Good Medical Practice: Supporting neuro-divergence in the workplace

Increased awareness of neuro-divergent conditions prompts a closer look at the challenges faced by neuro-divergent doctors, including GPs, under the General Medical Council’s updated Good Medical Practice. This can potentially lead to complex employment and regulatory situations, as explained by Tracy Sell-Peters, Healthcare Litigation Partner, and Joanne Staphnill, Consultant Healthcare Solicitor, both from Keystone Law

Increased awareness of neuro-divergent conditions is to be welcomed, so that fewer people struggle under incorrect or pejorative labels. There is no reliable information about how many neuro-divergent doctors, including GPs, are currently practising, but it seems reasonable to assume that there are many, both diagnosed and undiagnosed.

The GMC’s “Welcomed and Valued” guide recognises Autism Spectrum Disorder (ASD) and ADHD as disabilities under the Equality Act 2010, supporting doctors in training. However, it lacks guidance on supporting already qualified GPs and doesn’t address concerns about the term “disability” from some neuro-divergent individuals.

Updated Good Medical Practice (GMP) 2024

The updated Good Medical Practice (“GMP”) came into force on 30 January 2024. Key changes from the previous version include that doctors need to treat others with “kindness, courtesy and respect”. This includes, “communicating sensitively and considerately, particularly when you’re sharing potentially distressing issues about the patient’s prognosis and care.”

For colleagues, GMP 2024 says, “To develop and maintain effective teamworking and interpersonal relationships you must: a) listen to colleagues, b) communicate clearly, politely and considerately, c) recognise and show respect for colleagues’ skills and contributions, and d) work collaboratively with colleagues and be willing to lead or follow as the circumstances require.”

Challenges for neuro-divergent doctors

Neuro-divergent doctors (whether diagnosed or not) could find it more difficult to comply than neuro-typical peers. Some people with ASD find eye contact difficult, which can be misinterpreted as them not listening. Those with ADHD might find it harder to communicate “clearly” if they tend to make tangential comments. Others may find it harder to recognise social cues, and inadvertently come across as being rude or inappropriate.

Therefore, neuro-divergent GPs might end up disproportionately affected by disciplinary action at their practices, and/or GMC investigations, based on alleged breaches of the new “kindness” requirements.

However, GMP 2024 also states that doctors, “must not abuse, discriminate against, bully, or harass anyone based on their personal characteristics, or for any other reason. By ‘personal characteristics’ we mean … any of the characteristics protected by legislation – … disability …”. A GP who discriminated against a neuro-divergent colleague could themselves be breaching GMC 2024 and be subject to a disciplinary or GMC investigation.

Impact on GP practices

If a GP has a diagnosis, the employer practice is obliged to make reasonable adjustments or face a disability discrimination allegation. Most neuro-divergent conditions are spectrum conditions, so there will be a wide variation in what aspects of the job they find difficult, and the severity of the difficulties. The exact reasonable adjustments will depend on the individual, but examples could include training to support a GP with their communication skills. The practice must also take appropriate action against anyone who bullies or discriminates against a colleague because of their neuro-diverse condition.

Practices could face very complex situations, particularly where there is no formal diagnosis. There is a highly fact-sensitive interplay between employment law and the regulatory obligations of both the GP and the practice. Employment law requires the reasonable adjustments, but if a GP’s condition means that they still cannot communicate appropriately, then the GMC may have to consider whether it is a health issue that affects fitness to practise. The practice and the GP might need separate specialist holistic legal advice, to properly manage both the employment and regulatory aspects, and avoid unnecessary proceedings.

In navigating the implications of the General Medical Council’s updated Good Medical Practice for neuro-divergent doctors, Tracy Sell-Peters and Joanne Staphnill’s insights underscore the importance of balancing regulatory obligations with employment law considerations to address potential challenges effectively.