Saturday, September 30, 2023

Good medical practice a missed opportunity to embed sustainability in ethical standards

  1. Elaine Mulcahy, director,
  2. Richard Smith, chair

  1. UK Health Alliance on Climate Change

The General Medical Council’s (GMC) updated guidance, Good Medical Practice, is a disappointing missed opportunity to embed sustainability as a core focus of medical practice.

Following extensive consultation, which received more than 4,600 responses from across health professionals, patients and carers, the updated guidance includes very little reference to sustainability. Two duties have been added under a new heading on managing resources effectively and sustainably. This does not go far enough.

The climate crisis is a health emergency, and health workers have a duty to be educated, informed, and knowledgeable about the impacts on their patients and the public, and on the important changes that will be needed to the way in which care is delivered.

In May this year, the World Meteorological Organisation warned that global temperatures are likely to exceed 1.5C above pre-industrial levels within the next five years and that one of the next five years will be the warmest ever recorded. During the heatwaves between June and August 2022, 3000 excess deaths were recorded in England and Wales. Between April 2021 and March 2022, 176 flooding incidents in hospitals impacted patient care. Air pollution has been linked to several new causes of hospital admissions. The impacts are already being experienced in our health service and we must ensure doctors are equipped and empowered to be able to respond.

We cannot wait to take the important steps that are needed, and it is critical that organisations such as the GMC take the lead on this now and are looking ahead to the growing impact that climate change will have on patient safety and wellbeing.

Good Medical Practice describes what it means to be a good doctor. It is the core ethical guidance for all doctors registered to work in the UK, setting out the professional values and behaviours expected. Systemic and cultural changes are needed in medical care if the health service is to achieve its legal obligation to be net zero by 2040/45. This was a key moment for the GMC to set out how doctors should expect to be educated and encouraged to practice to achieve these targets, to set the groundwork for the incoming generation of doctors to be fully informed and able to act sustainably, and for patients to recognise this as part of their doctors’ practice.

More prominence of sustainability in Good Medical Practice would have acted as a driver for change that other regulators, education providers, and policy makers would have followed. By not emphasising sustainability in professional standards, it risks other initiatives being slower to formalise.

In their response to the consultation, the UK Health Alliance on Climate Change highlighted the urgency and called for explicit and clear requirements regarding sustainable practice to protect patients, the wider community, and the environment.1 A number of points and detailed insight was also provided by several other groups such as the Centre for Sustainable Healthcare, Greener Practice, medical colleges and individuals, many of which also attended a sustainability roundtable coordinated by the GMC to inform the review process.

Proposals put forward included sustainability to be woven through the document, or focused exclusively in a new fifth domain added to the guidance. Importantly, reflecting the fact that every diagnosis or prescribing choice is a sustainability choice, and ensuring prominence of sustainable practice for evidencing during appraisals were highlighted as key points.

This was the first major update to the guidance since it was first published 10 years ago. It may be years until the next update. The GMC represents the voice of the medical profession, one of the voices most trusted by the public. There has never been a more important time to use this voice to make a clear public statement that elevates the need and urgency of the transformative changes that are needed. Lack of prominence of sustainability in Good Medical Practice is a disappointing missed opportunity.


  • Competing interests: EM and RS contributed to the GMC Good Medical Practice consultation. These activities included the submission of a response to the consultation which was shared and consulted on with members of UKHACC, participation in a sustainability specialist roundtable hosted by the GMC, and a letter to the chair of the GMC during the consultation process.

  • Provenance and peer review: not commissioned, not peer reviewed.

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