Updating Good Medical Practice guidelines: a first step towards tackling sexism and sexual misconduct in healthcare

Sexism and sexual harassment and assault are uncomfortable to talk about in any environment. But in the past few years, the medical community has started to raise its voice to confront this damaging culture that permeates the whole of healthcare. The latest update to Good Medical Practice sees the General Medical Council (GMC) introducing guidance on these forms of sexual misconduct for the first time. After much campaigning, this is a sign of progress, but we must remember that there is much more work to do to stop these behaviours.

Since the BMA’s Sexism in Medicine report was published in 20211 we have gained some idea of the prevalence of these problems—91% of female doctors have experienced sexism in work and 31% have experienced unwanted physical misconduct. These figures show how widespread sexual misconduct is in medicine. More research is needed to formally assess the prevalence among other health professionals, but we know anecdotally from published testimonies that this affects everyone who works in healthcare.2

Regardless of your profession, being a target of sexual misconduct can be hugely damaging to your career, relationships, mental health, and wellbeing. As survivors of sexual misconduct in the healthcare workplace ourselves, we started our campaign, Surviving in Scrubs, to highlight the human cost of sexual misconduct, to educate healthcare organisations, and to advocate for policy change to provide support for survivors and stop sexual misconduct.

When we heard that the GMC was rewriting the Good Medical Practice ethical guidelines, we wrote to the organisation and joined the discussion as part of its public consultation.3 We thought that this was a valuable opportunity to include clauses on sexual misconduct perpetrated by doctors and to denounce these behaviours as unacceptable.

It is encouraging to see that this update of Good Medical Practice explicitly covers interprofessional sexual harassment and states how doctors “must not act in a sexual way towards colleagues with the effect or purpose of causing offence, embarrassment, humiliation, or distress.” This has been a long time coming and is a positive first step by the medical regulator in acknowledging the problem of sexual misconduct in the medical workforce. We now hope to see further actions that show the regulator is taking its responsibility to act on and prevent these behaviours seriously.

From the testimonials of survivors2 and data from the regulators,4 we know that doctors are the staff group most likely to be perpetrators of sexual misconduct. Perpetrators need to be appropriately held to account by both their employer and the GMC. More cases need to be investigated rather than dismissed, and sanctions must be proportionate to the severity and risk of the case. As part of that process, it also must be recognised that perpetrators very rarely commit a single offence.

Good Medical Practice now includes guidance for doctors who witness sexual harassment to speak up about unacceptable behaviours and report them. But many doctors describe the fear of personal and professional repercussions that make speaking up feel near impossible.5 We often read testimonials explaining that survivors are ignored, blamed for what happened, and re-victimised by those investigating, all while navigating unclear reporting pathways—if any pathway exists at all.2 A survivor might have to repeatedly recount their experience and relive the trauma to have their voice heard. Many survivors have to relay their story to their supervisor, employer, the perpetrator’s employer, the deanery, human resources, the police, and the GMC.

The latest update to Good Medical Practice guidelines gives clear advice that witnesses and those in positions of formal leadership should offer support for survivors—this should go some way to shifting the responsibility of action onto the employer. The GMC has detailed that survivors should be supported if they want to report, and it should now lead by example. This means listening to the experiences of survivors who have been through the GMC process and putting measures in place to improve the experience of survivors in the future.

To ensure that Good Medical Practice guidelines have any effect, clear reporting protocols and policy must be established that puts onus on employers to prevent and act on sexual misconduct with specialist sexual violence support services in place for survivors. Education on inappropriate behaviour, sexual misconduct, active bystander training, and professional standards needs to be provided at university and in the NHS, continuing throughout doctor’s careers. We need to see the GMC building trust with survivors and witnesses by supporting them when they report perpetrators and having transparent reporting procedures that are not intimidating and clearly explain what to expect from the process. Cases of sexual misconduct must be investigated rather than dismissed, and appropriate, proportionate sanctioning of perpetrators is essential.

The GMC is one stakeholder, but this work must happen across the whole healthcare sector to produce meaningful cultural change. We need to see work being done in the NHS across the devolved nations, in the Department for Health and Social Care, in the allied and nursing regulators, in trusts, integrated care boards, and royal colleges, and universities.