Domain 4: Trust and professionalism

'Domain 4: Trust and professionalism' is the fourth domain of Good Surgical Practice, which sets standards for surgeons and members of the surgical team. Good Surgical Practice uses the same headings that appear in Good Medical Practice and is the surgical companion to these General Medical Council (GMC) standards.

About Good Surgical Practice

4.1. Advertising, promotion and provision of information about your practice

4.2. Disclosure of interest and transparency in financial dealings

4.3. Specific considerations of work in the private sector

4.4. Honesty and objectivity when dealing with colleagues

Surgeons must demonstrate probity in all aspects of their professional practice and ensure that they do not abuse their patients’ trust in them or the public’s trust in the profession. They must act with honesty and integrity in all their public communications and financial dealings.

4.1. Advertising, promotion and provision of information about your practice

In addition to the standards set out in Good Medical Practice, you should:

1. Ensure that any information about your knowledge, skills and services is truthful, factual and serves the interests of patients.
2. Ensure that your name or practice is not used inappropriately in the promotion of personal commercial advantage. Any material designed to promote your own expertise, either in general or in a particular procedure, should be objective and accurate.
3. Surgeons in private practice should ensure that any marketing activities are honest and responsible and that promotional statements are realistic and ethical, in line with the code of the Advertising Standards Authority.
4. Refrain from the use of inducements that may influence the patient’s decision and undermine the informed consent process, such as commercial discounts, time-limited offers or two-for-one offers.
5. Obtain written consent from patients if you are using their photographs and testimonials for promotional purposes, even if the photographs are anonymised.
6. When advertising your services, aim to provide clear, factually correct and verifiable information. Advertising must not minimise or trivialise the risks of interventions, or mislead about the results they are likely to achieve, or exploit patients’ vulnerability.
7. Take responsibility for the promotion or advertising carried out by a third party on your behalf and proactively ensure that any relevant information is not misleading or deceptive about your skills, experience, qualifications, professional status and current role.
8. Ensure that the literature provided by the institution where you work and any interview you give to the media does not make unreasonable claims.

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4.2. Disclosure of interest and transparency in financial dealings

Surgeons working in the private sector must ensure transparency in their dealings with patients in respect of costs for services and any actual or potential limitations of clinical care. Surgeons should have the care and wellbeing of their patient as their primary consideration and they should disclose all interests and financial benefits relevant to the circumstances of the patient’s care.

In meeting the standards of Good Medical Practice, you should:

1. Ensure that patients are made aware of the fees for your services and the full cost of their treatment before seeking their consent to treatment. This should include fees relating to follow-up treatment or potential complications where further treatment or revision is required.
2. Inform patients if any part of the fee goes to any other healthcare professional.
3. Declare any commercial involvement that might cause a conflict of interest.
4. Disclose any personal affiliation or other financial or commercial interest relating to your practice including other private healthcare companies, pharmaceutical companies or instrument manufacturers.
5. Not allow financial benefits or interests to influence the advice or treatment you provide to your patients. These include:
   1. receiving a financial benefit indirectly (eg through one or more interposed entities);
   2. receiving a financial benefit by making an informal or verbal agreement;
   3. receiving a financial benefit that does not involve paying money (eg by receiving a financial advantage);
   4. buying an asset from or selling an asset to a person; leasing an asset from or to a person;
   5. supplying services to or receiving services from a person;
   6. receiving a grant of securities or an option from a person;
   7. having a person take up or release an obligation;
   8. soft inducements, such as theatre tickets, free use of property and other gifts that can create conflict between the patient and the surgical team. These should be avoided to the extent possible and a clear process should be followed ensuring transparency and openness
6. When faced with a conflict of interest, be open about the conflict, declare the interest formally and be prepared to exclude yourself from decision making.

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4.3. Specific considerations of work in the private sector

1. Make clear to patients the limits of the care available in any independent hospital used, such as the level of critical care provision and the qualification of the resident medical cover.
2. If working solely in private practice, organise and participate in annual appraisal and maintain a portfolio of evidence of your professional activities. You should enable peer review of your surgical activities and participate in audit and CPD.
3. Ensure that you are a member of a medical defence organisation or that you have other appropriate indemnity and insurance cover for the whole of your practice.
4. If you work both in the NHS and the private sector, you should:
   1. not allow your private commitments to interfere with the fulfilment of your NHS contracted duties;
   2. not use NHS staff or resources to aid your private practice unless specific arrangements have been agreed in advance. Time spent in private practice and away from your NHS duties should be clearly identified in your job plan;
   3. when seeing a patient as part of your NHS practice, not mention or recommend your private practice unless the patient raises this with you first.

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4.4. Honesty and objectivity when dealing with colleagues

1. Demonstrate honesty and objectivity in your dealings with others, including when providing references for colleagues and team members, or when acting as an expert witness, and when providing evidence to courts and tribunals.

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