Treating patients well: Principles for shared clinical practice

Medical knowledge is expanding at an increasing rate. The identification, understanding and treatment of many conditions has changed (and continues to do so) almost unrecognisably, in a short space of time. The framework for shared clinical practice is designed to provide specialty specific knowledge upon which any doctor can draw, at any time in their career, for those conditions where they are less confident and/or to which they have had less direct clinical exposure. The content is designed to apply to all clinical situations and can also act as Continuous Professional Development (CPD) for all doctors rather than being part of specialty curricula and assessment. It is aligned to both the GMC’s Generic Professional Capabilities and Good Medical Practice.

Our thanks are due to the various colleges who have brought the framework to life by providing three exemplars covering eating disorders, intellectual disabilities, and neuro-developmental conditions. These include but are not limited to, Royal College of Psychiatrists, Royal College of Emergency Medicine, Royal College of Paediatrics and Child Health, Royal College of General Practitioners and Royal College of Physicians of London.

I am grateful to the hard work of teams at both the GMC and the Academy for taking this important work forward.

Dr Jeanette Dickson

Chair of Council
Academy of Medical Royal Colleges

• Patients present to doctors with conditions that they may not have explicitly covered during their training.
• Rapid responses to concerns raised by governmental bodies, coroners, or other stakeholders when care does not go to plan are sometimes needed.
• The process addresses areas of both current and new common practice, and ways of addressing such presentations at an organisational level.
• We have kept it very high level to cover the diversity and large number of potential issues that could arise, including non-clinical areas of practice such as those covered by GPCs. It is applicable to all medical professionals at any stage of their career and intended to be deliverable within an organisation. It will be suitable for undergraduate medical students, doctors in training, locally employed doctors, SAS doctors, consultants, GPs, and all other practising medical professionals.
• The principles are not condition-specific, but rather sustainable, future-proofed and applicable to the medical profession across all four nations.

An overarching framework of principles of behaviour is provided below, which offers a
method for healthcare organisations to address concerns in a systematic and structured
way amenable to quality assurance.

a.  Consider patient preferences and treat all patients (to include their carers) without
discrimination as the experts on their own condition.

b.  Recognise and identify the area of concern, and level of prioritisation required.

c.  Be prepared to be flexible and open-minded, adapting processes and making
reasonable adjustments.

d.  Ask for “what matters” to understand the needs and concerns of the individual and
their carers. Listen closely to the answers, and say (and mean) “thank you for letting
me know”.

e.  Think about the patient holistically and respond to their individual needs.

f.  Consider using BRAN when discussing options with the patient (B = Benefits, R =
Risks, A = Alternatives, and N = what happens if you/we do Nothing).

g.  Ensure clear and accessible communication between all relevant parties involved in
the provision of care, ideally backed up with takeaway information.

h.  Identify immediate actions and local escalation required.

i.  Signpost to knowledge resources, including ‘just-in-time’ resources, and identify
where and how to refer onwards.

j.  Review and evaluate and ensure final ‘safety netting’ is carried out.