The Medical Council of New Zealand measures a doctor's conduct against Good medical practice, the standard it publishes for every registered doctor, and against the statements that sit beneath it on informed consent, sexual and professional boundaries, patient records, prescribing, electronic communication and social media, cultural safety and the disclosure of harm. When a concern is raised, the Council's letter, a performance assessment report, a Professional Conduct Committee's charge and a Tribunal decision each name the paragraphs that apply and set the record against them. Your response and reflection are stronger when they are written the same way: the paragraph named, what the record shows, where it matches and where it does not, and what you have done since.
What Good medical practice is
The Health Practitioners Competence Assurance Act 2003 (the HPCA Act) gives the Council the function of setting standards of clinical competence, cultural competence and ethical conduct for doctors. Good medical practice is the document that does this. It sets out what the Council expects of a doctor in the care of patients, in working with colleagues and within a system of care, in professional and ethical conduct, and in honesty and integrity, in numbered paragraphs. It expects a doctor to use judgement in applying its principles, and it says that serious or persistent failure to meet its standards can put registration at risk.
Beneath it the Council publishes statements that take one subject and set out what the standard requires in detail. The ones that appear in investigations are the statements on informed consent, on sexual boundaries and on professional boundaries in the doctor-patient relationship, on patient records, on good prescribing practice, on electronic communication and social media, on cultural safety and on disclosure of harm following an adverse event. A statement is read with Good medical practice, not instead of it, and the Council expects a doctor to know the statements that cover their practice.
Where the standard is used
In the Council's first assessment. The Council reads the notification and your response against the paragraphs that cover the concern. A response that shows the record meets the paragraph can close the matter there. The guide to what happens after a notification to the Medical Council describes the routes the Council can choose.
In a performance assessment. The Council's competence review of a doctor under section 36 of the HPCA Act measures your practice against the standard reasonably expected of a doctor in your scope. The assessors' report describes what they found in the records, interviews and any observed practice, and the Council reads it against Good medical practice and the statements that apply. The guide to the Medical Council performance assessment covers the day and the report.
In a Professional Conduct Committee. A Committee appointed under Part 4 of the Act investigates conduct and decides whether to recommend an outcome to the Council or lay a charge before the Tribunal. Its proposed findings and any charge set out the conduct and the paragraphs of the standard or the statement it departed from. The guide to how a Professional Conduct Committee process runs explains your right to respond to the proposed findings.
In the Tribunal. The Health Practitioners Disciplinary Tribunal decides whether conduct amounts to professional misconduct under the Act, which includes malpractice, negligence and conduct likely to bring discredit to the profession. It reads Good medical practice and the statements as the evidence of what the profession expects, and its published decisions refer to the paragraphs the doctor departed from. At penalty it weighs whether the doctor has since shown an understanding of the standard.
How an allegation is mapped to the standard
- The conduct is identified. The Council or the Committee states what it understands you did or did not do, in the words of the notification and the record: a consent discussion not documented, a prescription for a family member, a message to a patient outside clinical hours, a note written after the event.
- The subject is matched to a statement. Consent to the statement on informed consent; a relationship with a patient or a colleague to the statements on sexual and professional boundaries; a note to the statement on patient records; a prescription to the statement on good prescribing practice; a post or message to the statement on electronic communication and social media.
- The paragraphs are named. The letter or the charge cites the paragraphs of Good medical practice and of the statement that set the expectation the conduct is measured against.
- The record is set against the paragraphs. What the record shows is compared with what the paragraph requires. Where the record is silent, the Council treats the step as undocumented and asks you to account for it.
- The gap is weighed. The Council or the Committee decides whether the gap is a departure that calls for advice, a competence review, conditions or a charge, and it weighs what you have done since and whether you understand the standard now.
The subjects that appear in investigations
- Informed consent. The statement expects a discussion of the options, the risks and the benefits, in a form the patient can understand, and a record of it. A consent concern turns on whether the discussion happened and whether the record shows it. The Code of Health and Disability Services Consumers' Rights sets the same expectation from the patient's side, and the Health and Disability Commissioner applies it.
- Boundaries. The statements on sexual and professional boundaries cover a relationship with a current or former patient, a dual relationship where you treat a family member, a friend, a colleague or an employee, gifts, personal disclosure and contact outside care. A boundary concern with a patient or a colleague is measured against the same expectation: that the professional relationship is kept for the patient's benefit and that the doctor, not the other person, carries the duty to keep it.
- Patient records. The statement expects a record that is made at the time, accurate, complete enough for another clinician to take over care, and amended only with the date and the reason for the amendment visible. The Health Information Privacy Code 2020 sets the privacy duties around it.
- Prescribing. The statement on good prescribing practice covers assessment before prescribing, prescribing for yourself, family and colleagues, controlled drugs, repeats without review and prescribing at a distance. A prescribing concern is measured against it and against the Medicines Act and the Misuse of Drugs Act in general terms.
- Electronic communication and social media. The statement covers contact with patients by message and online, confidentiality in a post, and comment about patients, colleagues or employers. A post that identifies a patient or a colleague is measured against it and against the Privacy Act 2020.
- Cultural safety and Te Tiriti o Waitangi. The statement on cultural safety expects a doctor to reflect on their own culture and its effect on care, and to work in partnership with Māori patients and their families. A concern about communication with a patient's family can be measured against it.
- Disclosure of harm. The statement expects a doctor to tell a patient when something has gone wrong, what happened and what will be done. A concern that harm was not disclosed is measured against it.
Using the standard in your response and reflection
Write your response under the paragraphs the Council has named. For each one: the paragraph quoted, what the record shows with the page reference, where the record meets the paragraph, and where it does not. Where it does not, one plain sentence, then what you have done since and what you have understood. Where you believe the paragraph was met in a way the notifier did not see, show it from the record and from the circumstances the statement itself allows for. The guide to how to write a response to a Council notification gives the order of the whole document.
Write your reflection the same way. A reflection that says "I regret the distress caused" tells the Council about your feelings. A reflection that says "the statement on patient records expects an amendment to be dated and marked; my entry on that date was not; I now record every late entry with the time and reason, and my last three months of notes have been audited by my supervisor with the result attached" tells the Council that you understand the standard and have changed your practice to meet it. The guide to showing insight and building a remediation plan covers the difference between regret and insight.
Where remediation fits
A remediation plan reads as evidence when each item answers a paragraph of the standard. Professionalism for Doctors is written against Good medical practice and covers the duties the Council measures conduct against: working with patients and colleagues, honesty, records, boundaries and the use of social media. Ethics for Doctors covers consent, confidentiality, dual relationships with patients and colleagues, and the reasoning behind the statements. Reflection for Fitness to Practise covers how to write a reflection against a standard so that it reads as insight rather than regret.
Each course is NZ$200, takes 2 CPD hours, is self-paced with immediate access, and ends with a dated certificate issued by Healthcare Ethics Courses that you can submit to the Council or put in your remediation plan. The remediation courses for doctors facing a Medical Council investigation are listed on one page, and the Council and Board investigation process explained shows where each course sits in the stages. The guide to what happens after a notification to your Council or Board covers the HPCA Act process the standard is applied within.
Sources and further reading
- Medical Council of New Zealand: Good medical practice and the Council's statements on informed consent, sexual and professional boundaries, patient records, good prescribing practice, electronic communication and social media, cultural safety and disclosure of harm.
- Health Practitioners Competence Assurance Act 2003: the Council's standard-setting function, section 36 on competence reviews, and Part 4 on Professional Conduct Committees and the Tribunal.
- Health Practitioners Disciplinary Tribunal: published decisions involving doctors, which show how the Tribunal reads the standard and what it weighs at penalty.
- Health and Disability Commissioner: the Code of Health and Disability Services Consumers' Rights, which the Commissioner applies to the same conduct.
Frequently asked questions
Is Good medical practice law?
No. It is the Medical Council's statement of what it expects of a registered doctor, published under its functions in the HPCA Act. A departure from it is not an offence. It matters because the Council, a Professional Conduct Committee and the Health Practitioners Disciplinary Tribunal use it as the measure of whether conduct fell below the standard reasonably expected of a doctor, and a Tribunal decision can refer to the paragraphs a doctor departed from when it decides whether a charge is made out.
Which Medical Council statements are used in an investigation?
The ones that cover the concern. For a consent concern, the statement on informed consent. For a relationship with a patient or a colleague, the statements on sexual and professional boundaries. For notes, the statement on patient records; for a prescription, the statement on good prescribing practice; for a post or message, the statement on electronic communication and social media. The Council's letter names the statement it is applying. Read that statement in full before you write a word of your response.
How do I use Good medical practice in my response?
Quote the paragraph the Council has named, then answer it in the same terms: what the record shows you did, what the paragraph required, where the two match and where they do not. Where they do not, say so in one plain sentence and move to what you have done since. A response structured against the paragraphs reads as the response of a doctor who understands the standard. A response that does not mention the standard leaves the Council to do the mapping for you.
What if I think the standard did not apply to my situation?
Say so with reasons, after advice from the Medical Protection Society. Good medical practice states that a doctor must use judgement to apply its principles to the situation, and the Council accepts that a paragraph can be met in different ways. Set out the circumstances, the guidance you were applying, and why your decision was reasonable with the information you had. An argument of that kind is stronger when it is paired with an acknowledgement of anything that did fall short.
Does the Tribunal use Good medical practice too?
Yes. The Health Practitioners Disciplinary Tribunal decides whether conduct amounts to malpractice, negligence or conduct likely to bring discredit to the profession, and it reads Good medical practice and the Council's statements as the evidence of what the profession expects. Its published decisions refer to the paragraphs a doctor departed from. When it decides penalty it weighs whether the doctor has since shown an understanding of the standard, which is why a reflection written against the standard and a remediation plan with certificates matter at that stage.