Good Surgical Practice 2008

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Good Surgical PracticeFebruary 2008Review date: 2010


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Good Surgical Practice

Published: February 2008

Review date: 2010

Good Surgical Practice is endorsed by:

The Association of Surgeons of Great Britain and IrelandThe British Association of Oral and Maxillofacial SurgeonsThe British Association of Otorhinolaryngologists Head and Neck SurgeonsThe British Association of Paediatric SurgeonsThe British Association of Plastic, Reconstructive and Aesthetic SurgeonsThe British Association of Urological SurgeonsThe British Orthopaedic AssociationThe Royal College of Physicians and Surgeons of GlasgowThe Royal College of Surgeons in IrelandThe Royal College of Surgeons of EdinburghThe Society for Cardiothoracic Surgery in Great Britain and IrelandThe Society of British Neurological Surgeons


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Published by The Royal College of Surgeons of England

Registered Charity No. 212808

Professional Standards and RegulationThe Royal College of Surgeons of England3543 Lincolns Inn FieldsLondon WC2A 3PETel: 020 7869 6032Fax: 020 7869 6030Email: [email protected]

The Royal College of Surgeons of England 2008

All rights reserved. No part of this publication may be reproduced, stored in a retrievalsystem or transmitted in any form or by any means, electronic, mechanical,photocopying, recording or otherwise, without the prior written permission of The RoyalCollege of Surgeons of England.

While every effort has been made to ensure the accuracy of the information containedin this publication, no guarantee can be given that all errors and omissions have beenexcluded. No responsibility for loss occasioned to any person acting or refraining fromaction as a result of the material in this publication can be accepted by The RoyalCollege of Surgeons of England.

Designed and typeset by Close to Water Ltd, Crayford, KentPrinted by Latimer Trend & Company Ltd, Plymouth, Devon


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Contents

The duties of a doctor registered with the General Medical Council 5Note on terminology 5

Introduction 6Clinical governance 7Appraisal 7Revalidation, recerti cation and relicensure 8

1 Good clinical care 91.1 Providing a good standard of surgical practice and care 91.2 The treatment of emergencies 111.3 Working with children 121.4 Organ and tissue transplantation 131.5 Record keeping 141.6 Generic guidance: examples of individual standards 151.7 Presenting examples of your evidence 16

2 Maintaining and improving good surgical practice 172.1 Maintaining and improving your knowledge and performance 172.2 Adverse events 182.3 New techniques 192.4 Generic guidance: examples of individual standards 202.5 Presenting examples of your evidence 20

3 Teaching, training and supervising 213.1 Medical students 213.2 Surgical trainees 223.3 Staff and associate specialist-grade surgeons 233.4 Locum surgeons 233.5 Responsibilities of surgical trainees 243.6 Generic guidance: examples of individual standards 253.7 Presenting examples of your evidence 25


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4 Relationships with patients 264.1 Consent 264.2 Consent for transfusion 284.3 Maintaining trust 284.4 Communication 294.5 Generic guidance: examples of individual standards 304.6 Presenting examples of your evidence 31

5 Working with colleagues 325.1 Working together 325.2 Generic guidance: examples of individual standards 33

5.3 Presenting examples of your evidence 33

6 Probity in professional practice 346.1 Provision of information 346.2 Private practice 356.3 Research 366.4 Generic guidance: examples of individual standards 376.5 Presenting examples of your evidence 37

7 Health 38

7.1 Patient safety 387.2 Generic guidance: examples of individual standards 397.3 Presenting examples of your evidence 39

8 Additional guidance: armed con ict, developing countries and prisons 408.1 Armed con ict 408.2 Developing countries 408.3 Prisons 41

9 Further reading 429.1 Department of Health 429.2 General Medical Council 439.3 The Royal College of Surgeons of England 459.4 Other bodies 45

10 Useful contacts 4610.1 Surgical royal colleges in Great Britain and Ireland 4610.2 Surgical specialist associations and societies 4710.3 Other contacts 49

Acknowledgements 54


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The duties of a doctor registered with the General Medical Council

Patients must be able to trust doctors with their lives and health. To justify that trustyou must show respect for human life and you must do the following:

> Make the care of your patient your rst concern.

> Protect and promote the health of patients and the public.

> Provide a good standard of practice and care: > keep your professional knowledge and skills up to date; > recognise and work within the limits of your competence; and > work with colleagues in the ways that best serve patients interests.

> Treat patients as individuals and respect their dignity: > treat patients politely and considerately; and > respect patients rights to con dentiality.

> Work in partnership with patients: > listen to patients and respond to their concerns and preferences; > give patients the information they want or need in a way they can understand; > respect patients right to reach decisions with you about their treatment and care; and > support patients in caring for themselves to improve and maintain their health.

> Be honest and open and act with integrity:

> act without delay if you have good reason to believe that you or acolleague may be putting patients at risk; > never discriminate unfairly against patients or colleagues; and > never abuse your patients trust in you or the publics trust in the profession.

You are personally accountable for your professional practice and must always beprepared to explain and justify your decisions and actions.

Good Medical Practice , GMC, 2006.

Note on terminology

Good Medical Practice came into effect on 13 November 2006. In Good Medical Practice the terms you must and you should are used in the following ways:

> you must is used for an overriding duty or principle;

> you should is used when the General Medical Council (GMC) is providing anexplanation of how that overriding duty is to be met; and

> you should is also used where the duty or principle will not apply in all situations or circumstances, or where there are factors outside your control that affect whether or how you can comply with the guidance.

The same convention is used in this document.

Ensure is used where surgeons must do all that is within their control to make surethat the event takes place.

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Introduction

Good Surgical Practice sets standards for surgeons. The rst edition of Good Surgical Practice , published in 2002, followed the publication of the GMCsGood Medical Practice in 2001. This new edition follows the revision of Good Medical Practice published in 2006. The document combines a modi ed and revised text of Good Surgical Practice (RCS, 2002) and Criteria, Standards and Evidence (RCS,2004). A signi cant range of new references have been added to both the text and thefurther reading list.

The standards set are intended to be reasonable, assessable and achievable by allcompetent surgeons. They complement those standards required of all doctors by theGMC as set out in Good Medical Practice (GMC, 2006). Good Surgical Practice usesthe same headings that appear in Good Medical Practice and is the surgicalcompanion to the GMC document. Details of other useful guidance and informationare also provided.

Good Surgical Practice is written primarily for any surgeon, whether consultant, staff or associate specialist, or trainee, working within and/or outside NHS practice. It maybe used as a framework for providing evidence for appraisal and revalidation basedon the criteria and standards set out in Good Medical Practice . The standards set outin this document may be used both by surgeons to con rm their good practice and bythose who may have to make judgments about surgeons performance.

Good Surgical Practice is also intended for the use and bene t of patients, to givethem an informed understanding of the standards they can reasonably expect from acompetent surgeon.

It is recognised that good surgical practice depends not only on the personalattributes of the surgeon but also on effective team-working and adequate resourcesand time. All surgeons are responsible for the standards of clinical care that they offer to patients and should bring to the attention of their employing authority anyde ciencies in resources that impact on the quality of clinical care and patient safety.

Although it is acknowledged that a document of this kind may be seen as being either too prescriptive or ambiguous, it is for individuals to re ect on their practice and workto the standards set out in this document.

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Clinical governance

Clinical governance is a statutory duty across all NHS Trusts.* It can be de ned as aframework through which the NHS organisations are accountable for continuouslyimproving the quality of their services and safeguarding high standards of care bycreating an environment in which excellence in clinical care will ourish ( A First ClassService Quality in the New NHS , Department of Health, 1998). Clinically focusedpractice depends on the governance of clinicians by clinicians. The process issupported by the chief executive of the Trust who is required to con rm and facilitatethe process and is individually legally accountable for the service provided in the Trust.Similar arrangements should exist in the independent sector. Further usefulinformation can be obtained from:

> the Department of Health;

> the Clinical Governance Support Team (a learning organisation that uses theknowledge of its staff and its relationships with other NHS organisations to supportthose who shape the health care experience for patients, carers and the public); and

> the Healthcare Commission (the independent inspection body for both the NHS andindependent health care in England).

Appraisal

Appraisal is the process that gives surgeons an opportunity to formally discuss their professional roles and clinical practice ( Supporting Doctors, Protecting Patients ,Department of Health, 1999). Its dual role is to improve on good performance and alsoto recognise poor performance at an early stage. A national appraisal scheme wasintroduced in 2001 and is now a contractual requirement for all consultants working inthe NHS. Consultants who practise in both the NHS and the private sector have theopportunity to submit their private practice activity as part of their NHS appraisal.Consultants in independent practice who do not have an NHS contract will need tomake independent arrangements for appraisal. Appraisal is based on the seven coreheadings presented in Good Medical Practice (GMC, 2006), which sets out the

standards required of all doctors. They are:

1 good clinical care,2 maintaining good medical practice,3 relationships with patients,4 working with colleagues,5 teaching and training,6 health, and7 probity.

Each of these headings is addressed in this document.

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*This document has been written from an English perspective. Different health services operate in other parts of the UK and in Ireland. Nevertheless, the standards remain relevant.


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Revalidation, recertifcation and relicensure

Since the publication of the last edition of Good Surgical Practice , there have beensigni cant changes proposed in relation to revalidation. The white paper,Trust, Assurance and Safety: the Regulation of Health Professionals in the 21st Century (Department of Health, 2007), which builds on the responses to Sir LiamDonaldsons report, Good Doctors, Safer Patients (Department of Health, 2006),reaf rms the governments commitment to the introduction of a system of revalidation.The white paper is complemented by the governments response to the recommendationsof the Fifth Report of the Shipman Inquiry and to the recommendations of the Ayling,Neale and Kerr/Haslam Inquiries, Safeguarding Patients , which sets out a range of measures to improve and enhance clinical governance in the NHS.

Medical revalidation will have two core components: relicensure and specialistrecerti cation. All doctors wishing to practise in the UK will require a licence topractise. The GMC will issue these licences as soon as it is practicable to do so. Thelicence will be subject to ve-yearly renewal, based on a positive af rmation of thedoctors entitlement to practise, not simply on the absence of concerns ( Trust,

Assurance and Safety , paragraph 2.11, Department of Health, 2007).

Specialist recerti cation will apply to only those doctors who are on specialist practiceor general practice registers. They will be required to demonstrate that they continueto meet the particular standards that apply to their medical specialty. Recerti cationwill be carried out at regular intervals, of no more than ve years, where possiblecoinciding with relicensure. The medical royal colleges will have speci c responsibilityfor developing standards and systems for doctors in their particular specialty.

The Department of Health will be asking the GMC to consult with its key constituenciesto translate the recent update of Good Medical Practice (GMC, 2006) into an effectiveframework against which individual doctors practice can be appraised and objectivelyassessed ( Trust, Assurance and Safety , paragraph 2.21). The Department will beconsulting widely on the ways in which all these proposals will be put into effect in thefuture.

As plans for revalidation are developed, information will be available from:

> the Department of Health (http://www.dh.gov.uk/);

> the GMC (http://www.gmc-uk.org/);

> the Academy of Medical Royal Colleges (http://www.aomrc.org.uk/); and

> royal colleges including The Royal College of Surgeons of England(http://www.rcseng.ac.uk/).

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1 Good clinical care

Defnition

Good surgical care starts at rst consultation and diagnosis, with the patient as either an outpatient or inpatient. It is given in conjunction with other colleagues in the healthcare team. It concentrates particularly on the practice of safe, timely and competentsurgical intervention, ensuring that patients are prioritised and treated according totheir clinical need. Surgery should be avoided where the risks outweigh the bene ts.The decision of intervention is assessed on the basis of the surgeons ability andexperience, patient need and available resources, taking into account therequirements of both emergency and elective activity. Surgeons must demonstratecompetence in their own area of practice and a willingness to refer where necessary.They must demonstrate knowledge and understanding of the necessary ethical andlegal issues relating to their area of surgical practice. They must communicate clearlywith patients and their supporters* and ensure that comprehensive, legible andcontemporaneous records are kept of all their patient interactions.

1.1 Providing a good standard of surgical practice and care

In meeting the standards set out in Good Medical Practice (GMC, 2006), surgeonsmust provide good clinical care by:

> ensuring that patients are treated according to the priority of their clinical need;> communicating compassionately and clearly with patients and, with the patients

consent, with their supporters and, in the case of children, with their parent(s)/responsible adult(s);

> carrying out surgical procedures in a timely, safe and competent manner;

> providing elective care for patients with non-urgent conditions and carrying outprocedures on them that lie within the range of the surgeons routine practice;

> ensuring patients are cared for in an appropriate and safe environment that takes

into account any special needs they may have, ensuring that adequate resourcesare available for safe patient care and postponing planned procedures if they arenot. If patient safety may be compromised by a lack of resources, this must berecorded by the surgeon and communicated to the chief executive and medical director;

> ensuring patients receive satisfactory postoperative care and that relevant informationis promptly recorded and shared with the appropriate team, the patient and their supporter(s);

*The term supporter is used throughout this document to refer to the relative, carer or friend who has beenidenti ed by the patient as someone with whom they wish to share information about their treatment/operation.Information should only be shared with the supporter with the patients consent. (See section 4.1.) The name of thesupporter should be recorded clearly in the patients notes.

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> ensuring that, on the discharge of a patient from hospital care, appropriateinformation is shared with the patient and/or their carer(s);

> making good use of the resources available;

> ensuring that any instruction to withhold or withdraw treatment (for example,resuscitation categorisation) is normally taken in consultation with the patient or family and authorised by the appropriate senior clinician (see Withholding and Withdrawing Life Prolonging Treatments: Good Practice in Decision Making , GMC 2006);

> accepting patients on referral from GPs, consultant colleagues or as an emergencythrough the accident and emergency department. If a surgeon agrees to see a

patient directly without referral, the patient should be informed that the GP willnormally receive a report;

> utilising the knowledge and skills of other clinicians and transferring the patient,when appropriate, to another colleague or unit where the required resources andskills are available;

> being aware of current clinical guidelines in their eld of practice and the advice theycontain. Surgeons should explain to patients the reasons for not following suchguidance if an alternative course of clinical management is undertaken; and

> discussing with patients and their supporters alternative forms of treatment,Including non-operative care and recording the reasons for their decisions.

1.1.1 Further reading

Improving Your Elective Patients Journey , RCS Patient Liaison Group, 2007

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1.3 Working with children

Surgeons must:

> when communicating with a child or young person: > treat them with respect and listen to their views, > answer their questions to the best of your ability, and > provide information in a way they can understand;

> be aware of the needs and welfare of children and young people when seeingpatients who are parents and carers, as well as any patients who may represent adanger to young children ( Good Medical Practice , GMC, 2006);

> communicate effectively with parent(s)/responsible adult(s);

> protect the childs privacy; and

> treat children only if they have the appropriate training and ongoing experience inthe clinical care of children in their specialty, except in the case of an emergency.


Getting the Right Start: National Service Framework for Children, Young People and Maternity Services: Standards for Hospital Services , Department of Health, 2003

Surgery for Children: Delivering a First Class Service , RCS, July 2007Children in Hospital: Rights and Responsibilities of Children and Parents , RCS Patient

Liaison Group, June 2007018 Years: Guidance for all Doctors , GMC, September 2007

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1.4 Organ and tissue transplantation

Surgeons undertaking organ or tissue transplantation must:

> comply with current laws and ethics (see The Surgeons Duty of Care , Senate of Surgery of Great Britain and Ireland, 1997, pp. 2325) and follow the guidance setout in Towards Standards for Organ and Tissue Transplantation in the UK (BritishTransplantation Society, 1998);

> choose recipients solely on the basis of medical suitability;

> fully inform recipients of hazards and likely outcome when gaining informed consent;

> fully inform living donors of risks and outcome to themselves and of the bene ts andrisks for the recipient. Living organ donation must never be acquired by coercion or for pro t; and

> when using cadaver donors or other tissue, conform to current regulations regarding,for example, prior agreement, assent of relatives and certi cation of brain death.

Information regarding removal, storage and use of human organs can be found at thewebsite of the Human Tissue Authority (http://www.hta.gov.uk/).

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1.5 Record keeping

Surgeons must do the following:

> Ensure all medical records are legible, complete and contemporaneous, and havethe patients identi cation details on them.

> Ensure that when members of the surgical team make case-note entries they arelegibly signed and show the date, and, in cases where the clinical condition ischanging, the correct time.

> Ensure that a record is made of the name of the most senior surgeon seeing thepatient at each postoperative visit.

> Ensure that a record is made by a member of the surgical team of important eventsand communications with the patient or supporter (for example, prognosis or potentialcomplication). Any change in the treatment plan should be recorded.

> Ensure that there are legible operative notes (typed if possible) for every operativeprocedure. The notes should accompany the patient into recovery and to the ward

and should be in suf cient detail to enable continuity of care by another doctor. Thenotes should include:

> date and time; > elective/emergency procedure; > the names of the operating surgeon and assistant; > the operative procedure carried out; > the incision; > the operative diagnosis; > the operative ndings; > any problems/complications; > any extra procedure performed and the reason why it was performed; > details of tissue removed, added or altered; > identi cation of any prosthesis used, including the serial numbers of

prostheses and other implanted materials; > details of closure technique; > postoperative care instructions; and > a signature.

> Ensure that follow-up notes are suf ciently detailed to allow another doctor toassess the care of the patient at any time.

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1.6 Generic guidance: examples of individual standards

> A surgeon must communicate clearly with patients and their supporters, checkingconcerns and ensuring understanding by asking questions to test knowledge.

> A surgeon should ensure that the patient knows the name of the person responsiblefor their care.

> Whenever possible, a surgeon should ensure that only one team is responsible for the patients care at any one time.

> A surgeon must carry out emergency or elective surgical procedures in a timely, safe

and competent manner, delegating or referring to colleagues where appropriate; for example, when treating children or complex cancer.

> A surgeon will be aware of and follow current guidance in their eld of practice andwill be able to justify their actions, where appropriate, when that guidance has notbeen followed.

> A surgeon should demonstrate that patients are treated according to the priority of their clinical need.

> In their absence, the surgeon must arrange safe and effective cover and handover for the assessment, treatment and continuing care of emergency and electivepatients for whom they are responsible.

> A surgeon must comply fully with current ethical and legislative guidance in relationto their area of expertise.

> A surgeon must maintain legible, comprehensive and contemporaneous records.

> A surgeon will bring to the attention of those responsible any resource shortfalls thatmight jeopardise safe and effective patient care.

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1.7 Presenting examples of your evidence

Sources of evidence might include:

> job plan/work programme;

> information regarding annual caseload;

> examples of resource shortfalls that may have compromised patient care;

> record of examples of cancellations or deferment, for example, on account of patient safety;

> demonstration of knowledge of best practice as advised by College and associations;

> results of clinical outcomes as compared with relevant College/associationrecommendations or national or international benchmarks where available;

> record of attendance at audit meetings, of clinical audits and of implementation of audit recommendations;

> records of attendance of morbidity and mortality meetings and compliance withaudits of the National Con dential Enquiry into Patient Outcome and Death(NCEPOD). Surgeons should be present at, or receive minutes of, mortality

meetings, where patients who died under their care were discussed;> on-call rotas;

> results of random audit of medical records/minutes of meetings where records andnotes have been audited against agreed standards. Sample audit of clinical notesshould also include an audit of operation notes; and

> contribution of relevant data to national audit programmes and national registries.

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2 Maintaining and improving good surgical practice

Defnition

Surgeons are specialist doctors who offer effective, informed and up-to-date care topatients through surgical intervention. They ensure that their knowledge of surgicalprocedures is maintained on a regular basis by a variety of measures, includingregular evaluation of patient safety incidents. Surgeons work within teams, which includea range of professionals. All team members should learn continuously from each other,further enhancing the quality of care. They are committed to learning in many ways,including learning from mistakes. They recognise that good surgical practice requiresconstant review and regular continuing professional development (CPD) activities as

an essential part of their professional practice. They must record the progress of their career and CPD in a portfolio that re ects their professional practice.

2.1 Maintaining and improving your knowledge and performance

All surgeons must:

> keep up to date with the relevant literature;

> attend and contribute to regular meetings with colleagues in the same and related

specialties;

> attend multidisciplinary meetings with, for example, pathologists, radiologists,oncologists and other physicians;

> establish and maintain an up-to-date and valid portfolio of all procedures and clinicalactivity, which includes an accurate log book;

> include CPD and the need to maintain knowledge base in job plans;

> take part in annual appraisal;

> take part in quality-assurance and -improvement systems;> take part in national enquiries and audits, for example, the National Con dential

Enquiry into Patient Outcome and Death (NCEPOD) and the Scottish Audit of Surgical Mortality (SASM); and

> take part in regular morbidity/mortality and audit meetings.

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All surgeons should:

> be aware of the immediate results of operations and participate in the audit of thelong-term outcomes;

> be aware of the results obtained by peer groups and seek advice from colleagues if there is a major discrepancy;

> share their results through the audit process;

> keep an accessible record of their surgical activity complying with the DataProtection Act 1998;

> contribute to ongoing clinical trials wherever possible; and

> recognise when they are un t to work through fatigue, illness or the in uence of alcohol or drugs.

2.2 Adverse events*

Surgeons should inform patients of any adverse events that occur during their care,report the event to the responsible of cer of the Trust and, if considered necessary, to:

> a local audit meeting; then

> the National Patient Safety Agency.

All surgeons must be aware of the alert and hazard notices issued by the Medicinesand Healthcare Products Regulatory Agency (MHRA; previously the Medical DevicesAgency, or MDA). Adverse incidents arising from the failure of medical devices mustbe reported to the MHRA (http://www.mhra.gov.uk/). The Committee on Safety of Devices has been set up to advise ministers and complement the work of the MHRA(Devices sector).

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*National Patient Safety Agency guidance de nes the term patient safety incident as any unintended or unexpected incident that could have or did lead to harm for one or more patients receiving NHS funded healthcare.Seven Steps to Patient Safety, NPSA, February 2004.



2.3 New techniques

New techniques include:

> a new or personally developed operation;

> any major modi cations to an established procedure; and

> the introduction of a procedure not previously performed in the Trust/organisation.

When a new technique is to be used, the patients interests should be consideredparamount. Therefore, surgeons must:

> rst discuss the technique with colleagues who have relevant specialist experienceand the medical/clinical director;

> follow local protocols with regard to local ethics committee approval;

> contact the National Coordinating Centre for Health Technology Assessment(NCCHTA) to learn the status of the procedure and/or to register it;

> liaise with the relevant specialist association;

> ensure that patients and their supporters know when a technique is new beforeseeking consent and that all the established alternatives are fully explained prior to

recording their agreement to proceed;

> be open and transparent regarding the sources of funding for the development of any new technique;

> audit outcomes and review progress with a peer group;

> where possible, obtain necessary training in the new technique;

> take part in regular educational activities that maintain and further developcompetence and performance;

> enable the training of other surgeons in this new technique; and> ensure that any new device complies with European standards and is certi ed by

the competent body.

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> A surgeon must keep up to date with the literature and developments in their ownand associated elds of practice.

> A surgeon should take part in annual appraisal.

> A surgeon must keep an accessible record of their surgical practice complying withthe Data Protection Act 1998.

> A surgeon must ensure that they have undergone a period of appropriate trainingbefore undertaking a signi cantly new procedure (for the individual concerned) on a

patient (where that procedure has been shown to be of value).> A surgeon undertaking a new procedure should ensure that appropriate ethical

approval has been sought and con rmed by the medical director and should alsocontribute to the evaluation of that new procedure, complying with NCCHTAguidelines or similar standards.


Sources of evidence might include:> a detailed summary of annual CPD activity, and how practice has been altered;

> record of attendance at multidisciplinary meetings, for example minutes/register of the meeting and certi cates of attendance at course s;

> use of journals and other educational and evidence-based tools;

> authorship of publications, authored guidelines, etc;

> record of last appraisal, personal development plan (PDP) and subsequent changesin practice;

> record of all surgical procedures and clinical activity, which will be required for recerti cation;

> record of any patient safety incidents and their outcomes, and how they havein uenced practice; and

> when employing a new technique or new technology, proof that there is a goodevidence base for its use, that it is registered with or has been reported to theNCCHTA or that it is being tested formally by research. Surgeons often havenew ideas or employ modi cations of an older technique.

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3 Teaching, training and supervising

Defnition

Surgeons should be willing, as part of their professional practice, to engage in thetraining and supervision of students, trainees and other members of the surgicaland health care team. They have responsibilities for creating a learning environmentsuitable for teaching, training and supervising students, trainees and others. Theyshould contribute to the theoretical and clinical training of students while ensuring thatpatients have the right to refuse to be seen by students if they so wish. They mustensure that effective supervision arrangements are in place for all grades of trainee,allowing for the acquisition of the necessary experience while ensuring that patient

safety is paramount. Individuals with whom trainees can legitimately share concernsshould be identi ed. Surgeons should understand and demonstrate effective skills of delegation, assuring themselves at all times of the competence of those to whom theydelegate across the health care team.

3.1 Medical students

Surgeons should:

> encourage and support medical students;

> involve themselves actively in teaching if students are attached to their team;

> be aware of the professional competencies to be achieved by students;

> explain to patients that they have the right to refuse to participate in student teachingand reassure patients that such a refusal will not prejudice their treatment in any way;

> ensure that students are introduced to patients;

> ensure that privacy and con dentiality are maintained and that students understandand respect this requirement; and

> ensure that when a student is involved in speci c examinations or procedures onpatients under general anaesthesia, written consent has been obtained giving thefull extent of the students involvement.


The Doctor as a Teacher , GMC, 1999Generic professional competencies are set out on the Intercollegiate SurgicalCurriculum Programme (ISCP) website.

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3.3 Staff and associate specialist-grade surgeons

Surgeons must:

> ensure that staff and associate specialists are only appointed to standard,recognised grades.

Staff and associate specialist surgeons must:

> perform to the standards detailed in this document;

> be accountable for their activities to a named consultant;

> identify and agree the extent of their delegated responsibilities with a namedconsultant, including the level of independent activity expected; and

> undertake CPD.

3.4 Locum surgeons

Consultant surgeons practising in the same specialty, or the specialty nearest to thatof the locum concerned, must ensure that the locum is:

> fully conversant with the routines and practices of the surgical team;> familiar with, and takes part in, the audit processes of the unit;

> not isolated and knows from whom to seek advice on clinical or managerial matters; and

> not required or expected to work outside their eld of expertise.

A locum consultant, not on the GMC Specialist Register, must be under thesupervision of a named substantive consultant in the same specialty. Locum surgeonsmust perform to the standards detailed in this document.

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3.5 Responsibilities of surgical trainees

(Foundation Year 1; Foundation Year 2; Specialist Trainees 16)

In addition to the requirements of all surgeons set out in this document, trainees must:

> ensure continuity of care for patients for whom they are responsible by formallyhanding over the patients care to a responsible colleague at the end of their periodof duty;

> know which consultant is on call and seek advice or assistance when appropriate;

> understand the importance of seeking advice from someone with more experience;> recognise the circumstances in which they are expected to seek advice and

assistance from a more senior member of the team;

> be available according to a rota published in advance;

> maintain all records relating to their training;

> maintain legible and up-to-date clinical records;

> support and assist their colleagues, in particular those junior to them;

> be prepared to share concerns about possible shortcomings in patient care thatthey perceive in those with whom they work, whether senior or junior to them;

> inform the responsible consultant before a patient is taken to theatre for a major surgical procedure; and

> recognise when they are un t to work through fatigue, illness or the in uence of alcohol or drugs.

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> A surgeon must maintain the privacy, dignity and con dentiality of patients whileworking with all members of the surgical team, including undergraduates.

> A surgeon should contribute to the provision of a learning environment suitable for teaching, training and supervising students, trainees and others.

> A surgeon must only delegate duties and responsibilities that are appropriate tothe level of competence of those with whom they are working and check that thedelegated duty has been performed.

> If involved in teaching, a surgeon should ensure that they have the necessary skillsand have taken part in training.

> A surgeon must be honest and open when assessing and appraising.

> A surgeon should be courteous when working with all members of the surgical team.



> evidence of attendance at an appropriate teaching course, for example Training theTrainers or equivalent. This could include a piece of self-re ective work on teachingstyle or peer review for a teaching session;

> for surgeons responsible for undertaking the assessment of trainees, evidence of attendance at an appropriate course;

> a summary of formal teaching/lecturing activities and supervision/mentoring duties; and

> results of formal and informal feedback from trainees on the effectiveness of postgraduate and undergraduate teaching and training.

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4 Relationships with patients

Defnition

Surgeons must make every effort to establish and maintain the trust of their patientsat all times. Surgeons must establish and maintain effective relationships with patientsand, where appropriate, their supporters, in a number of ways. They must allowsuf cient time to explain surgical procedures, risk and alternative treatment options;they must ensure understanding of the surgical and associated processes involved;and they must ascertain and respect patients wishes. Surgeons must understand thatseeking informed consent for surgical intervention is a process, not merely the signingof a form, and one that requires time, clarity of explanation and patience. Surgeons

must take every opportunity to demonstrate to patients that their safety is paramountand treat complaints with courtesy and respect, responding promptly, openly andhonestly.

The following principles are laid out in Good Medical Practice (GMC, 2006) but are of particular relevance to surgeons.

4.1 Consent

The Department of Health has published a Reference Guide to Consent for Examinationor Treatment (Department of Health, 2001). All surgeons must be familiar with theprocesses and details in this document before seeking agreement to proceed withany intervention. Obtaining consent involves a dialogue between surgeon and patient,which leads to the signing of the consent form.

In addition, surgeons must:

> establish whether a patient has a supporter as early as possible in the relationshipand mark this clearly on their notes;

> meet with the patient prior to surgery to discuss operation and implications;> ensure that patients, including children, are given information about the treatment

proposed, any alternatives and the main risks, side effects and complications whenthe decision to operate is made. The consequences of non-operative alternativesshould also be explained;

> provide time for patients and their supporters to discuss the proposed procedure andprovide an opportunity for the patient to make a fully informed and unharassed decisionto agree to the treatment suggested and to indicate by signature their willingness to proceed;

> carefully consider any advance decision (living will) that the patient may havewritten under the Mental Capacity Act 2005 (c. 9);

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> give the patient the opportunity to indicate any procedure they do not wish to becarried out;

> make sure that the patient understands, and is agreeable to, the participation of students and other professionals in their operation;

> gain agreement from the patient if video, photographic or audio records are to bemade for purposes other than the patients records (for example, teaching, researchor public transmission);

> follow appropriate guidance for the retention of tissue;

> clearly mark the site to be operated on with the patients agreement while they areawake and prior to premedication;

> verify the operation to be undertaken by checking the records, including images andconsent form and, where possible, with the patient, rather than relying solely on theprinted operating list for the procedure being performed;

> ensure that the written consent and the notes include, when appropriate, the side tobe operated on using the words left or right in full;

> ensure that digits on the hand are named and on the foot numbered and similarly

marked with the patients agreement while they are awake and prior topremedication; and

> record all discussions about consent in the patients records.


Seeking Patients Consent: The Ethical Considerations , GMC, 1999Con dentiality: Protecting and Providing Information , GMC, 2004Con dentiality FAQs , GMC, 2004Patient Rights and Responsibilities , RCS Patient Liaison Group, 2002Improving Your Elective Patients Journey , RCS Patient Liaison Group, 2007Explaining the Risks and Bene ts of Treatment Options: Suggestions for Hospital

Doctors , Royal College of Physicians, 2006

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4.2 Consent for transfusion

Surgeons must establish the views held by individual patients regarding their positionin relation to transfusion as certain forms of transfusion may be unacceptable.


Code of Practice for the Surgical Management of Jehovahs Witnesses , RCS, 2002

4.3 Maintaining trust

In addition to abiding by the recommendations of Good Medical Practice (GMC, 2006),surgeons must:

> ensure their working arrangements allow adequate time to listen and properlycommunicate with patients and their supporters. The chief executive and medicaldirector must be informed if there are inadequacies;

> fully inform patients and their supporters of the plans and procedures for their treatment, the risks and anticipated outcomes and any untoward developments as

they occur, or as soon as possible afterwards;> support any request for a second opinion and give assistance in making the

appropriate arrangements;

> obtain the patients verbal consent before carrying out any clinical examination;

> support a request by a patient for a third person to be present while they areundergoing a clinical examination;

> explain the purpose and nature of any examination of the breast, genitalia or rectum

and observe GMC guidance on intimate examinations;> be aware of cultural differences and sensitivities and respect them; and

> contribute to patient surveys and respond to their ndings.


Maintaining Boundaries , GMC, 2006

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4.4 Communication

All surgeons must:

> listen to and respect the views of patients and their supporters;

> listen to and respect the views of other members of the team involved in thepatients care;

> recognise and respect the varying needs of patients for information and explanation;

> insist that time is available for a detailed explanation of the clinical problem and thetreatment options;

> encourage patients to discuss the proposed treatment with their supporter(s);

> fully inform the patient and their supporter of progress during treatment;

> explain any complications of treatment as they occur and explain the possiblesolutions; and

> act immediately when patients have suffered harm and apologise when appropriate.


Personal Beliefs and Medical Practice: A Draft for Consultation , GMC, 2007

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> A surgeon should ensure that, as part of the ongoing process of obtaining consent,they give patients and, where appropriate, their supporters, relevant and adequateinformation, including bene ts and risks, in a timely manner.

> A surgeon should observe the relevant legislation and guidance in respect of honouring the wishes of a patient in their care.

> A surgeon should ensure that details of all proposed surgical procedures are, wherepossible, checked with the patient, as well as with the written record.

> A surgeon should ensure that patients and, where appropriate, their supporters areaware of their rights with respect to appropriate national and local guidance on theretention of tissue and that patients and their supporters are aware of their part inthe processes involved.

> A surgeon should gain agreement from the patient, in accordance with the policy of the relevant Trust, when video, photographic or audio records are to be made for any purpose.

> A surgeon should contribute to appropriate means of testing patient satisfaction.

> A surgeon should ensure that a patients dignity is respected at all times, for example with unconscious patients and in clinical demonstrations.

> A surgeon should respond appropriately and professionally to any comments or complaints from patients or their supporters about the service they have receivedand cooperate fully with any complaints procedures, offering an apologywhere appropriate.

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> examples of participation in validated patient surveys and other methods of patientinvolvement;

> applying/implementing results from participation in random audit of patient consent forms;

> examples of approach to handling informed consent;

> examples of plaudits from patients and colleagues; unsolicited expressions of satisfaction and gratitude and compliments on management; and

> a summary of complaints made against the surgeon, the process by which they arehandled and details of the outcomes and, where appropriate, evidence of changesto practice.

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5 Working with colleagues

Defnition

Surgeons work in partnership with others in the health care team which includes other professionals, technicians, support staff and management in order to offer safe andeffective care to patients. They must work to develop effective relationships, respectingthe professionalism of all colleagues. Knowledge and understanding of, and respect for,the roles and views of others are essential to achieving good patient outcomes.Surgeons must ensure continuity of patient care by arranging effective cover for their own patients where possible and be prepared to cover for colleagues in emergencies.

5.1 Working together

Apart from in exceptional circumstances, surgeons must always make formalarrangements for cover. However, in such exceptional circumstances, surgeons musttake responsibility for patients under the care of an absent colleague even if formalarrangements have not been made.

Ineffective team working must not be allowed to compromise patient care.

Surgeons must:

> work effectively and amicably with colleagues in multidisciplinary teams, attendmultidisciplinary team meetings, share decision making, develop commonmanagement protocols where possible and discuss problems with colleagues;

> continue to participate in the care of, and decisions concerning, their patients whenthey are in the intensive care unit or the high-dependency unit;

> willingly and openly participate in regular appraisal of both themselves and traineesurgeons and other staff;

> always respond to calls for help from trainees and others in the operating theatreand elsewhere as a matter of priority;

> ensure there is a formal handover of continuing care of patients to another colleagueat the commencement of leave; and

> ensure that, when acting as manager or director, their practice and appraisalprocesses are subject to the same scrutiny as others.


The Leadership and Management of Surgical Teams , RCS, 2007Management of Healthcare: the Role of Doctors , paragraphs 1921, GMC, 1999

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> A surgeon should willingly and openly participate in regular appraisal of boththemselves and trainee surgeons and other staff, where appropriate.

> A surgeon should always respond to calls for emergency help from trainees,colleagues and other members of the surgical team in the operating theatre andelsewhere as a matter of priority.

> A surgeon should ensure that there is a formal and explicit handover/cover of continuingcare of patients to another named colleague when unavailable for any reason.

> A surgeon should recognise their own technical and professional limitations andrefer to colleagues where necessary or appropriate.

> A surgeon should share their concerns about the physical or psychological health or well-being of any members of the health care team, through appropriate channels.

> A surgeon should work together with other members of the health care team in aprofessional and supportive manner to maintain continuity of patient care, regardlessof patient location.



> description of the setting within which you work and the structure within whichyou practice;

> evidence of multi-/interdisciplinary relationships, for example minutes of multidisciplinary team meetings;

> details of additional responsibilities within the team, for example clinical director or surgical tutor; and

> evidence of attendance at team development events and compliance with agreedprocedures and behaviours, including 360-degree appraisal/multi-source feedback.

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6 Probity in professional practice

Defnition

Surgeons must understand the need to demonstrate probity in all aspects of their professional practice and adhere to the principles set out in Good Medical Practice (GMC, 2006), regardless of where they may be working (for example, the NHS or privatesector). They must demonstrate honesty, objectivity and courtesy in their dealings withothers. They must declare any commercial involvement, which may give rise to actual or potential con ict of interest and ensure that neither their name nor practice is usedinappropriately in the promotion of personal commercial advantage. Surgeons workingin the private sector must ensure transparency in their dealing with patients in respect of

costs for services and any actual or potential limitations of clinical care.

6.1 Provision of information

Surgeons should adhere to all the principles set out in Good Medical Practice(GMC, 2006). In particular, when providing information surgeons must:

> avoid any material that could be interpreted as designed to promote their ownexpertise, either in general or in a particular procedure;

> declare any commercial involvement that might cause a con ict of interest;

> avoid denigrating others;

> ensure that the literature provided by the institution where they work and anyinterview they give to the media does not make unreasonable claims; and

> demonstrate honesty and objectivity when providing references for colleagues andteam members.

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6.2 Private practice

All surgeons working in the private sector, including independent sector treatmentcentres (ISTCs), must:

> make arrangements for the continuity of care of any inpatients;

> maintain the standard of record keeping as listed in section 1.5 and audit all surgicalactivity;

> be honest in nancial and commercial matters relating to work and in particular:

> ensure that patients are made aware of the fees for their services andcost of any treatment by quoting, where possible, their professional feesin advance,

> inform patients if any part of the fee goes to any other doctor, and

> not allow commercial incentives to in uence treatment given to a patient;

> make clear to patients the limits of care available in any independent hospital used;for example, the level of critical care provision provided and the quali cations of theresident medical cover; and

> if working solely in private practice, enable peer review of their surgical activities andparticipate in meaningful audit, CPD and appraisal.

Doctors working in England and Wales who are wholly engaged in private practice inpremises that are otherwise unregistered must register under the Care StandardsAct 2000.

Surgeons who work in both the NHS and the independent sector should:

> undertake similar types of procedures in both;

> ful l their NHS contracted duties; and

> not use NHS staff or resources to aid their private practice unless speci carrangements have been agreed in advance.

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6.3 Research

Surgeons who undertake research must:

> submit full protocols of proposed research and details of intended new technicalprocedures to the research/ethics committee before starting;

> treat patients participating in research as partners;

> ful l the regulations of the World Medical Association Declaration of Helsinki 1964(http://www.wma.net/);

> fully inform research participants about aims, intentions, values, relevance,methods, hazards and discomforts and record this in their notes;

> fully inform patients in randomised trials about the procedures being compared andtheir risks and bene ts and record this in their notes;

> inform participants how their con dentiality will be respected and protected;

> accept that a patient may refuse to participate or withdraw during the programme, inwhich case their treatment must not be adversely in uenced;

> seek guidance from the ethics committee concerning the need for consent for theuse of tissue removed during an operation for research purposes in addition toroutine histopathology;

> seek permission to remove tissue beyond that excised diagnostically or therapeutically;

> acquire speci c permission to use any removed tissue for commercial purposes; for example, to grow cell lines or for genetic research;

> ful l the strict regulations of the Animals (Scienti c Procedures) Act 1986 when

obtaining permission to carry out research on animals;

> discourage the publication of research ndings in non-scienti c media beforereporting them in reputable scienti c journals or at meetings;

> disclose any nancial interest in, for example, pharmaceutical companies or instrument manufacturers;

> ensure that anything regarding the project that may be published on the internet or elsewhere follows ethical principles;

> report any fraud that is detected or suspected to the local research/ethics

committee; and

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> recognise and be familiar with the Human Tissue Act 2004 regulations and obtainappropriate licenses where necessary.

Further information on research governance can be found at http://www.dh.gov.uk/and on the Scottish Executive website at http://www.show.scot.nhs.uk/cso/.


Research: The Role and Responsibilities of Doctors , GMC, 2002


> A surgeon should declare any actual or potential con ict of interest in line withnational guidelines and local policy.

> A surgeon must demonstrate honesty and objectivity when providing references for colleagues and other team members.

> A surgeon who works in the NHS and the private sector must maintain identicalstandards and performance in both sectors.

> A surgeon must ensure that their professional practice is based on best clinicalevidence, and not in uenced by commercial considerations.

> A surgeon undertaking research should ensure that there is an audit trail of documentation and that research is carried out under appropriate ethical standardsand complies with research governance, including the careful recording and storageof data.



> details of actual or potential con icts of interest, which must be declared; and

> evidence of meeting local policy on probity.

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7 Health

Defnition

Surgeons have a duty of care to maintain patient safety at all times and not to workin any health state that might impair judgement and/or jeopardise patient safety. Theymust take particular precautions against the transmission of blood-borne diseases, inboth their own and their patients best interests. They must understand and honour theimportance of reporting serious communicable disease in the public interest, in either themselves or their colleagues.

7.1 Patient safety

Surgeons must not compromise patient safety because of ill health, fatigue or theeffects of drugs or alcohol.

Surgical operations place surgeons at particular risk of acquiring and transmittingblood-borne viruses that can cause serious communicable diseases, such as hepatitisand HIV. (See Serious Communicable Diseases , GMC, 1997 and related note insection 9.2).

In the event of a needlestick injury, surgeons must follow established Trust/organisation guidelines.

Surgeons must take precautions and follow established guidelines when operating onhigh-risk patients.

All surgeons have a duty of care to their patients and must seek advice from anappropriately quali ed doctor if they believe they have a serious communicabledisease. Surgeons also have a duty of care to inform the appropriate authority if theyknow of a colleague who may have a serious communicable disease or any illnessthat is liable to put patients at risk. They must ensure that health risks are addressedand that patients are not put at unnecessary risk due to transfer of blood or tissue infection.

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> A surgeon must not work when their health state is adversely in uenced by fatigue,disease, drugs or alcohol.

> A surgeon must exercise a duty of care in terms of reporting serious communicabledisease or health states that might jeopardise safe patient care, in either themselvesor colleagues.

> A surgeon must be aware of health and safety regulations in respect of their practiseand follow Trust guidelines and relevant legislation.



> a signed declaration by the surgeon of evidence of adherence to local practice; for example, that health issues have not and do not affect their tness to practise;

> hepatitis status; and

> record of absence through sickness.

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8 Additional guidance: armed con ict, developing countries

and prisonsAdditional guidance is given for surgeons working in the following circumstances.

8.1 Armed con ict

> In armed con ict, standards of surgical practice should be, as far as practicallypossible, as laid out in Good Surgical Practice , given the conditions andenvironment in which one is practising.

> Only operate at the request and with the consent of the patient. If the patient isincapable of giving consent, then act only in the patients best interests.

> Do not discriminate between the protagonists. Prioritise patients for treatment on thebasis of clinical need alone.

> Maintain the highest professional standards within the limitations of thecircumstances. Ensure that treatment is culturally sensitive and non-discriminatory.

> Take personal precautions consistent with providing the highest level of care.

8.2 Developing countries

Those seeking to assist health care professionals in developing countries byproviding surgical services should aim to do so in the spirit of mutual partnershipbased on humanitarian service and avoid any patronising or dominant attitudes. Thisincludes humanitarian deployment following natural or man-made disasters.

Surgeons must:

> ensure that whatever is done is for the bene t of the individual and for the local population;> retain the highest standards of care, compatible with the local conditions;

> ensure that, as written informed consent may not always be obtainable, the patientunderstands and voluntarily agrees to the planned procedure. This must always bein the interest of the patient;

> adhere to local legal requirements; and

> never participate in mutilating operations.

Research projects should be undertaken with the highest ethical standards and with thefull awareness and agreement of the local and national communities and health agencies.

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8.3 Prisons

The duty of care remains the same when treating prisoners. Surgeons should notcondone or contribute to in icting physical or mental suffering, whether deliberately,systematically or wantonly. (See The Surgeons Duty of Care , Senate of Surgery of Great Britain and Ireland, pp 28, 29, 1997).

Surgeons should report evidence of abuse and deliberate injuries to the appropriateauthority.


Seeking Consent: Working With People in Prison , Department of Health, 2002

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9 Further reading

9.1 Department of Health

All Department of Health documents can be found at http://www.dh.gov.uk/ in thePolicy and Guidance section.

Trust, Assurance and Safety: the Regulation of Health Professionals , Cm 7013Gateway Reference 7823, Department of Health, February 2007

Safeguarding Patients , Cm 7015 Gateway Reference 7864, Department of Health,February 2007

Health Act 2006: Code of Practice for the Prevention and Control of Healthcare Associated Infections , Department of Health, October 2006

Guidelines for the NHS in Support of the Memorandum of Understanding Investigating Patient Safety Incidents Involving Unexpected Death or SeriousUntoward Harm , Department of Health, November 2006

Good Doctors, Safer Patients: Proposals to Strengthen the System and Improve thePerformance of Doctors and to Protect the Safety of Patients , Department of Health,July 2006

Seeking Consent: Working With People in Prison , Department of Health, 2002

Guide to Consent for Examination or Treatment with Consent Forms for Adults, AdultsWithout Capacity and Children and Young People , Department of Health, November 2001

Reference Guide to Consent for Examination or Treatment , Department of Health,April 2001

Supporting Doctors, Protecting Patients , Department of Health, 1999

A First Class Service Quality in the New NHS , Department of Health, 1998

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9.2 General Medical Council

All documents can be found at http://www.gmc-uk.org/publications/.

018 Years: Guidance for all Doctors , GMC, September 2007

Writing References , GMC, August 2007

Personal Beliefs and Medical Practice, a draft for consultation , GMC, 2007

Valuing Diversity Resource Guides , GMC, 2006

Raising Concerns about Patient Safety , GMC, 2006

Good Practice in Prescribing Medicines , GMC, 2006

Management for Doctors , GMC, 2006Maintaining Boundaries , GMC, 2006

Good Medical Practice , GMC, November 2006

Good Practice in Prescribing Medicines , GMC, 2006

Withholding and Withdrawing Life Prolonging Treatments: Good Practice in DecisionMaking , GMC, 2006

GMC & PMETB Principles of Good Medical Education and Training , GMC, 2006

Con icts of Interest , GMC, 2006

The Meaning of Fitness to Practise , GMC, 2005

Con dentiality FAQs , GMC, 2004

Continuing Professional Development , GMC, 2004

Con dentiality: Protecting and Providing Information , GMC, 2004

Research: The Role and Responsibilities of Doctors , GMC, 2002

Making and using Visual and Audio Recordings of Patients , GMC, 2002

The Doctor as a Teacher , GMC, September 1999

Seeking Patients Consent: The Ethical Considerations , GMC, 1998

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(Note: A new document entitled Consent: Patients and Doctors Making DecisionsTogether is due to be published in 2008. The new guidance will replace the 1998publication. It is broader in scope than its predecessor, placing greater emphasison how doctors and patients work together to make good decisions, and providinga framework that will apply to the range of situations that doctors face in practice. Italso re ects changes in the law, including the new mental capacity legislation andcase law that requires doctors to explain the range of risks associated with aproposed intervention.)


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Serious Communicable Diseases , GMC, October 1997

Guidance for Doctors who are asked to Circumcise Male Children , GMC, 1997

Transplantation of Organs from Live Donors , GMC, 1992

(Note: The GMC is currently drafting Guidance on Expert Witnesses .)

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(Note: update to serious communicable diseases guidance, non-consensual testingfollowing injuries to health care workers.

The GMCs guidance on consent for testing for HIV or other communicable diseasesfollowing a needlestick injury or other occupational exposure to patients blood or bodily uids has been superseded by various changes to the law. This means thatparagraphs 811 of Serious Communicable Diseases are out of date.

In England, Wales and Northern Ireland, this area is now governed by the HumanTissue Act 2004, which came into force on 1 September 2006. The MentalCapacity Act 2005, which came into force in April 2007, also affects this area of law.How or whether the Mental Capacity Act will apply in Northern Ireland is still to bedetermined. In Scotland, this area is governed by the Adults with Incapacity(Scotland) Act 2000, which came into force in April 2001 and the Human Tissue(Scotland) Act 2006, which came into force on 1 September 2006.

The GMC advises that you must comply with the requirements set out in thelegislation and any statutory regulations and codes of practice issued by therelevant authority or ministers. For information and advice on the law, contact your defence body or professional association or seek legal advice.

The GMC will update this statement when they have further information about theeffect of the operation and interaction of the human tissue and mental capacitylegislation across the UK. For more information on the GMCs guidance and thisstatement, contact the GMCs standards and ethics team on 020 7189 5404.)



9.3 The Royal College of Surgeons of England

All documents can be found at http://www.rsc.eng.ac.uk/publications/docs/.

Surgery for Children: Delivering a First Class Service , RCS, July 2007

Children in Hospital: Rights and Responsibilities of Children and Parents , RCS PatientLiaison Group, June 2007

The Leadership and Management of Surgical Teams , RCS, June 2007

Continuing Professional Development: Advice to All Surgeons from the Senate of Surgery of Great Britain and Ireland , Senate of Surgery of Great Britain and Ireland, January 2006

The Surgical Workforce Interim Report and Policy Update , RCS, October 2006

Delivering High-quality Surgical Services for the Future. A consultation document fromthe Royal College of Surgeons Recon guration Working Party , RCS, March 2006

Management of Waiting Lists: What is Important to Patients , RCS Bulletin , RCSPatient Liaison Group, 2005

Developing a Modern Surgical Workforce , RCS, January 2005

Equality and Diversity Policy , RCS, 2004

Maintaining your Performance Dossier of Guidance on Continuing Professional Development for Surgeons , Senate of Surgery of Great Britain and Ireland, 2004

Patient Rights and Responsibilities , RCS Patient Liaison Group, 2002

Better Care for the Severely Injured , RCS and British Orthopaedic Association, July 2000

Code of Practice for the Surgical Management of Jehovahs Witnesses , RCS, 1996;see also Personal Beliefs and Medical Practice, a draft for consultation , GMC, 2007

The Surgeons Duty of Care: Guidance for Surgeons on Ethical and Legal Issues ,Senate of Surgery of Great Britain and Ireland, October 1997

Guidelines for Clinicians on Medical Records and Notes , RCS, 1994 (revised from 1990)

9.4 Other bodies

Good Medical Practice Guidance from the Disability Rights Commission , DRC, 2007

Gynaecological Examinations. Guidelines for Specialist Practice , Royal College of Obstetricians and Gynaecologists, September 2002

Towards Standards for Organ and Tissue Transplantation in the UK , BritishTransplantation Society, 1998

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10 Useful contacts

10.1 Surgical royal colleges in Great Britain and Ireland

The Royal College of Physicians and Surgeons of Glasgow232242 St Vincent Street, Glasgow G2 5RJTel: 0141 221 6072Fax: 0141 221 1804www.rcpsg.ac.uk

The Royal College of Surgeons of EdinburghNicolson Street, Edinburgh EH8 9DW

Tel: 0131 527 1600Fax: 0131 557 6406Email: [email protected]

The Royal College of Surgeons of England3543 Lincolns Inn Fields, London WC2A 3PETel: 020 7405 3474Fax: 020 7831 9438www.rcseng.ac.uk

The Royal College of Surgeons in Ireland123 St Stephens Green, Dublin 2, IrelandTel: 00 353 1 402 2100Email: [email protected]

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10.2 Surgical specialist associations and societies

All the associations and societies are based at The Royal College of Surgeons of England, 3543 Lincolns Inn Fields, London WC2A 3PE.

Association of Surgeons of Great Britain and IrelandTel: 020 7973 0300Fax: 020 7430 9235Email: [email protected]

British Association of Oral and Maxillofacial SurgeonsTel: 020 7405 8074Fax: 020 7430 9997Email: of [email protected]

British Association of Otorhinolaryngologists Head and Neck SurgeonsTel: 020 7404 8373Fax: 020 7404 4200Email: [email protected]

British Association of Paediatric SurgeonsTel: 020 7869 6915Fax: 020 7869 6919Email: [email protected]

British Association of Plastic, Reconstructive and Aesthetic SurgeonsTel: 020 7831 5161Fax: 020 7831 4041Email: [email protected]

British Association of Urological SurgeonsTel: 020 7869 6950Fax: 020 7404 5048Email: [email protected]

British Orthopaedic AssociationTel: 020 7405 6507Fax: 020 7831 2676Email: [email protected]

www.boa.ac.uk

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Society of British Neurological SurgeonsTel: 020 7869 6892Fax: 020 7869 6890Email: [email protected]

Society for Cardiothoracic Surgery in Great Britain and IrelandTel: 020 7869 6893Fax: 020 7869 6890Email: [email protected]

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10.3 Other contacts

Academy of Medical Royal Colleges70 Wimpole Street, London W1G 8AXTel: 020 7486 0067Fax: 020 7935 9214Email: [email protected]

Association of Surgeons in Training3543 Lincolns Inn Fields, London WC2A 3PETel: 020 7973 0300Fax: 020 7430 9235Email: [email protected]

British Association of Medical ManagersPetersgate House, St Petersgate, Stockport SK1 1HETel: 0161 474 1141Fax: 0161 474 7167Email: [email protected]

British Medical AssociationBMA House, Tavistock Square, London WC1H 9JPTelephone 020 7387 4499Fax: 020 7383 6400www.bma.org.uk

British Orthopaedic Trainees Association3543 Lincolns Inn Fields, London WC2A 3PETel: 020 7405 6507www.bota.org.uk

British Association of Day Surgery3543 Lincolns Inn Fields, London WC2A 3PETel: 020 7973 0308Fax: 020 7973 0314Email: [email protected]

British Association for Emergency MedicineChurchill House, 3rd Floor, 35 Red Lion Square, London WC1R 4SGTel: 020 7404 1999Fax: 020 7067 1267Email: [email protected]

www.emergencymed.org.uk

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British Transplantation SocietyAssociation House, South Park Road, Maccles eld SK11 6SHTel: 01625 504 060Fax: 01625 267 879Email: [email protected]

Clinical Governance Support Team1st Floor, St Johns House, 30 East Street, Leicester LE1 6NBTel: 0116 295 2000Email: [email protected]

Department of Health (England)Richmond House, 79 Whitehall, London SW1A 2NSTel: 020 7210 4850Email: [email protected]

Department of Health, Social Services and Public SafetyCastle Buildings, Stormont, Belfast BT4 3SJTel: 028 9052 0500Fax: 028 9052 0572www.dhsspsni.gov.uk

Federation of Independent Practitioner Organisations14 Queen Annes Gate, London SW1H 9AATel: 020 7222 0975Fax: 020 7222 4424www. po.org.uk

General Medical CouncilRegents Place, 350 Euston Road, London NW1 3JNTel: 08457 357 8001Email: [email protected]

GMC Fitness to Practise Directorate5th Floor St Jamess Buildings, 79 Oxford Street, Manchester M1 6FQTel: 0845 357 0022Email: [email protected]

Healthcare CommissionFinsbury Tower, 103105 Bunhill Row, London EC1Y 8TGTel: 020 7448 9200

Email: feedback@healthcarecommission.org.ukwww.healthcarecommission.org.uk

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The Medical Defence Union230 Blackfriars Road, London SE1 8PJTel: 020 7202 1500Email: [email protected]

The Medical and Dental Defence Union of ScotlandMackintosh House, 120 Blythswood Street, Glasgow G2 4EATel: 0845 270 2034Fax: 0141 228 1208Email: [email protected]

The Medical Protection Society (Leeds)Granary Wharf House, Leeds LS11 5PYTel: 0113 243 6436; lo-call: 0845 605 4000Fax: 0113 241 0500

The Medical Protection Society (London)33 Cavendish Square, London W1G OPSTel: 020 7399 1300; lo-call: 0845 605 4000Fax: 020 7399 1301Email: [email protected]

Medical Research Council20 Park Crescent, London W1B 1ALTel: 020 7636 5422Fax: 020 7436 6179www.mrc.ac.uk

Medicines and Healthcare Products Regulatory Agency102 Market Towers, 1 Nine Elms Lane, London SW8 5NQTel: 020 7048 2000 (weekdays 9.0017.00) or 020 7210 3000 (out of hours)Fax: 020 7084 2353Email: [email protected]

National Clinical Assessment Service (England Of ce)1st Floor, Market Towers, 1 Nine Elms Lane, London SW8 5NQTel: 020 7084 3850; advice line: 020 7062 1655Fax: 020 7084 3851Email (general): [email protected] (advice): [email protected]

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National Clinical Assessment Service (Wales Of ce)Sophia House, 28 Cathedral Road, Cardiff CF11 9LFTel: 029 2066 0280Fax: 029 2066 0279

National Clinical Assessment Service (Northern Ireland Of ce)Lisburn Square House, Of ce Suite 2, Haslems Lane, Lisburn BT28 1TWTel: 028 9266 3241Fax: 028 9267 7273

National Con dential Enquiry into Patient Outcome and Death48 Maple Street, London W1T 5HDTel: 020 7631 3444Fax: 020 7631 4443Email: [email protected]

National Coordinating Centre for Health Technology AssessmentMailpoint 728, Boldrewood, University of Southampton, Southampton SO16 7PXTel: 023 8059 5586Fax: 023 8059 5639Email: [email protected]

National Counselling Service for Sick DoctorsTel: 0870 241 0535

National Institute for Health and Clinical ExcellenceMidCity Place, 71 High Holborn, London WC1V 6NATel: 020 7067 5800Fax: 020 7067 5801Email: [email protected]

National Library for HealthSpecialist Library for Surgery, Theatres & Anaesthesiawww.library.nhs.uk/theatres

National Patient Safety Agency48 Maple Street, London W1T 5HDTel: 020 7927 9500Fax: 020 7927 9501Email: [email protected]

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Patient Liaison Group of The Royal College of Surgeons of England3543 Lincolns Inn Fields, London WC2A 3PETel: 020 7869 6045Fax: 020 7869 6044Email: [email protected]/patient_information

Public Liaison Group of the Royal College of Surgeons of EdinburghNicolson Street, Edinburgh EH8 9DWwww.rcsed.ac.uk

Scottish Government Health DirectorateSt Andrews House, Regent Road, Edinburgh EH1 3DGTel: 0131 556 8400Fax: 0131 244 2162Email: [email protected] Scottish Audit of Surgical Mortality2nd Floor, Cirrus, Marchburn Drive, Paisley PA3 2SJTel: 0141 282 2280Email: [email protected]

Welsh Assembly GovernmentCardiff Bay, Cardiff CF99 1NATel: 029 20 825111www.wales.gov.uk

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Acknowledgements

The revision and updating of this version of Good Surgical Practice and associateddocumentation was undertaken, on behalf of the Professional Standards Committee of The Royal College of Surgeons of England, by Maggy Wallace MA BA RN DipEd FHEA.

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The Royal College of Surgeons of England

3543 Lincolns Inn Fields

London WC2A 3PE

T: 020 7405 3474

www.rcseng.ac.uk

Registered charity number 212808

Documents

Good Surgical Practice 2008