or not you24

routinely see children and young people as patients. You should be aware o the

needs and welare o children and young people when you see patients who are

parents or carers, as well as any patients who may represent a danger to children

or young people.

You must saeguard and protect the health and well-being o children and young25

people.


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You should oer assistance to children and young people i you have reason to think26

that their rights have been abused or denied.

When communicating with a child or young person you must:27

treat them with respect and listen to their views(a)answer their questions to the best o your ability(b)

provide inormation in a way they can understand(c)

The GMC gives urther online ethical guidance in 018 years: Guidance or All Doctors.

relatives, carersandPartners

You must be considerate to relatives, carers, partners and others close to the patient,29

and be sensitive and responsive in providing inormation and support, including

ater a patient has died. In doing this you must ollow the guidance in Confdentiality:

Protecting and Providing Inormation.

beinGoPenandhonestwithPatientsifthinGsGowronG

I a patient under your care has suered harm or distress, you must act immediately30

to put matters right, i that is possible. You should oer an apology and explain

ully and promptly to the patient what has happened, and the likely short-term and

long-term eects.

Patients who complain about the care or treatment they have received have a right to31

expect a prompt, open, constructive and honest response including an explanationand, i appropriate, an apology. You must not allow a patients complaint to aect

adversely the care or treatment you provide or arrange.

maintaininGtrustintheProfession

You must not use your proessional position to establish or pursue a sexual or32

improper emotional relationship with a patient or someone close to them.

You must not express to your patients your personal belies, including political,33

religious or moral belies, in ways that exploit their vulnerability or that are likely to

cause them distress.You must take out adequate insurance or proessional indemnity cover or any part34

o your practice not covered by an employers indemnity scheme, in your patients

interests as well as your own.

You must be amiliar with your GMC reerence number. You must make sure you are35

identiable to your patients and colleagues, or example by using your registered

name when signing statutory documents, including prescriptions. You must make

your registered name and GMC reerence number available to anyone who asks

or them.


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endinGyourProfessionalrelationshiPwithaPatient

In rare circumstances, the trust between you and a patient may break down, and38

you may nd it necessary to end the proessional relationship. For example, this

may occur i a patient has been violent to you or a colleague, has stolen rom the

premises, or has persistently acted inconsiderately or unreasonably. You should notend a relationship with a patient solely because o a complaint the patient has made

about you or your team, or because o the resource implications o the patients

care or treatment.

Beore you end a proessional relationship with a patient, you must be satised that39

your decision is air and does not contravene the guidance in paragraph 7 [oGood

Medical Practice]. You must be prepared to justiy your decision. You should inorm

the patient o your decision and your reasons or ending the proessional relationship,

wherever practical in writing.

You must take steps to ensure that arrangements are made promptly or the continuing40care o the patient, and you must pass on the patients records without delay.


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RCPsych Good PsychiatricPractice Relationships with patients

Good psychiatric practice and successul relationships between psychiatrists

and patients depend on respect, openness, trust and good communication.The need or psychiatrists to develop trusting relationships with patients may

be more dicult where patients need to be detained against their wishes and/or treatments given without consent, or when concerns arise regarding thesaeguarding o children and vulnerable adults.

It is also important or psychiatrists to develop trusting relationships with the

carers and amilies o their patients when this is appropriate and with theagreement o the patient.

It may not be possible or appropriate or psychiatrists to provide, or reer onor, the treatment interventions requested by patients. The psychiatrist must

at all times act in the best interests o the patient.

Particular attention must be paid to the vulnerability o some patients andto the need to maintain clear boundaries in proessional relationships withall patients. The College has published detailed guidance on maintaining

boundaries and on sexual boundary issues. Psychiatrists must be amiliar withthe ollowing documents: Vulnerable Patients, Sae Doctors: Good Practice

in our Clinical Relationships (CR146); Sexual Boundary Issues in Psychiatric

Settings (CR145).

establishinGandmaintaininGtrustandGoodcommunication

A psychiatrist must listen to the patient, ask or and respect their views,28and must:

respect the patients right to seek a second opinion(a)

respect the patients right to decline to take part in teaching or(b)

research and ensure that reusal does not adversely aect care and

treatmentrespect the patients right to lodge a complaint or appeal, and ensure(c)that this does not adversely aect care and treatment

consider and explain to the patient the risks and benets o acting in(d)accordance with or against the patients expressed wishes.

A psychiatrist must provide inormation, both verbal and written, to support29patients in maintaining their health. In particular, the psychiatrist must:

provide inormation in understandable terms regarding diagnosis,(a)

treatment, prognosis and the support services available; this shouldrecognise diversity o language, literacy and verbal skills


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i any medication is prescribed, provide inormation about side-eects(b)and, where appropriate, dosage, as well as relevant inormation shouldan o-license drug be recommended.

A psychiatrist must respect a patients right to be accompanied, supported30or represented by their choice o carer, amily, riend or advocate.

When negotiating the aims and outcomes o treatment plans, a psychiatrist31

must recognise and respect the diversity o patients liestyles, includingcultural issues, religious and spiritual belies, ambitions and personalgoals.

A psychiatr ist must take a child-centred, developmentally appropriate32

approach to engaging, assessing and communicating with children thatis at the same time respectul o their parents, amily and carers.

Following an incident o harm to a patient, a psychiatrist must explain ully33and promptly to the patient, and amily and carers where appropriate, what

has happened and the likely long- and short-term eects o such harm.The psychiatrist should act immediately to put matters right i possible

and, where appropriate, oer an apology:

in the case o an adult patient who lacks capacity, the explanation(a)should be given to a person with responsibility or the care and welareo the patient, or the patients partner, close relative or a riend who

has been involved in the care o the patient, unless there is reason tobelieve the patient would have objected to the disclosure

in the case o children, the incident should be explained to those with(b)parental responsibility and to the child i the child has the maturity tounderstand the issues.


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GMC Good MedicalPractice 2006 Consent

You must be satised that you have consent or other valid authority beore you36

undertake any examination or investigation, provide treatment or involve patients

in teaching or research. Usually this will involve providing inormation to patients

in a way they can understand, beore asking or their consent. You must ollow the

guidance in Seeking patients consent: The ethical considerations, which includes

advice on children and patients who are not able to give consent.


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RCPsych Good PsychiatricPracticeConsent

Psychiatrists oten decide on treatment options, and also on detention o

patients, where the patient is either unwilling to consent or lacks capacity tomake a judgement. Psychiatrists must ensure that the principle o airnessinorms all their decisions concerning patients, irrespective o the patientsage or capacity.

GoodPsychiatricPracticeinrelationtoconsent

A psychiatrist must participate in hearings and tribunals, and other similar34activities that protect the rights o the patient, in a timely and appropriatemanner, ensuring adherence to mental health legislation relating to consent

to treatment and detention. The psychiatrist must provide written reportsas required.

A psychiatrist must engage the patient and, where appropriate, carers,35amily members and patient advocates (particularly any person with

the right to consent or the patient) in ull and open discussions abouttreatment options.

Where patients have capacity to make a decision, a psychiatrist must36ensure that the patients valid consent to any proposed treatment is sought

and their decision recorded.A psychiatrist must demonstrate an awareness o the rights o children and37the responsibilities o parents when deciding on treatment options.

Where the issues are complex, unclear or beyond their competence, a38psychiatrist must seek legal advice and a second opinion.


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GMC Good MedicalPractice 2006 Condentiality

Patients have a right to expect that inormation about them will be held in condence37

by their doctors. You must treat inormation about patients as condential, including

ater a patient has died. I you are considering disclosing condential inormation

without a patients consent, you must ollow the guidance in with Confdentiality:

Protecting and providing inormation.


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RCPsych Good PsychiatricPracticeCondentiality

Patients have a right to expect that inormation about them will be held in

conidence by psychiatrists. Inormation about patients must be treatedas condential. There will be circumstances when, in the best interest othe patient or the public, disclosure o conidential inormation without apatients consent is considered. This includes disclosure o inormation to

carers and amilies. In so doing, a psychiatrist must ollow the GMC guidanceConfdentiality: Protecting and Providing Inormation (in the ethical guidanceseries) and the detailed guidance in the College document Good Psychiatric

Practice: Confdentiality and Inormation Sharing (CR133). A psychiatrist musthave knowledge o and practise in accordance with the Data Protection Act,the policies and inormation-sharing protocols o employing and partner

organisations, and seek the advice o the organisations Caldicott Guardianas appropriate.

GoodPsychiatricPracticeinrelationtoconfidentiality

A psychiatrist must maintain up-to-date knowledge on issues relating to39

condentiality and ensure that their practice is in accordance with currentGMC advice.

A psychiatrist must acknowledge and consider the views o carers and40

amily members, recognising the right o the patient to condentiality butalso recognising the right o carers and amily members to share andhighlight their concerns:

the psychiatrist must ensure that the patient understands the benets(a)o sharing, and the risks o not sharing, inormation with their carers

and amily, acknowledging the important role that carers and amilyhave in the patients care and treatment, and o their need orinormation to ull this role

when treating children or adults lacking capacity, particular attention(b)

needs to be given to relationships with carers, parents, amily membersand other proessionals involved. Consideration should be given tosharing inormation in the best interests o the patient.

A psychiatrist must be aware when dealing with children that there may41be situations in which disclosure ensures that the psychiatrist is acting in

the overall best interests o the child.


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GMC Good MedicalPractice 2006 Working with colleagues

workinGinteams

Most doctors work in teams with colleagues rom other proessions. Working in teams41does not change your personal accountability or your proessional conduct and the

care you provide. When working in a team, you should act as a positive role model

and try to motivate and inspire your colleagues. You must:

respect the skills and contributions o your colleagues(a)

communicate eectively with colleagues within and outside the team(b)

make sure that your patients and colleagues understand your role and(c)

responsibilities in the team, and who is responsible or each aspect o patient

care

participate in regular reviews and audit o the standards and perormance o the(d)team, taking steps to remedy any deciencies

support colleagues who have problems with perormance, conduct or health.(e)

I you are responsible or leading a team, you must ollow the guidance in42

Management or doctors.

conductandPerformanceofcolleaGues

You must protect patients rom risk o harm posed by another colleagues conduct,43

perormance or health. The saety o patients must come rst at all times. I you have

concerns that a colleague may not be t to practise, you must take appropriate stepswithout delay, so that the concerns are investigated and patients protected where

necessary. This means you must give an honest explanation o your concerns to

an appropriate person rom your employing or contracting body, and ollow their

procedures.

I there are no appropriate local systems, or local systems do not resolve the problem,44

and you are still concerned about the saety o patients, you should inorm the

relevant regulatory body. I you are not sure what to do, discuss your concerns with

an impartial colleague or contact your deence body, a proessional organisation,

or the GMC or advice.

I you have management responsibilities you should make sure that systems are in45

place through which colleagues can raise concerns about risks to patients, and you

must ollow the guidance in Management or doctors.

resPectforcolleaGues

You must treat your colleagues airly and with respect. You must not bully or harass46

them, or unairly discriminate against them by allowing your personal views to aect

adversely your proessional relationship with them. You should challenge colleagues

i their behaviour does not comply with this guidance.


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You must not make mal icious and unounded criticisms o colleagues that may47

undermine patients trust in the care or treatment they receive, or in the judgement

o those treating them.

arranGinGcover

You must be satised that, when you are o duty, suitable arrangements have been48

made or your patients medical care. These arrangements should include eective

hand-over procedures, involving clear communication with healthcare colleagues.

I you are concerned that the arrangements are not suitable, you should take steps

to saeguard patient care and you must ollow the guidance in paragraph 6.

takinGuPandendinGaPPointments

Patient care may be compromised i there is not sucient medical cover. Thereore,49

you must take up any post, including a locum post, you have ormally accepted, andyou must work your contractual notice period, unless the employer has reasonable

time to make other arrangements.

sharinGinformationwithcolleaGues

Sharing inormation with other healthcare proessionals is important or sae and50

eective patient care.

When you reer a patient, you should provide all relevant inormation about the patient,51

including their medical history and current condition.I you provide treatment or advice or a patient, but are not the patients general52

practitioner, you should tell the general practitioner the results o the investigations,

the treatment provided and any other inormation necessary or the continuing care

o the patient, unless the patient objects.

I a patient has not been reerred to you by a general practitioner, you should ask or53

the patients consent to inorm their general practitioner beore starting treatment,

except in emergencies or when it is impractical to do so. I you do not inorm the

patients general practitioner, you will be responsible or providing or arranging all

necessary ater-care.

deleGationandreferral

Delegation involves asking a colleague to provide treatment or care on your behal.54

Although you will not be accountable or the decisions and actions o those to

whom you delegate, you will still be responsible or the overall management o the

patient, and accountable or your decision to delegate. When you delegate care

or treatment you must be satised that the person to whom you delegate has the

qualications, experience, knowledge and skills to provide the care or treatment

involved. You must always pass on enough inormation about the patient and the

treatment they need.


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Reerral involves transerring some or all o the responsibility or the patients care,55

usually temporarily and or a particular purpose, such as additional investigation,

care or treatment that is outside your competence. You must be satised that any

healthcare proessional to whom you reer a patient is accountable to a statutory

regulatory body or employed within a managed environment. I they are not, the

transer o care will be regarded as delegation, not reerral. This means you remain

responsible or the overall management o the patient, and accountable or your

decision to delegate.


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RCPsych Good PsychiatricPracticeWorking with colleagues

workinGasamemberofateam

Most psychiatrists work as members o multidisciplinary teams. Psychiatristsshould be aware o the key role that they oten play in ensuring the success

and good unctioning o such teams. Whether or not psychiatrists have a ormalleadership role within the team, they should use their skills and knowledge toensure that the ocus o the team is on the provision o high-quality care or

patients. I a psychiatrist is responsible or leading a team, they must ollow theGMC guidance in Management or Doctors (in the ethical guidance series).

Psychiatrists should recognise that although individual members o a teammay have dierent roles, successul teams have shared goals. Psychiatrists

should play a key role in ormulating and delivering these shared goals byworking collaboratively with their colleagues. Working in teams does notchange personal accountability or proessional conduct and the care provided.

When working in a team, a psychiatrist should act as a positive role model tomotivate and inspire colleagues.

The GMC has published guidance on delegation and reerral as it appliesto psychiatrists working within multidisciplinary or multi-agency teams in

Accountability in Multi-Disciplinary and Multi-Agency Mental Health Teams (inthe ethical guidance series). This is summarised in the ollowing points.

Psychiatrists should be competent in all aspects o their work, including:

reviewing and auditing the standards o care they provide; training and

supervising colleagues; and managing sta and the perormance o theteams in which they work when they have management responsibility.

Psychiatrists should ensure that the systems in which they are working

provide a good standard o care to patients. I they cannot be satised

that this is the case, they should draw the matter to the attention o theiremploying or contracting body.

Psychiatrists should establish clearly with their employing or contractingbody both the scope and the responsibilities o their role. This includes

clariying: lines o accountability or the care provided to individualpatients; any leadership roles and/or line management responsibilitiesthat they hold or colleagues or sta; and responsibilities or the quality

and standards o care provided by the teams o which they are members.This is particularly important in circumstances in which responsibility orproviding care is spread between a number o practitioners and/or dierent

agencies.

Doctors are not accountable or the decisions and actions o otherclinicians. This means that when a psychiatrist delegates assessment,


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treatment and care to a more junior doctor, the psychiatrist is notaccountable to the GMC or the decision or actions o the junior doctor butis responsible or ensuring that the junior doctor is appropriately trained,

experienced and supervised.

Psychiatrists can delegate the care o patients or whom they have agreed

to take responsibility. However, many psychiatrists work in systems thatare not based on reerral o patients to a specic consultant. Reerralsare oten made to multidisciplinary teams and decisions about allocation

are made according to the teams policies. The responsibility or the careo the patients is distributed between the clinical members o the team.Consultant psychiatrists retain oversight o the group o patients allocated

to their care. They are responsible or providing advice and support to theteam. They are not accountable or the actions o other clinicians in theteam. Nevertheless, they must do their best to ensure that arrangements

are in place to monitor standards o care, and to identiy potential orcurrent problems. They should notiy their employer about any unresolvedconcerns or problems.

A psychiatrist must work with colleagues in a collaborative way, having the42best interests o the patient as a guiding principle, and must:

have an understanding o the various proessional roles within the(a)team

listen to, respect and take account o the opinions o colleagues in(b)

determining the care o patientswork with colleagues to ensure that patients receive the best possible(c)care within the resources available

be willing to provide advice to colleagues when requested and where(d)

appropriate within their expertise.

A psychiatrist must develop collaborative working relationships with43other proessionals based on mutual proessional respect, acilitating anatmosphere within the team in which individual opinions and the diversity

o team members are valued.

A psychiatrist must treat colleagues airly and with respect, seek to resolve44proessional diculties and conficts, and ensure that such diculties donot impair patient care.

A psychiatrist must acknowledge and work within the lines o accountability45

established in their own and partner organisations.

A psychiatrist must set an example o good communication both within46the team and with other agencies/proessionals.

I a psychiatrist has concerns about a colleague or other proessional, the47concerns should be raised in a considered and measured way.


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A psychiatrist must work fexibly with colleagues in other teams, and must48not be constrained by rigid demarcations, to provide care that is in thebest interests o the patient.

A psychiatrist must provide sucient inormation when making a reerral49

to ensure that the receiving team is able to provide sae and completemanagement.


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GMC Good MedicalPractice 2006 Working with management

For detailed guidance see Management or Doctors, in the GMCs ethical guidance

series.


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RCPsych Good PsychiatricPracticeWorking with management

All doctors are responsible or the use o resources. Psychiatrists who take

on management roles assume a responsibility or resources provided togroups o patients and cannot simply advocate on behal o a single patient.This role needs to be recognised, valued and supported by colleagues. Manypsychiatrists also lead teams or are involved in the supervision o colleagues.

Most work in managed systems. Psychiatrists have responsibilities to theirpatients, employers and those who contract or their services. This means thatpsychiatrists are both managers and managed.

standardsforPsychiatristsasemPloyeesorworkinGwithmanaGersinamanaGedsystem

A psychiatrist must demonstrate respect or and an understanding o the50dierent roles and responsibilities o clinical and non-clinical management

colleagues.

A psychiatr ist must work col laboratively with col leagues who have51management responsibilities or healthcare in order to plan and deliverpatient-ocused services and to develop a clear articulation o the values

and working practices o the multidisciplinary team.

A psychiatrist must support management colleagues in resolving dicult52 clinical situations and demonstrate awareness o the balance betweenthe needs o an individual patient and the needs o the wider clinical

service.

A psychiatrist must alert managers i there are concerns about the provision53o patient care.

A psychiatrist must collaborate with managers in improving patient services54and in seeking appropriate remedies or identied areas o concern.

A psychiatrist must be open to challenge and to peer review, and be55 prepared to justiy and/or adjust clinical decisions in light o discussion.

A psychiatrist must ully cooperate with complaint and adverse incident56investigations that involve themselves or their team, including thedevelopment and implementation o appropriate action plans.

A psychiatrist must maintain proessional standards when reviewing a57

colleagues or teams clinical management or perormance.


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GMC Good MedicalPractice 2006 Research

Research involving people directly or indirectly is vital in improving care and reducing70

uncertainty or patients now and in the uture, and improving the health o the

population as a whole.

I you are involved in designing, organising or carrying out research, you must:71

put the protection o the participants interests rst(a)

act with honesty and integrity(b)

ollow the appropriate national research governance guidelines and the guidance(c)

in Research: The role and responsibilities o doctors.


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RCPsych Good PsychiatricPracticeResearch

Research is important to improving the psychiatric care and treatment, and

the mental well-being, o the population as a whole.A psychiatris t must be aware o the importance o research in the58

understanding and treatment o mental illness.

A psychiatrist involved in designing, organising, supervising, conducting59or publishing research must be aware o the associated issues regardingethics, research and inormation governance, consent and publication,

and probity.


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GMC Good MedicalPractice 2006 Probity

beinGhonestandtrustworthy

Probity means being honest and trustworthy, and acting with integrity: this is at the56heart o medical proessionalism.

You must make sure that your conduct at all times justies your patients trust in you57

and the publics trust in the proession.

You must inorm the GMC without delay i, anywhere in the world, you have accepted58

a caution, been charged with or ound guilty o a criminal oence, or i another

proessional body has made a nding against your registration as a result o tness

to practise procedures.

I you are suspended by an organisation rom a medical post, or have restrictions59

placed on your practice you must, without delay, inorm any other organisations orwhich you undertake medical work and any patients you see independently.

ProvidinGandPublishinGinformationaboutyourservices

I you publish inormation about your medical services, you must make sure the60

inormation is actual and veriable.

You must not make unjustiable claims about the quality or outcomes o your services61

in any inormation you provide to patients. It must not oer guarantees o cures, nor

exploit patients vulnerability or lack o medical knowledge.

You must not put pressure on people to use a service, or example by arousing62

ill-ounded ears or their uture health.

writinGrePortsand cvs, GivinGevidenceandsiGninGdocuments

You must be honest and trustworthy when writing reports, and when completing or63

signing orms, reports and other documents.

You must always be honest about your experience, qualicat ions and posi tion,64

particularly when applying or posts.

You must do your best to make sure that any documents you write or sign are not65

alse or misleading. This means that you must take reasonable steps to veriy the

inormation in the documents, and that you must not deliberately leave out relevant

inormation.

I you have agreed to prepare a report, complete or sign a document or provide66

evidence, you must do so without unreasonable delay.

I you are asked to give evidence or act as a witness in litigation or ormal inquiries,67

you must be honest in all your spoken and written statements. You must make clear

the limits o your knowledge or competence.


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You must co-operate ully with any ormal inquiry into the treatment o a patient68

and with any complaints procedure that applies to your work. You must disclose

to anyone entitled to ask or it any inormation relevant to an investigation into your

own or a colleagues conduct, perormance or health. In doing so, you must ollow

the guidance in Confdentiality: Protecting and providing inormation.

You must assist the coroner or procurator scal in an inquest or inquiry into a patients69

death by responding to their enquiries and by oering all relevant inormation. You are

entitled to remain silent only when your evidence may lead to criminal proceedings

being taken against you.

financialandcommercialdealinGs

You must be honest and open in any inancial arrangements with patients. In72

particular:

you must inorm patients about your ees and charges, wherever possible beore(a)asking or their consent to treatment

you must not exploit patients vulnerability or lack o medical knowledge when(b)

making charges or treatment or services

you must not encourage patients to give, lend or bequeath money or gits that(c)

will directly or indirectly benet you

you must not put pressure on patients or their amilies to make donations to(d)

other people or organisations

you must not put pressure on patients to accept private treatment(e)

i you charge ees, you must tell patients i any part o the ee goes to another()healthcare proessional.

You must be honest in nancial and commercial dealings with employers, insurers73

and other organisations or individuals. In particular:

beore taking part in discussions about buying or selling goods or services, you(a)

must declare any relevant nancial or commercial interest that you or your amily

might have in the transaction

i you manage nances, you must make sure the unds are used or the purpose(b)

or which they were intended and are kept in a separate account rom your

personal nances.

conflictsofinterest

You must act in your patients best interests when making reerrals and when providing74

or arranging treatment or care. You must not ask or or accept any inducement, git

or hospitality which may aect or be seen to aect the way you prescribe or, treat

or reer patients. You must not oer such inducements to colleagues.

I you have nancial or commercial interests in organisations providing healthcare75

or in pharmaceutical or other biomedical companies, these interests must not aect

the way you prescribe or, treat or reer patients.


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I you have a nancial or commercial interest in an organisation to which you plan76

to reer a patient or treatment or investigation, you must tell the patient about your

interest. When treating NHS patients you must also tell the healthcare purchaser.

healthYou should be registered with a general practitioner outside your amily to ensure77

that you have access to independent and objective medical care. You should not

treat yoursel.

You should protect your patients, your colleagues and yoursel by being immunised78

against common serious communicable diseases where vaccines are available.

I you know that you have, or think that you might have, a serious condition that you79

could pass on to patients, or i your judgement or perormance could be aected by

a condition or its treatment, you must consult a suitably qualied colleague. You must

ask or and ollow their advice about investigations, treatment and changes to yourpractice that they consider necessary. You must not rely on your own assessment

o the risk you pose to patients.


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RCPsych Good PsychiatricPracticeProbity

Probity is at the heart o medical and psychiatric proessionalism. A psychiatristmust make sure that their conduct at all times justies their patients trust in

them and the publics trust in the proession. It is o particular importance tomaintain a high standard o practice and vigilance with regard to issues oprobity when dealing with vulnerable children and adults.

A psychiatrist must be aware o and comply with equal opportunities legislation

and work to ensure the ongoing development o antidiscriminatory practice,including challenge to stigma and cultural bias.

The College has published urther guidance with regard to probity inrelationships with pharmaceutical and other commercial organisation in Good

Psychiatric Practice: Relationships with Pharmaceutical and Other CommercialOrganisations (CR148).

ProbityinGoodPsychiatricPractice

A psychiatrist must be aware o the risks o accepting gits rom patients,60

seek advice i necessary, and declare gits that are other than smalltokens.

A psychiatrist must not accept gits or inducements that could be seen as61

aecting judgement in making clinical decisions, be they o prescribing,treatment or reerral.

A psychiatr ist must provide reerences or sta that are air, actually62correct and do not omit relevant inormation, in particular perormanceor conduct issues.


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Royal College of Psychiatrists 2009

ISBN 978-1-904671-76-3

good psychiatric practice

Documents