SJT: Free Mastering the MSRA SJT (3 of 3): The Essential GMC Core Guidance Cheat Sheet

A rapid-fire deep dive into the GMC’s core guidance and key UK laws for the MSRA SJT.

We compress 33 essential GMC guidelines into exam-ready actions, scenarios, and sticky mnemonics—so you can prioritise safety, escalate early, act lawfully, and document like a pro.

What you’ll learn
• Good Medical Practice (2024): safety first, work within competence, escalate early, document clearly.
• Confidentiality & Data Protection: minimum necessary info; implied vs explicit consent; secure handling.
• Education & Training: anonymise first; get explicit consent if identifiable/sensitive.
• Third-party reports (employers/insurers): written consent + relevant, factual, proportionate disclosure.
• Serious Communicable Disease & Public Interest: seek senior/Caldicott advice; document decisions.
• Fitness to Drive (DVLA/DVA): advise legal duty to notify; if persistent risk → inform DVLA and tell patient.
• Violence/Knife/Gunshot: treat first; safeguarding; usually inform police for non-accidental injuries.
• Social/News Criticism: never reveal patient info; keep responses general; get defence/comms advice.
• Personal Beliefs: no discrimination; conscientious objection only with seamless onward access; emergencies override.
• Conflicts of Interest: declare interests; don’t let them influence care; transparent fees/gifts.
• Social Media: same standards online; protect confidentiality; be clear about your role.
• Ending the Professional Relationship: only after genuine trust breakdown; follow process; ensure continuity.
• Safeguarding & 0–18s: best interests; Gillick/Fraser; lawful information-sharing; follow local pathways.
• Prescribing: adequate knowledge of patient; evidence-based; avoid self/family prescribing (except true emergency).
• Consent & Capacity: shared decisions; material risks; presume capacity; MCA best interests if lacking.
• Recordings/Images: implied consent for direct care; explicit consent for teaching/research/media; store securely.
• Research: REC approval; valid consent; protections for those lacking capacity.
• End-of-Life: DNACPR = CPR only; ADRTs/LPAs; early advance care planning; meticulous documentation.
• Leadership & Raising Concerns: speak up early; use formal channels; keep records.
• Duty of Candour: be open; sincere apology; explain; offer remedy; report and learn (near-misses too).
• Delegation vs Referral: check competence; transfer complete info; clarify responsibility.
• Legal/Witness/Reporting: duty to court; impartial evidence; tell GMC promptly about cautions/charges/findings.
• 2024–25 Update: GMC standards also apply to Physician Associates and Anaesthesia Associates (within scope).

Mnemonics featured
ACCESS • REPORT • CONTACT • DRIVE • STAB • SILENT • BELIEF • SOCIAL • CONTINUE • CHILD • SAFER • INFORM • CROPP • VALID • ADVANCE • TEAMS • SPEAKUP • APOLOGY • SAFE TRANSFER • HONEST

📎 More MSRA resources to accompany this episode:
• PassTheMSRA – Home: https://www.passthemsra.com
• SJT for the MSRA (course): https://www.passthemsra.com/courses/sjt-for-the-msra/
• SJT Mock Papers (x10): https://www.passthemsra.com/courses/sjt-msra-mock-papers-x-10/
• YouTube channel (free videos): https://www.youtube.com/@PasstheMSRA

Educational only—always follow your local policies and the most current national guidance.

Episode Transcript

(00:00):
All right, future doctors, you know, preparing for the MSRASJT
can feel a bit like, well, navigating a maze.
Right. Absolutely.
So here on the Deep Dive, we're trying to build you a clearer
path. We're cutting through the noise,
you know, helping you truly think like a doctor in those
tricky situations. Yeah, exactly.
Prioritising safety, acting withintegrity, understanding the

(00:21):
legal stuff, Proportionality, knowing when to escalate early,
and yeah, documenting absolutelyeverything meticulously.
That's the plan. Our mission today is to give you
those essential Nuggets, those aha moments that really, really
stick. Precisely.
Today we're doing a rapid fire deep dive into the General
Medical Council score guidance. We'll touch on key UK laws too,

(00:44):
like the Data Protection Act 2018 and the Equality Act 2010.
OK, we've got, I think 33 crucial areas on our radar, all
distilled from the latest UK summaries.
Think of it as your superchargedCHEAT SHEET Really for the exam,
packed with insights you can immediately use Really to dive
in. Absolutely.
Let's start right up the foundation.
Good medical practise. What does it actually mean to be

(01:07):
a doctor here in the UK? One good medical practise.
Duties of a doctor. OK, so good medical practise
essentially defines what being agood doctor in the UK is all
about. It covers professional values,
behaviours all geared towards patient centred care,
professionalism and importantly,public trust.

(01:28):
Right. The absolute core idea is
always, always putting patient care 1st.
You've got to stay competent, keep your skills up to date and
be ready to justify your decisions and actions.
OK, so let's paint a picture. Imagine you're that new
foundation doctor, first night shift, maybe feeling a bit out
of your depth, and a complex patient suddenly deteriorates
quite rapidly. What's the immediate priority

(01:49):
there? Get senior support.
Immediately. You absolutely cannot delay
escalating because you're worried about looking
incompetent or inexperienced. Yeah, that's a big pitfall.
It really is. Remember, patient safety Trump's
everything in the exam. You'll definitely find questions
testing this, acting within yourcompetence, communicating
clearly, working with the team, being honest and documenting

(02:13):
meticulously. That documentation point again,
always. Yeah, because if it's not
written down, yeah, well, it's like it didn't happen in many
ways. OK, so maybe a way to remember
this is care competence action, especially on safety,
relationships with patients and colleagues, and ethics like
honesty and integrity. It's all about maintaining that
trust and knowing your limits. That's a great way to put it.

(02:35):
Care works well. Handling patient information.
OK. Building on that foundation of
trust, then, how we handle patient information is
absolutely fundamental, isn't it?
What's the real essence of confidentiality in medicine?
It's your ethical and legal dutyto protect patient information.
It's a balancing act. You know, balancing privacy with
sharing what's absolutely necessary for safe and effective

(02:56):
care. The key rules use the minimum
necessary personal information, always manage and protect
information properly, stop improper disclosure, and you
need to know the difference between implied consent, which
often covers direct care, and when you need explicit consent
for disclosures that go beyond that immediate care.
OK, scenario time. You're on a really busy ward.

(03:19):
Things are hectic. A colleague may be distracted.
These are patients, printed notes, just lying on the desk
while they nip away. What's your immediate move?
What's the safest thing to do? Right, you need to act
instantly. Secure those notes, cover them
up, move them somewhere safe, then have a quiet word with your
colleague later, discreetly justreminding them about information
security. So ignoring it is not an option.

(03:40):
Definitely not. That risks a serious breach of
confidentiality and data protection rules for the exam.
Think Protect. Protect information.
Keep it relevant. Use only what's necessary.
Maintain trust, get explicit consent when needed, comply with
the law and tell the patient about disclosures.
We're practical. Education and training
disclosures. And sticking with

(04:01):
confidentiality, but moving intoeducation.
Patient information is obviouslyvital for learning, but again,
it needs really careful handling.
The gold standard for training purposes is always anonymized
information. OK, but what if you're, say,
using patient images in a teaching presentation?
Even if you've anonymized them, is there something else you

(04:21):
should really be doing, a step that's maybe easily missed?
Yeah. Absolutely.
You need explicit patient consent for sharing any
identifiable data, for educationor training unless there's a
clear legal basis, and honestly,even for properly anonymized
images or case details, especially if it's a rare or
sensitive case, getting consent is still best practise.

(04:43):
It shows respect. Right, makes sense.
Common pitfalls here include thinking you've anonymized
something when you haven't quitemanaged it, Maybe combining bits
of information could still identify someone, or just
assuming you have consent for educational use when it's
outside direct care. So for the exam checklist on
this one, maybe a CCESS? I like that.
ACCESS anonymize first consent explicit if identifiable.

(05:07):
Case study care, Handle with care, Educate students
appropriately, secure the data, and be extra sensitive with
potentially identifiable material.
Employment insurance disclosures.
OK, switching tax slightly. What about when third parties
come knocking, you know, employers, insurance companies
asking for patient data? What's the core principle

(05:28):
guiding us there? It really boils down to two
things, informed consent and relevance.
You absolutely must have seen written consent from the patient
before disclosing anything. OK, and you need to be satisfied
that the patient actually understands why their
information is being shared, thescope of it, and potential
consequences. Then, critically, only disclose
factual, substantiated information that is directly

(05:50):
relevant to the specific request.
So no sending the entire medicalrecord just because they asked.
Definitely not, unless it's specifically required and
justified, perhaps for some benefit.
Claims or legal processes generally avoid it.
It's usually excessive. What about this scenario?
An insurance company sends you aform.
The patient has consented, but the form asks for their entire
medical history, including totally unrelated past stuff.

(06:13):
What's the safest next step? Right.
You provide only the factual information that's relevant to
that specific insurance request,make sure it's unbiased and you
can back it up. And then you politely inform the
insurance company that providingthe full record isn't usually
appropriate and might breach data protection principle.
Stick to that minimum necessary idea.
Got it. And for a quick checklist here

(06:34):
maybe REPORT. Let's see.
REPORT sure it's relevant, get explicit consent, offer the
patient a review of the report before sending.
Stick to only fax, no reasonabledelay.
Act promptly and make sure the third party is aware of the
scope. Yeah, that works.
Serious communicable diseases. OK, now this one can feel really
challenging balancing patient confidentiality with public

(06:56):
interest, especially around serious communicable diseases.
Think HIV TB confidentiality is still vital, but it's not
absolute here. Right.
It's a classic ethical dilemma. So take the example of a patient
with a serious, highly transmissible disease who knows
the risks but refuses point blank to tell their housemates
who are clearly at risk. What's the doctor's duty then?

(07:18):
Well, first, you really try hardto persuade the patient to
disclose the information themselves, explain the risks,
offer support. But if they continue to refuse,
and you genuinely believe that not disclosing poses a risk of
death or serious harm to others,then what?
Then disclosure in the public interest may be justified even
without consent. Yeah, but this is a really
significant decision. Yeah, it sounds like it.

(07:38):
It is. So you absolutely must seek
advice. First.
Talk to your Caldecott Guardian,that senior person responsible
for patient data, or an experienced senior colleague.
Document everything meticulously.
OK, a mnemonic for this tricky 1C ONTACT.
Let's try it. CONTACT.
Seek consent first. Consider others at risk.

(07:58):
Is it notifiable? Maintain trust where possible.
Anonymize if that serves the purpose.
Assess capacity and talk to the patient.
Explore options. Yeah, that covers the key steps.
Fitness to drive. DVLA, DVA.
OK, another area where public safety bumps up against
confidentiality. Assessing patient's fitness to
drive. What's the Doctor's role here in

(08:19):
the UK system with the DVLA or DVA in Northern Ireland?
Your main job initially is to advise the patient It's their
legal responsibility to inform the DVLA or DVA about any
medical condition that might affect their safe driving.
You need to alert them to this duty right now if a patient is
clearly unfit to drive, perhaps due to a condition like poorly

(08:40):
controlled epilepsy or worseningdementia, and they insist on
continuing to drive despite youradvice, and you believe they
pose a real risk of causing death or serious harm to others.
Then you step in. Then you may need to breach
confidentiality and inform the DVLA or DVA directly, even
without the patient's consent. But crucially, you should always
try to tell the patient beforehand that you intend to do

(09:01):
this. So what if they just refuse?
You've advised them clearly theyknow the risks but they say
Nope, I'm still driving to work.You make every reasonable effort
to persuade them first, maybe offer a second opinion if they
dispute your assessment. But if they still refuse and the
risk is serious, you must prioritise public safety.
You contact the DVLA and you inform the patient, ideally in

(09:23):
writing, that you have done so. OK, this feels like prime SJT
territory. A mnemonic Dr Check DVLA
guidance, assets, risk of serious harm.
Inform the patient of your intentions.
Verify the diagnosis and fitnessstandard.
Make every effort to persuade first.
Good one. Gunshot and knife wounds police.

(09:45):
Moving on to another really sensitive area where
confidentiality meets public interest reporting gunshot and
knife wounds. The general rule is if it seems
to be a non self-inflicted gunshot wound or a knife wound
resulting from an attack, the police should usually be
informed. OK, but what if it's less clear
cut? Say a 16 year old comes in with
a nasty knife wound, Claims it was an accident shopping veg but

(10:06):
you have a nagging feeling it might be game related.
Right, First things first, treatthe patient.
Their immediate medical needs are the absolute priority and
must not be delayed by police involvement or questioning.
Always. Then, because they're a minor
under 18, you immediately think safeguarding.
This is a potential child protection concern, so you'd
consult with a senior colleague or ideally the hospital

(10:27):
safeguarding lead. They help assess the risk to the
child or others. Based on that assessment, you
decide whether to notify the police or social services
following local procedures. And document everything
carefully. Meticulously, the rationale for
your decisions is key. OK, so a mnemonic for this STAB.
STAB safety first patient care. Tell police if it's an attack,

(10:51):
non accidental, non self-inflicted, Ask for consent
to speak to police if the patient is able and it's
appropriate, and balance confidentiality against the risk
of harm. Responding to criticism in
media. OK, this happens more often now
with social media. What if you or your practise
face public criticism, perhaps online or in the local paper?

(11:11):
It's natural to want to defend yourself, but patient
confidentiality remains absolute.
Right. You can't just jump online and
share patient details to prove your point, even if the
criticism feels unfair or inaccurate.
Absolutely not. Cannot disclose any patient
information in the public domainwithout their explicit consent.
That's a fundamental breach of trust.

(11:31):
So let's take a scenario. A patient's relative posts a
really critical, maybe even factually wrong, account of the
care their loved one received online.
They even include details that could identify the patient.
What's the safest way for the doctor or practise to respond?
The very first step should be toseek advice.
Talk to your medical defence organisation or your employer's

(11:53):
communications team. OK.
Your public response, if any, should generally be very
limited. You can explain your duty of
confidentiality that you can't discuss individual cases
publicly. You might be able to provide
some general information about your usual practise or standards
of care, but absolutely no specifics about the patient or
their treatment without consent.Right.

(12:13):
Stay general. Explain the confidentiality
rule. Exactly.
Getting drawn into a public argument with patients specifics
is a major pitfall. So SILENT for the mnemonic.
Let's try it. Seek advice first.
Inform generally if needed. Limit your public response.
Need explicit consent for details.
No identifiable information ever.

(12:35):
Protect trust. Yes.
SILENT works 9. Personal beliefs and medical
practise. This guidance is absolutely
fundamental to fair and ethical practise.
It stresses that your personal beliefs, religious, moral,
whatever must never lead to unfair treatment, discrimination
or cause distress to patients. So you have to treat everyone
equally, regardless of their lifestyle, background or

(12:57):
beliefs. Precisely.
Treat all patients fairly and respectfully.
Your personal views cannot compromise the care you provide.
What about conscientious objection?
Say a doctor has a strong personal belief against
providing a certain procedure like contraception or maybe male
circumcision for religious reasons.
Can they just refuse? They can refused to provide a
specific procedure due to conscientious objection, but,

(13:20):
and this is crucial only if the patient's care is not
compromised as a result. OK, So what does not compromise
mean in practise? It means you have a duty to tell
the patient sensitively that youobject, explain they have the
right to see another Doctor Who can provide the service, and you
must actively help them access that alternative care promptly
and without judgement. You can't just say no and leave
them stranded. And in an emergency?

(13:41):
In an emergency, you must not refuse necessary, potentially
life saving treatment because ofyour personal beliefs.
The patient's immediate well-being comes first.
OK, it's a way to remember this Bel i.e.
F. DEL i.e.
F Balance your beliefs with professional duties.
Ensure equality and non discrimination.

(14:02):
Life saving treatment cannot be refused on grounds of belief.
Inform the patient if you objectExplore patient beliefs
respectfully if relevant Facilitate alternative care
smoothly. 10 Financial and commercial arrangements
Conflicts of interest right Thisis all about maintaining trust
by being completely honest and transparent in any financial or

(14:23):
commercial dealings related to your practise.
The key principle is that your clinical decisions shouldn't be
swayed by personal gain. Exactly.
Your decisions about prescribing, treating, referring
patients or commissioning services must never be
influenced by any financial or commercial interest you might
have. If there's a potential conflict,
you need to declare it formally and potentially exclude yourself

(14:44):
from the decision making process.
OK, let's take a practical example.
You're AGP and you happen to have a financial interest.
Maybe you own some shares in a new private physiotherapy clinic
that's just opened locally. A patient comes in with back
pain asking for physio referral.What's your obligation?
Transparency is key. You must tell the patient about
your financial interest in that specific clinic, but then,

(15:07):
critically, you must also give them comprehensive, balanced
information about all the suitable physiotherapy options
in the area, including NHS services and other private
providers. So they can make a truly
informed choice. Precisely.
Their decision must be based purely on their needs and
preferences, completely free from any influence related to
your financial interest. You also shouldn't solicit gifts

(15:28):
and only accept unsolicited onesif they're modest and don't
affect your judgement. Be upfront about any fees you
charge. OK, so a mnemonic for this might
be HONEST. HONEST, honest financial
dealings. Open declaration of interests.
No influence on patient care. Exclude yourself from decisions
if conflicted. Solicit no gifts or money.

(15:49):
Tell patients clearly about any fees.
Yeah, that works well. 11 doctors use of social media.
Moving into the digital world now, How does GMC guidance apply
to doctors using social media? Does professionalism stop when
you log off from work? Absolutely not.
The guidance is crystal clear. The same standards of
professional conduct apply online as they do in face to

(16:11):
face interactions. So that means confidentiality
still applies. Definitely maintain
confidentiality, protect patientprivacy, and crucially, maintain
professional boundaries online. Avoid blurring the lines between
your social and professional life.
Remember, even with tight privacy settings, nothing online
is ever truly private and it canbe very difficult to remove
content once it's out there. What about the classic scenario?

(16:33):
A current patient sends you a friend request on your personal
Facebook profile, the one with your holiday snaps and family
pictures. Safest bet?
Decline the request politely. If that patient then tries to
contact you about their medical care through your private
profile, you need to gently redirect them back to the proper
professional channels, like booking an appointment or
contacting the surgery. Don't get drawn into clinical

(16:55):
discussions on personal platforms.
Right. Keep those boundaries clear.
Exactly. And if you do identify yourself
as a doctor online, perhaps on Twitter or professional forum,
use your real name. Be aware that your posts might
be seen as representing the profession.
Be respectful to colleagues online.
No bullying or substantiated comments, and declare any
conflicts of interest if you're posting material.

(17:17):
OK, so maybe SOCIAL for the demonic?
Let's see SOCIL apply the same standards online.
Keep content only professional regarding patients.
Uphold confidentiality. Identify yourself properly.
If speaking as a doctor, avoid mixing personal and professional
relationships. Limit personal information
shared where patients might see it.
Yeah, that fits 12 Ending your professional relationship with a

(17:40):
patient. This is a really significant
step and shouldn't be taken lightly.
Ending a professional relationship with a patient
should only happen when there's been a genuine breakdown of
trust that fundamentally prevents you from providing good
clinical care. So it's not just because a
patient complaints a lot or maybe they miss appointments.
No complaints or resource issuesalone are generally not

(18:01):
sufficient grounds. We're talking about situations
like violence or threats towardsstaff theft, persistent
seriously inconsiderate behaviour, or maybe
inappropriate advances from the patient.
Things that make a safe and effective therapeutic
relationship impossible. OK, so let's say a patient has
made repeated, unwarranted complaints against you and the
team. It's disrupting care.

(18:21):
You've tried addressing their concerns, but the relationship
feels totally broken, impacting your ability to treat them
effectively. Can you just remove them from
the list? Not straight away.
There's a process. First, you should usually warn
the patient about their behaviour and its consequences.
You should try to restore the relationship if possible, maybe
explore mediation or alternatives.
You absolutely must consult withcolleagues or your employer

(18:44):
practise manager. And if all that fails.
If after all that, the trust breakdown genuinely prevents
good care, then yes, you can proceed.
But you must inform the patient clearly in writing, explaining
the decision and the reasons. And critically, you must make
arrangements for their prompt continuing care elsewhere.
You can't just abandoned them. Transfer records needs to be
smooth. Right.

(19:05):
Ensuring continuity of care is vital.
Absolutely, and the decision must be fair, unbiased and non
discriminatory. Be prepared to justify it.
OK. And mnemonic, Yeah, maybe
CONTINUE. CONTINUE consider if trust
breakdown truly prevents good care.
Have options been explored? Notify the patient in writing.

(19:26):
Arrange transfer of care. Attempt informal resolution
first. Ensure a decision is non
discriminatory. Help patient understand the
reasons. Explain and be ready to justify
good. 13 Intimate examinations and chaperones OK intimate
examinations. These obviously require
particular sensitivity, always respecting the patient's privacy

(19:48):
and dignity. The core principles from good
medical practise apply strongly here.
You mentioned this isn't explicitly detailed in every
summary we have. That's right, specific detailed
guidance on chaperones wasn't inthe core summaries provided for
this deep dive, so always check your local trust or practise
policy for the exact procedures.However, the fundamental GMC
principles are clear. Treat patients with respect,

(20:09):
protect their dignity and privacy, and always obtain valid
consent before any examination. So based on those principles,
what's the best immediate actionif you're, say, a male doctor
about to perform an intimate examination on a female patient
and you realise you haven't actually offered her a
chaperone? The safest and most appropriate
thing to do is to pause. Stop before you proceed with the
examination and explicitly offerthe patient a chaperone.

(20:33):
Explain who the chaperone would be and what their role is.
So offering is better than just asking if they're comfortable
with that one. Yes, offering proactively
presents the option properly andrespects their right to have
one. It ensures their comfort and
dignity are prioritised and it also protects both the patient
and the doctor. Documenting the offer and
whether it was accepted or declined is also good practise.

(20:54):
Right and even for non intimate exams the basics still apply
don't they? Explain what you're doing.
Get consent, ensure privacy. Absolutely.
Close the curtains, provide a gown if needed, explain, get
consent, ask if they have questions.
It's all part of respectful patient care. 14 maintaining
professional boundaries. This is all about the trust
inherent in the doctor patient relationship.

(21:16):
GMC guidance is very clear. Doctors must not abuse this
trust. You must not view patients as
potential sexual or romantic partners.
So pursuing any kind of sexual or improper emotional
relationship with the current patient is completely out of
bounds. Totally inappropriate if a
patient tries to pursue such a relationship with you.
You need to be firm but professional, reinforce the

(21:37):
boundaries and document it. If this leads to a a breakdown
of trust where you can no longertreat them effectively, you'd
follow the guidance on ending the relationship, ensuring
continuity of care. What about former patients?
Is that always OK? Not necessarily.
The guidance says. Personal relationships with
former patients may also be inappropriate.
It depends on several factors. Like what?

(21:59):
Like how long ago the professional relationship ended,
the nature of that relationship,and particularly the patient's
vulnerability. For instance, pursuing a
relationship with a former patient you treated for
significant psychiatric issues or a paediatric patient who's
now an adult could easily be seen as an abuse of your former
position. There's no set time limit, but

(22:19):
the more recent or vulnerable, the less appropriate it is.
OK, scenario. A former patient, someone you
treated for depression ending six months ago, sends you a
message on a dating app. Maybe you found them attractive
when they were your patient. What's the safest move?
Decline the message Given the context, the recent professional
relationship, the patient's vulnerability due to depression
engaging would be highly inappropriate and risky.

(22:42):
It could breach ethical boundaries.
If you're ever unsure in these situations, seek confidential
advice from your medical defenceorganisation.
OK, a mnemonic for boundaries. BOUNDRY.
Let's see BOUNDRY, don't believeyou can abuse trust.
Sexual emotional relationships are out of bounds, unsuitable
with former patients. If recent vulnerable not for

(23:04):
personal gain and gain care to start relationship, discuss with
colleagues defence body. If unsure, always maintain
professionalism, refer end relationship if trust breaks due
to patient pursuit and yes, for clarity and communication.
Yeah that covers it. 15 Sexual behaviour and duty to report
colleagues. OK, this follows on logically.
Patient safety is absolutely paramount here.

(23:26):
Doctors must ensure no sexual advances, behaviour or
inappropriate comments are directed towards patients.
And what's your absolute duty ifa patient does report that a
colleague has breached sexual boundaries, or if you suspect it
yourself? You must act promptly.
Report your concerns immediatelyto someone or an organisation
that can properly investigate. This could be your employer,
your clinical director, HR, the responsible officer, or even the

(23:50):
GMC directly if necessary. No hesitation.
No hesitation, especially if thesuspicion involves potential
criminal activity like sexual assault, in which case you
should also report it to the police.
Your primary focus must be supporting the affected patient
and ensuring their safety. OK, scenario.
A patient tearfully confines in you that a senior colleague made

(24:11):
a sexually suggestive comment during their last appointment.
You're shocked. What's the single safest, best
next step? First, support the patient.
Listen, reassure them, ensure they feel safe.
Then clearly and accurately document exactly what they've
told you. After that, you promptly report
the concerns to an appropriate person in authority who can
initiate an investigation, like the clinical director or the

(24:32):
trust HR department. If it sounds like it could be a
criminal offence, you should also involve the police.
So confronting the colleague directly isn't the right move.
Generally not for serious allegations like this.
It could put you at risk, escalate the situation and it
bycasses the formal impartial investigation process needed.
Ignoring it, we're waiting to see if it happens again is

(24:53):
absolutely unacceptable. It puts other patients at risk.
OK. SAFETY for the mnemonic.
SAFETY Support the patient firstTake action report promptly put
patient for our first. Their safety is paramount.
Escalate to an appropriate investigator.
Protect trust in the profession and yes, involve police if

(25:15):
potentially criminal. 16 protecting children and young
people. This is a huge area of
responsibility for all doctors. We have a fundamental duty to
protect the health and well-being of children and young
people. That's anyone under 18 from
abuse and neglect. And the guiding principle is
always the child's best interests.
Always, that comes above everything else.
You need to be able to recognisethe signs of potential abuse or

(25:38):
neglect, assess capacity appropriately for their age,
maturity and know when confidentiality needs to be
breached to protect a child. Right, that confidentiality
point is key, isn't it? Sometimes you have to share
information. Absolutely.
While you aim to maintain confidentiality to encourage
young people to seek help, if you have concerns about abuse or
neglect, or if a child's safety is seriously compromised, you

(26:00):
must share that information withrelevant agencies like social
services or the police, often without parental consent, and
sometimes even without informingthe parents if doing so could
increase the risk to the child. OK scenario.
A 7 year old child comes in withmultiple bruises, all at
different stages of healing. The parents give vague,
inconsistent explanations for the injuries.

(26:23):
What's the safest approach? First, ensure the child's
immediate medical needs are met and they are safe right now.
Then, given the concerning pattern and inconsistent story,
you absolutely must raise your concerns.
Talk to a senior colleague, the paediatric team or your
designated safeguarding lead immediately.
Follow your local child protection procedures precisely
and document every observation, conversation and concern

(26:45):
meticulously. So you don't just accept the
explanation. No, not when the signs are
suspicious like that. You have a duty to investigate
further through the proper channels.
Confronting the parents directlyis usually unwise and could put
the child at greater risk. Sending them home without action
is unacceptable. OK, Safeguarding mnemonic SAF.
e.g. UARD.

(27:05):
Let's see SAF e.g. UARD child safety first act on
your concerns, find advice senior safeguarding lead
escalate following policy, get consent where appropriate, but
welfare overrides. Remember they're under 18 and
potentially vulnerable. Collaborate with agencies,
record everything and don't discriminate.
Yes, that's a good 117 zero 18 years guidance.

(27:27):
This guidance builds on safeguarding really.
It helps doctors make ethical and lawful decisions
specifically for children and young people up to 18.
It covers best interests involving families
appropriately, consent and confidentiality, and paediatric
care. You mentioned Gillick competence
earlier. Can you remind us what that is?
Sure. Gillick competence refers to the
assessment used for children under 16 in the UK to decide if

(27:49):
they have sufficient maturity and understanding to make a
decision about their own medicaltreatment without needing
parental consent. OK, so let's take the example of
a 15 year old girl asking for contraception.
She understands the implications, the risks, the
benefits, but she explicitly doesn't want her parents
involved. If you assess her as Gillet

(28:09):
competent, what do you do? If she's gillet competent and
you judge the treatment to be inher best interests, you can
provide the contraception confidentially without informing
her parents. This respects her autonomy and
ensures access to necessary healthcare.
What about refusal of treatment?Say a 14 year old who seems
competent is refusing treatment for a serious but treatable

(28:29):
condition. The parents are maybe unsure now
because she's distressed. That's complex.
First, you need a really robust assessment of her capacity.
Gillick competence. Ensure she truly understands
everything. Talk extensively with her and
her parents. Explore why she's refusing.
If she is confident and persistsin refusing, but the treatment

(28:50):
is essential to save her life orprevent serious irreversible
deterioration, and the parents won't consent to override her
refusal, you would likely need to seek legal advice about
applying to the court for authorization to treat in her
best interests. So it's a high bar for
overriding A competent refusal. It is, but the child's best
interests, especially regarding life and serious harm, are
paramount. In emergencies, though, you

(29:12):
provide immediately necessary treatment without consent if
needed. CHILD for the mnemonic.
CHILD assess capacity Gillick prioritise health and best
interests involve family appropriately understand legal
exceptions confidentiality Courtdocument decisions fully 18

(29:34):
Prescribing and managing medicines devices right
prescribing. As doctors you are
professionally and legally responsible for every
prescription you issue. The absolute rule is you must
only prescribe if you have adequate knowledge of the
patient's health. And the prescription needs to be
appropriate for them. Yes, you need to be satisfied.
It actually serves the patient'sneeds, is safe, and ideally
based on the best available evidence like NICE guidance or

(29:56):
local formularies. You should also be familiar with
the BNF, especially the BNFC forchildren.
What about prescribing for yourself or family and friends?
Avoid it. GMC guidance strongly advises
against prescribing for yourselfor anyone you have a close
personal relationship with, especially controlled drugs or
anything potentially addictive or harmful.
There might be very rare exceptions in a true emergency

(30:18):
where no other doctor is available, but generally just
don't do it. OK, scenario.
A patient contacts you, maybe they've just moved to the area.
They asked for a repeat prescription for a controlled
drug, say a strong painkiller that they used to get from their
old doctor in another city. You have absolutely no medical
records for them. What's the safe approach?
You have to decline to prescribethat controlled drug, right?

(30:41):
Then you simply don't have adequate knowledge of their
health or history. It would be unsafe and
potentially illegal. So what do you advise them?
Advise them to contact their previous doctor to arrange for a
transfer of their medical records or care summary.
Or better still, register with alocal GP.
Practise urgently so a doctor there can access their full
history, assess them properly and establish an ongoing

(31:04):
prescribing relationship if appropriate.
You can't just issue controlled drugs drugs based on the
patient's word alone. OK, SAFER prescribing.
SAFER, prioritise safety, have adequate knowledge of the
patient, be familiar with prescribing guidance, BNF local
rules, ensure treatment is evidence based and needed and

(31:25):
report adverse drug reactions ADRs via the Yellow Card scheme.
19 Decision making and consent this is absolutely central to
everything we do. Shared decision making and
obtaining valid consent are fundamental legal and ethical
requirements for practically allpatient care.
And the starting point for adults is assuming they have
capacity. Yes, you must presume capacity

(31:47):
in adults unless there's evidence to suggest otherwise.
Your role is to provide them with the necessary information,
clearly, without jargon about their condition, the treatment
options, risks, benefits, alternatives, everything.
They need to make an informed decision that reflects their own
values and preferences. It's a dialogue, not just
telling them what to do. Exactly, it's an exchange, you
need to listen to their views, support their decision making

(32:09):
process, maybe using interpreters if needed or
respecting requests to record the consultation.
If a patient lacks capacity, then decisions must be made in
their overall best interest, involving relevant people like
family or those with power attorney and always considering
the least restrictive option. OK scenario.
An adult patient comes in with suspected appendicitis.

(32:32):
They're clearly confused, maybe delirious, unable to give
consent for the urgent surgery they likely need.
Their adult daughter is with them.
What's the best approach? Right first step is a formal
assessment of the patient's capacity specifically for this
decision consenting to surgery. Document that assessment.
If they are found to lack capacity then you need to act in
their best interests. Which involves the daughter.

(32:54):
Yes, you absolutely involve the daughter as a close relative in
the discussion. You also involve the rest of the
healthcare team. You discuss what's known about
the patients, likely wishes and values, the clinical situation
and determine the overall benefit of the surgery
considering least restrictive options.
Document this whole best interest decision making
process. If it's immediately life

(33:15):
threatening and delaying is dangerous, you can proceed under
the doctrine of necessity while continuing the best interests
process. Got it.
So INFORM for consent. INFORM involve the patient,
always provide necessary information, clearly check they
understand the facts, respect the outcome, their decision,
record the process meticulously and be familiar with the Mental

(33:37):
Capacity Act principles for those who lack capacity. 20
Making views during visual and audio recordings of patients
This guidance covers the ethicaland legal side of making
recordings, photos, videos, audio of patients.
Again, respecting privacy and dignity is paramount.
Is specific consent always needed for any recording?
Not necessarily for recordings that are an integral part of the

(33:59):
investigation or treatment itself.
Think things like X-rays, ultrasound scans, maybe
recording heart sounds for direct clinical comparison
later. For these, implied consent as
part of agreeing to the overall investigation or care is usually
sufficient. OK.
What if the recording isn't for their direct care?
Say you want to use it for teaching, research, maybe even

(34:21):
public media. Then you absolutely do need
separate explicit consent. The patient needs to understand
exactly why you're recording, how it will be used, how their
privacy will be protected or example anonymization, where it
will be stored and that they canwithdraw consent later.
Right, so scenario. You want to take a photo of a
patient's really unusual, diagnostically interesting skin

(34:41):
condition. You plan to use it for teaching
at a hospital grand round. The patient seems quite happy to
help out. What's a proper process?
Even though they seem happy, youmust get their explicit informed
consent specifically for this purpose.
Teaching at Grand Round. Explain how you'll ensure
anonymity, Blurring faces, removing identifying marks.
Tell them how the image will be stored securely and eventually

(35:03):
disposed of. Document this consent carefully
and make sure you actually do anonymize it properly before
using it. Makes sense.
I'm on it for recordings. CROPP.
Let's try CROPP get consent explicit for secondary use
ensure it's recording specific consent use only necessary
recordings protect privacy and dignity always and protect the

(35:25):
recording through secure storageand handling just like any other
part of the medical record. 21 Consent to research Consent for
research has its own specific guidance building on the general
principles. Valid consent here absolutely
must be informed, given voluntarily and by someone with
the capacity to make that decision.
And participants need to know they can back out.
Crucially, yes, they must be clearly informed of their right

(35:47):
to withdraw from the research atany time for any reason, and
that withdrawing will not negatively affect their ongoing
clinical care in any way. What about involving vulnerable
people in research, say someone who lacks capacity?
There are very strict rules for adults lacking capacity.
Research can usually only proceed if it's directly related
to their specific incapacitatingcondition or its treatment.

(36:10):
You need to follow detailed legal and ethical guidelines,
which typically involves seekingthe views of those close to the
person, like family or someone with legal power of attorney,
and absolutely critically getting approval from a research
Ethics Committee first. OK scenario.
You're involved in a research study and want to recruit a
patient with a severe neurological condition.

(36:30):
It's clear they lack the capacity to consent themselves.
What's the essential first step?Ensure the research meets the
criteria. Is it directly related to their
condition? Then you must ensure you have
approval from a research Ethics Committee REC.
You'll then need to follow the specific legal process for
involving adults lacking capacity, which usually involves
consulting with appropriate representatives about the

(36:51):
patient's likely wishes and feelings.
So REC approval is non negotiable.
Absolutely non negotiable for research involving patients,
especially those lacking capacity.
You also need to comply with laws around using human tissue,
if that's relevant. OK, VALID consent for research.
VALID consent must be voluntary,participants must be adequately

(37:13):
informed, special care for thoselacking capacity or vulnerable.
It must be an intelligent decision based on understanding
and document the entire process meticulously. 22 Treatment and
care towards the end of life. This is obviously a profoundly
important and sensitive area of practise.
The guidance provides a framework for making decisions
grounded in respecting human life, protecting patient dignity

(37:36):
and prioritising patient centredcare.
It heavily involves applying theMental Capacity Act principles.
And encouraging conversations early is key, right?
Advanced care planning. Very much so, doctors should
support early discussions about preferences for future care,
addressing patient wishes, fearsand values.
This includes things like advanced decisions to refuse
treatment, ADR, TS, appointing Alasting Power of attorney, LPA

(37:59):
for health and welfare, and discussions about resuscitation
status, DN, A/C, PR. What if a patient has capacity
and makes a clear decision, say to refuse all future life
prolonging treatments, includingfeeding tubes, but their family
is really strongly against that decision?
Whose view takes precedence? If the patient has capacity and
has been fully informed, their autonomous decision to refuse

(38:22):
treatment must be respected, even if it leads to their death
and even if the family disagrees.
Your role then includes sensitively explaining this to
the family, supporting them, butultimately upholding the
patient's legal and ethical right to decide.
That must be incredibly difficult sometimes.
It can be clear communication, empathy, and robust
documentation of the patient's decision and the discussions are

(38:42):
absolutely vital. Similar principles apply to
decisions about clinically assisted nutrition and
hydration. CANH and do not attempt cardio
pulmonary resuscitation. DN, A/C, PR orders.
They must be based on clinical appropriateness and the
patient's wishes or best interests if they lack capacity.
OK, a mnemonic for end of life care ADVANC.

(39:03):
ADVANCE, encourage advanced careplanning.
Uphold patient dignity, Understand patient values.
Respect autonomy and capacity. If no capacity act in best
interests. Consult family team
appropriately. Illicit end of life wishes 23
When a patient seeks advice about assistance to die right.

(39:24):
This is another very sensitive topic and the legal position in
the UK is critical background here.
Assisting or encouraging suicideremains a criminal offence
across the UK. So what is a doctor's
responsibility when a patient, perhaps suffering from a
terminal illness, asks about assisted dying?
Your primary responsibilities are to continue providing
compassionate and appropriate care, to listen empathetically,

(39:45):
to understand the reasons behindtheir request, suffering the
fears, and to adhere strictly tothe law.
So you can't give them information about, say,
organisations abroad that facilitate assisted dying.
Absolutely not providing information or advice that could
be seen as encouraging or assisting.
Suicide is illegal. Your response must be limited to
explaining the legal position inthe UK and discussing the lawful

(40:06):
clinical options available to them here.
Which would be focused on palliative care.
Exactly. The focus should be on ensuring
all their palliative care needs are being met.
Physical symptom control, psychological support, spiritual
care, social support. Addressing their suffering
through all available lawful means is key.
You must not, under any circumstances, take any action

(40:27):
that constitutes assisting suicide.
OK scenario. A patient with a rapidly
progressing neurological condition who definitely has
capacity tells you they're considering travelling abroad
for assisted dying. They ask for your opinion on
which country might be best. What's the safe and legal
response? You listen empathetically to
understand their distress and reasons.
Then you clearly and unequivocally explain that

(40:50):
assisting or encouraging suicideis a criminal offence in the UK
and therefore you can't provide any advice or information about
accessing assisted dying abroad.Then you gently but firmly pivot
the conversation back to what you can do, which is optimise
their current care, enhance palliative support, address
their fears and symptoms and offer ongoing compassionate care
within the bounds of UK law. Got it.

(41:11):
LAWFUL, the mnemonic. LAWFUL Discuss only lawful
options. Assist no suicide.
Focus on patient well-being. Focus on palliative care.
Explain UK law clearly Listen empathetically. 1st 24
Leadership and Management for all Doctors This might surprise
some trainees, but the GMC sees leadership and management skills

(41:33):
as integral to being a good doctor right from the start of
your career. It's not just for consultants or
partners. So it applies to everyone, even
foundation doctors. What does it involve at that
level? It involves contributing
positively to the team, improving patient safety and the
quality of care wherever you can, promoting A respectful and
inclusive working environment, working collaboratively, and

(41:54):
even contributing to teaching and training junior colleagues
or students, acting as a positive role model.
OK so say you're an F1 or F2 on a ward and you notice staff
morale is really low, people seem burnt out, maybe due to
workload pressures, and you're genuinely concerned it's
starting to affect patient care,perhaps leading to mistakes or
delays. What's a good leadership step

(42:14):
you could take? A really good step would be to
discreetly raise your observations and concerns with
someone senior, your direct clinical supervisor or perhaps
the ward manager. Explain what you've seen, link
it specifically to potential patient safety risks, and maybe
even suggest some constructive ideas for improvement if you
have any. So not just complaining to your

(42:34):
peers. No, that rarely solves anything.
Taking your concerns constructively up the
appropriate channel shows leadership and responsibility.
Ignoring the problem is also notan option if patient safety
might be affected. It's also about managing
resources fairly and managing your own interests to avoid
conflicts. TE AM S for the mnemonic.
TE AM S contribute to teaching and training, help manage

(42:57):
efficiency and resources fairly,be accountable for your actions,
support morale and well-being, and focus on safety and quality
improvement. 25 raising and acting on concerns about patient
safety This follows on directly from leadership.
All doctors have an absolute overarching duty to raise
concerns if they believe patientsafety, dignity or comfort is

(43:18):
being compromised, and importantly, to help create a
culture where all staff feel safe and empowered to do the
same. So if you see something wrong,
you have to speak up. Yes, prompt action is required
if safety is or even may be seriously compromised.
If a patient isn't receiving basic care, you tell someone who
can act immediately. If resources or policies are

(43:38):
inadequate and causing risk, tryto fix it if you can.
But definitely raise it through official channels like your
workplace's incident reporting system for EG day ticks, or by
speaking to a manager and document the steps you took.
What about concerns about a colleague?
Maybe you think they aren't fit to practise?
That's a tough one, but the dutyremains.
If you think a colleague's health behaviour or performance

(43:59):
is putting patients at risk, youshould seek advice, perhaps from
another senior colleague, your defence body or even the GM CS
confidential helpline. If you're still concerned after
seeking advice, you must report it formally again documenting
the steps you took. OK scenario.
You observe A locum Dr on your ward who seems to be

(44:19):
consistently making medication errors, putting patients at
direct risk. You've had a quiet word
informally, but the errors are continuing.
What's the definite best next step?
This has gone beyond an informalchat because there's a clear,
ongoing risk to patient safety. You must immediately escalate
this. Formally raise your specific
concerns about the Locum's fitness to practise to your

(44:40):
direct clinical supervisor, the consultant in charge or the
hospital's responsible officer. Follow your workplace policy for
raising concerns about colleagues and document the
specific errors and the steps you've already taken.
Patient safety cannot be compromised further.
Right, no more waiting. No, delaying is a major pitfall.
SPEAKUP for the mnemonic. SPEAKUP Put safety first, take

(45:03):
prompt action, Escalate appropriately.
Use all internal channels first.Keep records of everything.
Understand your workplace policy.
Going public is an absolute lastresort and needs careful
handling regarding confidentiality. 26 Duty of
candour, Openness and honesty Candour This is the professional

(45:23):
duty and in England also a statutory duty for organisations
to be open and honest with patients and also with your
colleagues and organisation whensomething goes wrong in their
care that causes or could cause harm or distress.
So it's about owning up to mistakes.
Yes, but it's more than that. It's about apologising
sincerely. And importantly, an apology
doesn't mean admitting legal liability.
It's about taking professional responsibility.

(45:44):
It's about explaining clearly what happened and what the
likely short and long term effects are, offering remedy or
support, and crucially, reporting the incident in
internally so that lessons can be learned to improve safety for
future patients. Does it apply even if no harm
actually occurred, like a near miss?
Yes, the professional duty of candour also applies to near
misses that could have caused harm.

(46:05):
Being open about these is vital for building a strong safety
culture. You should also discuss
potential risks with patients before treatment starts as part
of the consent process. OK scenario.
During a routine procedure you make a small error, an
inadvertent complication. It doesn't cause any lasting
harm, but it does mean the patient needs to stay in

(46:26):
hospital an extra day. What's the approach according to
the duty of candour? You must be open and honest with
the patient as soon as possible.Explain fully what happened, why
it happened, if known, what the immediate effects are, the extra
day in hospital and what you're doing about it.
Offer a sincere apology for whathappened.
Document the incident itself, your discussion with patient,

(46:47):
including the apology, and report it internally via Deadx
or your local system so that theteam can learn from it.
So hiding it or downplaying it is completely wrong.
Absolutely. That destroys trust and goes
against the core principles. MPOLOGY for the mnemonic.
APOLOGY, Apologise sincerely, act promptly, be open and
honest, foster a learning culture, offer remedy or

(47:10):
support, give a clear explanation and say yes, things
can go wrong, let's learn from it. 27 Delegation and referral
It's really important to understand the difference here.
Delegation is asking a colleague, often more junior but
not always, to provide care or treatment on your behalf.
You, the delegating Dr, usually retain overall responsibility

(47:33):
for the patient's care. OK.
So you're still in charge overall?
Generally, yes, and because of that you must be satisfied that
the person you're delegating to has the appropriate
qualifications, skills and experience to do the task safely
and competently. And referral.
Referral is different. That's when you arrange for
another practitioner, often a specialist, to provide
assessment or care because it falls outside your own area of
competence. You're transferring

(47:54):
responsibility for that aspect of care.
Right. In both cases, communication is
key. Absolutely vital.
You need to inform the patient about the delegation or referral
and why it's happening. You must transfer all relevant
information about the patient's condition, history and required
treatment to ensure safe continuity of care.
And you need clarity on who holds responsibility, especially

(48:16):
if it's a temporary handover versus a permanent transfer.
Ensure the patient understands and consents to their
information being shared. OK, tricky scenario for junior
doctor. You're on a busy ward around
your consultant asks you to perform a procedure, let's say a
lumbar puncture that you've onlywatched once before and you
really don't feel confident or confident doing it

(48:38):
independently. What's the safest and most
professional response? The safest thing is to be honest
and assertive, but polite. You need to clearly state to
your consultant something like consultant.
I've only observed that procedure once and I don't feel
competent to perform it independently yet.
Could I please have direct supervision or would you be able
to do it? So don't just try and wing it.
Absolutely not. That risks patient harm and goes

(49:00):
against the fundamental principle of working within your
competence. Refusing outright without
explanation might seem unhelpful, and asking someone
even less experienced is irresponsible.
Speaking up clearly about your competence level is the right
thing to do. OK.
SAFETRA&SFER for the mnemonic. Let's break it down.
Ensure colleague has skills. Acknowledge your responsibility

(49:22):
in delegation. Share facts, info clearly
explain to the patient transfer relevant info.
Referral if outside competence. Get assurance if referring to
non registered therapist. Notify patient of transfer,
prioritise safety, check familiarity competence, Ensure
patient understanding. Record the handover.
Yeah, covers the main points. 28Acting as a witness in legal

(49:45):
proceedings. Sometimes doctors get called
upon to act as witnesses in legal cases, perhaps related to
a patient they've treated or maybe as an expert in their
field. The key principle here is that
you're overriding duty is to thecourt.
Not to the person who asked you or is paying you.
Correct. Your duty to the court comes
first. This means you must act
independently, honestly and impartially at all times.

(50:07):
Your evidence, whether written in a report or given orally,
must be accurate, complete and fair.
Use clear language that the court can understand.
What's the difference between being a witness of fact and an
expert witness? A witness of fact testifies
about things they personally sawor did based on their clinical
observations and actions, relying heavily on the

(50:29):
contemporaneous clinical records.
An expert witness is there to assist the court with their
specialist knowledge, providing objective, unbiased opinions
within their area of expertise and acknowledging if there's a
range of professional opinions on a matter.
Crucially, you have to stick to what you know.
Absolutely. You must make clear the limits
of your competence and knowledge.
Don't stray outside your expertise.

(50:50):
Be honest and trustworthy. Never provide evidence that's
false or misleading. OK scenario.
You're asked to provide a factual witness statement for a
court case about a patient you treated two years ago.
You pull up the notes, but they're, well, a bit patchy,
incomplete in places you can't quite remember all the details
not written down. What's the best approach?
Honesty is the only policy. You provide a statement based

(51:14):
strictly and only on the accurate and complete
information that is available inyour records.
You must explicitly state where the notes are incomplete or
where your memory failed you regarding details not recorded.
Do not guess, speculate, or fillin gaps.
That would be dishonest. If you're unsure, always seek
advice from your medical defenceorganisation before submitting
anything. HONEST for the mnemonic.

(51:35):
HONEST be honest be objective and impartial base evidence on
notes and records limit evidenceto your expertise share factual
information accurately your dutyis the truth to the court. 29
Reporting criminal regulatory proceedings right this is a
professional obligation outlinedin good medical practise.
Doctors have a duty to inform the GMC promptly if they become

(51:57):
involved in certain criminal or or regulatory proceedings
anywhere in the world. Promptly, meaning without delay.
What sort of things need reporting?
Yes, without undue delay. You must tell the GMC if you've
accepted a police caution if you've been charged with or
found guilty of a criminal offence, apart from minor things
like fixed penalty notices for parking, if another professional

(52:19):
body finds against your registration, or if you're
criticised by an official inquiry.
So even a caution needs reporting.
It's not just convictions. Correct.
Accepting a caution is a formal admission of committing an
offence, so it must be reported.The GMC needs to be aware of
anything that could potentially raise questions about your
fitness to practise or damage public trust in the profession.

(52:41):
OK, scenario. You were charged with a driving
offence. Something more serious than a
simple speeding ticket, maybe dangerous driving.
It's still just a charge at thisstage, not a conviction.
What's your immediate professional?
Duty You must inform the GMC without delay that you have been
charged with that criminal offence.
Don't wait to see if you'll be convicted.
You should also inform any organisations you work for,

(53:03):
especially if it could impact your work.
And definitely seek advice from your medical defence
organisation about the implications and the process.
So ignoring it or hoping it goesaway is not the right approach.
Definitely not failing to reportwhen required is a breach of
good medical practise in itself and could lead to separate
fitness to practise proceedings.INFORMGM.

(53:24):
CINFORMGMC report Immediately notify about findings.
Charge cautions report findings against registration by other
bodies. Any criminal offence usually
report regulatory issues. Maybe a caution counts.
Yes it does. Applies globally.
Minimal exclusions like fixed penalties.
Consult your defence body or GMCif unsure. 30 Writing references

(53:46):
Doctors are often asked to writereferences for colleagues,
perhaps for job applications, appraisals or other assessments.
When you do this, the key principles are honesty,
objectivity, and fairness. So the reference needs to be a
true and accurate reflection. Yes, it must be accurate,
complete and fair, including allrelevant information about the
colleagues competence, performance and conduct.

(54:09):
You mustn't write anything falseor misleading, either explicitly
or by omitting important information.
What about negative points if someone was generally good but
had some issues? If there were relevant
performance or conduct issues, especially if they were formally
addressed or documented, they should generally be included
factually and objectively. You need to base your comments

(54:30):
on evidence, not personal bias. Avoid personal details unless
they are directly relevant and you have consent or there's a
public interest justification. OK scenario.
You're asked to write a reference for a former junior
colleague. You like them personally, they
were friendly, but they had somesignificant documented
performance issues during their time with you which were
formerly discussed and managed. What's the correct approach when

(54:53):
writing the reference? You have to write an accurate,
objective and fair reference. That means you must include the
relevant information about thoseperformance issues and how they
were addressed. You can and should also include
their strengths, but omitting the documented problems would be
misleading and potentially unfair to the prospective
employer, possibly even risking patient safety down the line.

(55:14):
Stick to the facts. Exclude personal feelings.
And you should normally let the person see the reference you've
written. Yes, the guidance says you
should normally provide a copy of the reference to the
candidate if they ask for it. FAR for the mnemonic.
FAIR keep it factual, make it accurate, be inclusive of all
relevant information, positive and negative.

(55:35):
Ensure it's reliable and evidence based. 31 Cosmetic
interventions Doctors who offer OK cosmetic interventions While
specific, detailed guidance wasn't in our core prep
summaries today, the general principles of good medical
practise absolutely apply to doctors offering cosmetic
procedures, both surgical and non surgical.
So things like honesty and advertising, managing conflicts

(55:57):
of interest and ensuring proper consent are key.
Exactly. You must make sure any
information you publish about your services is factual,
verifiable, and doesn't exploit patients.
Vulnerability or lack of medicalknowledge, aggressive marketing
tactics, or misleading before and after pictures would fall
foul of this. And patient safety is paramount,
presumably. Always your decisions about

(56:19):
recommending or providing treatments must be based on
clinical appropriateness and patient benefit, not driven by
financial incentives or patient pressure.
If you have interest in particular products or devices,
these must be declared. Consent needs to be fully
informed, covering risks, benefits, alternative and costs,
with adequate time for reflection.
What if a patient really wants acosmetic procedure, but you

(56:42):
genuinely believe it's not clinically appropriate for them?
Maybe the risks outweigh the benefits in their specific case.
You must explain your reasoning clearly and sensitively to the
patient, outlining why you believe it's not appropriate for
them. And you should refuse to provide
the treatment if you assess it as not being clinically
indicated or of overall benefit.You are not obliged to provide

(57:03):
treatments you deem inappropriate, even if the
patient insists. So it goes back to those core
GMC principles again. It does patient safety, informed
consent, honesty, managing conflicts of interest, they all
apply strongly in the cosmetic sector. 32 Good practise and
research We touched on consent for research earlier, but the

(57:24):
GMC also has broader principles about good practise and research
itself. The Absolute Foundation is
acting with honesty and integrity in every aspect,
designing, organising, conducting and reporting
research. And following established
guidelines. Yes, you must follow National
Research, governance guidelines and, of course, relevant GMC
guidance like the consent principles we already discussed,

(57:44):
informed voluntary consent, the right to withdraw special
protections for vulnerable groups and the need for ethical
approval. OK scenario, you've been invited
to be a Co investigator on a newresearch project.
You're reviewing the protocol and documents and you notice the
patient information leaflet is incredibly dense, full of
technical jargon, really hard tounderstand.

(58:06):
What's the ethically correct step?
You have a responsibility to raise that concern, speak to the
lead investigator, and potentially flag it to the
research Ethics Committee. You need to advocate for the
information sheet to be revised into clear, simple language that
potential participants can realistically understand.
Informed consent isn't truly informed if the information

(58:27):
isn't comprehensible. So just hoping patients will ask
questions isn't good enough. No.
The information provided must beaccessible from the start.
Proceeding with a complex leaflet compromises the validity
of the consent. OK, ETHICS and research.
Let's try. Ethical approval is essential.
Be transparent in methods and reporting.
Act with honesty and integrity. Ensure informed consent is

(58:49):
valid. Consider capacity and
vulnerability. Prioritise participant safety.
Yes, that works. 33 If sources include 202425 updates for pass
A's note scope and cross references.
And finally, just a really important point about recent
changes. The GMC guidance, including the
cornerstone document Good Medical Practise, has been

(59:10):
updated effective from 2024 or 2025 for different pieces to
explicitly include Physician Associates, P AS and anaesthesia
Associates as. The GMC now regulates these
professions too. Right, I've seen that mentioned.
So does this mean that all theseprofessional standards,
everything we just spent this time discussing, now apply
equally to P, AS and de Hays working in the UK?

(59:31):
Essentially, yes. The GMC refers to Doctors P as
and Day as as 3 distinct professions working together.
The professional standards set out in GMC Guidance apply to all
registrants Doctors P as and dayAS to the extent that they are
relevant to their specific scopeof practise.
So principles like confidentiality, consent, duty
of candour, raising concerns, maintaining boundaries, they

(59:53):
apply across the board. Exactly.
It's about ensuring consistent standards of professionalism and
patient safety across the entireGMC regulated workforce.
So if you're working alongside PAS or A bays, you should expect
them to adhere to the same high ethical standards outlined in
this guidance. OK, quick scenario.
Then you observe A physician associate APA working in your

(01:00:14):
department. You see them giving what looks
like medical advice on a public social media forum.
They identify themselves vaguelyas a healthcare professional,
but don't specify they are APA. What's the best approach?
The best first step would be a quiet professional conversation.
Approach the PA privately, remind them that the GMC social
media guidance now applies to them too, and explain the

(01:00:36):
importance of transparency usingtheir real name and clearly
stating their professional role,IE physician, associate.
If they're identifying themselves in a professional
capacity online. This helps maintain public trust
and avoids confusion. So not ignoring it, but
addressing it constructively. Precisely, It's about supporting
colleagues in upholding professional standards.
OK, APPLY for the mnemonic. APPOY all GMC standards apply,

(01:01:00):
includes PAS&AA's. They are distinct professions
must ensure legal compliance. Yes, relevant to their scope of
practise Outro. Wow, what a journey.
That was a truly comprehensive and pretty fast-paced deep dive
into that core GMC guidance. It really does form the bedrock
of ethical practise and honestly, it's absolutely vital

(01:01:22):
stuff for your MSRASJT. Let's try and pull out some real
golden rules to keep right at the front of your mind.
OK, golden rules. Definitely safety first.
Always, always prioritise patient safety and protection
above all else #2 escalate earlyif you spot a risk.
If you're out of your depth, actpromptly.
Tell someone senior who can actually make a difference.
Don't sit on concerns. Right.
And be candid, be open, be honest when things inevitably go

(01:01:45):
wrong, sometimes explain what happened, apologise sincerely.
It's crucial for trust. Absolutely, and protect data.
Patient information is sacred. It's confidential.
Only share what is necessary. Get consent when you need it, or
make sure you have a clear legaljustification if you don't have
consent. OK, what else?
Respect, consent to capacity. You've got to involve patients

(01:02:07):
in decisions about their own bodies and care, respect their
autonomy and properly assess their capacity to make those
decisions, using the Mental Capacity Act framework if
needed. Couldn't agree more.
And then document meticulously. We've said it a few times, but
honestly if it's not clearly, accurately and timely written
down in the notes, it's like it didn't happen.
For accountability, for continuity, for everything.

(01:02:29):
So true. And maybe finally, know your
limits and work as a team. Don't try to be a hero and work
beyond your competence. Delegate safely, refer
appropriately and collaborate effectively with everyone in the
multidisciplinary team, including your PA and a A
colleagues now too. That's a great summary.
You know, navigating these complex ethical situations isn't
just about ticking boxes for an exam.

(01:02:51):
It's genuinely about building the foundations for a
trustworthy, justifiable, and fulfilling medical career.
Think about it, how can you proactively apply these
guidelines every single day, even in small ways, to maybe
prevent some of those really challenging situations from even
arising in the 1st place? How will you embed these golden
rules into your daily practise right now?

(01:03:13):
That's a brilliant thought to end on.
OK, that really is it for this deep dive.
Remember, for a free STT textbook and Lowe's More podcast
to help you ace your exams, you can head over to
https.www.passthemsra.com. And don't forget to subscribe to
us on YouTube as well. Search for pass them SRA.
That's PASSTHEMSRA. The very best of luck with all

(01:03:35):
your revision.