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Good Surgical Practice: 
Good Surgical Practice
The Royal Col ege of Surgeons of England
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The Royal College of Surgeons of England
Published: September 2014 
Professional Standards
The Royal College of Surgeons of 
England
35–43 Lincoln’s Inn Fields
London WC2A 3PE
Email: xxx@xxxxxx.xx.xx
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Good Surgical Practice 
Good Surgical Practice
Good Surgical Practice has been written with the collaboration of the following 
organisations and is endorsed by them:
The Association of Surgeons of Great Britain and Ireland
The British Association of Oral and Maxillofacial Surgeons
The British Association of Otorhinolaryngologists – Head and Neck Surgeons
The British Association of Paediatric Surgeons
The British Association of Plastic, Reconstructive and Aesthetic Surgeons
The British Association of Urological Surgeons
The British Orthopaedic Association
The Royal College of Physicians and Surgeons of Glasgow
The Royal College of Surgeons in Ireland
The Royal College of Surgeons of Edinburgh
The Society for Cardiothoracic Surgery in Great Britain and Ireland
The Society of British Neurological Surgeons
The Vascular Society of Great Britain and Ireland
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The Royal College of Surgeons of England
Foreword
“I would be happy to be treated this way if this 
patient were me or a member of my family.”
We share the privilege of working as surgeons, with the responsibilities, joys and 
disappointments that this brings. As surgeons we understand the fulfillment of delivering 
a successful outcome, and the humility and strength required when surgery goes wrong 
or is unlikely to be a patient’s best option. We are all human, we all make mistakes and so 
we all benefit from guidance. We are fortunate; our profession is still respected and held 
in high esteem. Our behaviours and attitudes are observed by those we work alongside 
and impact directly on the care we deliver to our patients. 
The challenge of providing compassionate, high quality, safe care is at the top of our 
professional agenda. This document provides guidance as we address this challenge and 
highlights skills needed by a highly performing surgeon in today’s ever more demanding 
environment.
The recent publication of national outcomes data means that surgery has led the way 
in transparency, openness and accountability. This document reaffirms and sets out 
surgeons’ commitment to personal responsibility and to the continuous improvement of 
quality of care and of patient safety. 
Good Surgical Practice aims to be a base line of clear and assessable standards for individual 
surgeons and their practice. It is not a statutory code or a regulatory document but rather 
seeks to exemplify the standards required of all doctors by the GMC in the context of 
surgery. It represents the profession’s core values, the skills and attitudes that underpin 
surgical professionalism to which all surgeons should aspire in order to deliver high 
quality care.
No matter where you work, within the NHS, independent or voluntary sector these 
statements of principle are applicable to all surgeons, regardless of grade. We hope they 
will provide you all with guidance and support as you reflect on your work and set 
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Good Surgical Practice: Foreword
yourselves goals. You should use your professional judgment to apply these principles in 
practice. Good Surgical Practice specifies for surgery those overarching GMC standards as 
set out in Good Medical Practice 2013, which you will all use as an integral part of your 
appraisal and the revalidation process.
The emphasis of this document is on collaborative working, particularly with patients as 
active participants in decisions about their care, rather than simply as passive recipients of 
care. 
Surgery, as we all know, is not a solitary activity. Patient safety and good practice 
certainly depend on the individual surgeon, but also on effective teamworking both 
within the surgical team and the wider multidisciplinary team. Maintaining effective 
relationships with non-clinical management is also critical. Some statements in the 
document focus on improving organisational systems and services and require the 
collaboration of the surgeon’s employing organisation and the wider operating team to be 
met in full. The aim of such statements is an expectation that surgeons will demonstrate 
leadership by engaging positively with their organisations’ efforts to improve care 
delivery.
All the surgical royal colleges and the surgical specialty associations have collaborated, 
given freely of their advice and contributed generously to this document. I thank them all 
for giving of their time and expertise.
My hope is that the new Good Surgical Practice will guide all surgeons as we advance 
surgical standards and travel that road, seeking to develop our professionalism to meet 
current demands. 
Clare Marx CBE DL PRCS
President
The Royal College of Surgeons of England 
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The Royal College of Surgeons of England
Contents
The duties of a doctor registered with the General Medical Council 
6
Note on terminology 
8
Domain 1: Knowledge, skills and performance 
9
1.1  Develop and maintain your professional performance  
9
1.2  Apply knowledge and experience to practice  
11
1.2.1 
Good standards of clinical practice 
11
1.2.2 
Emergency surgery 
13
1.2.3 
Clinical and basic science research 
15
1.2.4 
Introduction of new techniques 
17
1.3  Record your work clearly, accurately and legibly  
19
Domain 2: Safety and quality 
21
2.1  Contribute to and comply with systems to protect patients 
21
2.1.1 
Ensuring consistency in patient safety 
21
2.1.2 
Measuring quality and outcomes 
22
2.2  Respond to risks to safety 
24
2.3  Protect patients and colleagues from any risk posed by your health 
26
Domain 3: Communication, partnership and teamwork 
27
3.1  Communicate effectively 
27
3.1.1 
Communication with patients 
27
3.1.2 
Communication with colleagues 
28
3.2  Work collaboratively with colleagues to maintain and improve patient care  29
3.2.1 
Individual behaviour 
29
3.2.2 
Teamworking 
30
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Good Surgical Practice: Contents
3.3  Teaching, training, supporting and assessing 
32
3.3.1 
Medical students  
32
3.3.2 
Surgeons in training 
33
3.3.3 
Staff grades, associate specialists and specialty surgeons 
35
3.3.4 
Locum surgeons 
35
3.4  Continuity and coordination of care 
36
3.5  Establish and maintain partnerships with patients  
38
3.5.1 Consent 
38
3.5.2 
Preoperative checks 
41
3.5.3 
Patient feedback 
42
3.5.4 
Responding to harm and duty of candour 
42
Domain 4: Maintaining trust 
44
4.1  Show respect for patients 
44
4.2  Treat patients and colleagues fairly and without discrimination 
46
4.3  Act with honesty and integrity 
47
4.3.1 
Provision of information about surgeons’ practice 
47
4.3.2 
Private practice 
48
4.3.3 Probity 
49
Useful contacts 
50
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The Royal College of Surgeons of England
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 trust 
you must show respect for human life and make sure your practice meets the standards 
expected of you in four domains.
Knowledge, skills and performance 
»  Make the care of your patient your first concern.
»  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. 
Safety and quality 
»  Take prompt action if you think that patient safety, dignity or comfort is being 
compromised.
»  Protect and promote the health of patients and the public. 
Communication, partnership and teamwork 
»  Treat patients as individuals and respect their dignity.
»  Treat patients politely and considerately.
»  Respect patients’ right to confidentiality.
»  Work in partnership with patients.
»  Listen to, and respond to, their concerns and preferences.
»  Give patients the information they want or need in a way that they can 
understand.
»  Respect patients’ right to reach decisions with you about their treatment and 
care.
»  Support patients in caring for themselves to improve and maintain their health.
»  Work with colleagues in the ways that best serve patients’ interests. 
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Good Surgical Practice: Duties
Maintaining trust 
»  Be honest and open and act with integrity.
»  Never discriminate unfairly against patients or colleagues.
»  Never abuse your patients’ trust in you or the public’s trust in the profession. 
You are personally accountable for your professional practice and must always be 
prepared to justify your decisions and actions.”
NOTE: The duties of a doctor on pages 6 and 7 have been reproduced from Good Medical 
Practice, GMC, 2013.
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The Royal College of Surgeons of England
Note on terminology
Good Surgical Practice uses the same headings that appear in Good Medical Practice, which 
came into effect on 22 April 2013.
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 is providing an 
explanation of how you will meet the overriding duty.
»  ‘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 follow the guidance.
The same convention is used in this document. ‘Ensure’ is used where surgeons must do 
what is reasonably within their control to make sure that the event takes place.
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Good Surgical Practice: Knowledge, skills and performance
Domain 1: Knowledge, skil s and 
performance
1.1  Develop and maintain your professional performance  
Surgeons are responsible for keeping themselves up to date and maintaining 
competence in all areas of their practice. In meeting the standards of Good 
Medical Practice, you should:
»  Demonstrate and maintain competence in your area of clinical practice and the 
full scope of your professional work, including, where relevant, management, 
teaching and research.
»  Keep up to date with current clinical guidelines in your field of practice, and be 
fully compliant with ethical and legislative guidance in relation to your practice.
»  Ensure that your skills and knowledge are up to date by undertaking continuing 
professional development (CPD) and educational activities in all aspects of your 
work. These activities must be relevant to your practice and support your current 
skills, knowledge and career development. CPD should be planned in discussion 
with your appraiser and reflected in your annual personal development plan.
»  Where relevant, make appropriate use of simulation to support learning of new 
procedures.
»  Undertake all mandatory training required as part of your contractual 
arrangements with your place of employment.
»  Dedicate appropriate time each week for activities that are essential to the long-
term maintenance of the quality of the service such as CPD, education, structured 
teaching, audit, research, clinical management and service development. The 
surgical royal colleges and surgical specialty associations recommend a minimum 
of 50 hours of CPD activity per year, or 250 hours of CPD activity across the 
5-year revalidation cycle. 
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The Royal College of Surgeons of England
»  If your job plan does not allow you to keep up to date, you should address this in 
discussion with your appraiser and medical director.
»  Develop and maintain an accurate portfolio of evidence of all your procedures and 
clinical activity (for example, a logbook). Such evidence must encompass your 
whole practice wherever this is delivered, including private practice.
»  Engage in quality assurance processes and quality improvement activities, 
including participation in national and local audit, measuring validated outcome 
data, peer review, multidisciplinary meetings and morbidity and mortality 
meetings.
»  Participate in performance reviews and in the local annual appraisal process, taking 
time to reflect critically on your whole practice (including non-clinical roles and 
private practice). You should have a constructive discussion with your appraiser 
using evidence gathered throughout the year, as outlined in the surgery guidance 
Further reading
Continuing Professional Development: A Summary Guide for Surgery (Joint 
on supporting information for revalidation.
Committee on Revalidation, 2013)
Guidance on Supporting Information for Revalidation for Surgery (Joint Committee 
on Revalidation, 2014)
Advice on Supporting Professional Activities (AoMRC, 2010)
Surgeon’s Portfolio (https://www.surgeonsportfolio.org)
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Good Surgical Practice: Knowledge, skills and performance
1.2  Apply knowledge and experience to practice  
1.2.1  Good standards of clinical practice
In meeting the standards set out in Good Medical Practice surgeons must 
provide good clinical care by applying their clinical skills, knowledge and 
experience to practice. You should:
»  Ensure that patients are treated according to the priority of their clinical need.
»  Take full responsibility for patient management, leading the surgical team to 
provide best care. Responsibility should encompass preoperative optimisation and 
postoperative recovery.
»  In conjunction with colleagues in the multidisciplinary healthcare team, construct 
and discuss with the patient a diagnostic and treatment plan based on clinical 
evidence and investigation findings. The risks and benefits of surgical intervention 
and the use of alternative forms of treatment should be considered carefully. 
Ensure that multidisciplinary team meetings are fully utilised both preoperatively 
and postoperatively.
»  When providing elective care for patients with non-urgent conditions, carry out 
procedures that lie within the limits of your competence and the range of your 
routine practice, and refer where necessary.
»  Carry out surgical procedures in a timely, safe and competent manner, and ensure 
that you follow current clinical guidelines in your field. 
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The Royal College of Surgeons of England
»  Use the skills and knowledge of other clinicians. When the complexity of the 
procedure is an issue, you should consider shared decision making and shared 
operating with another expert consultant colleague. When appropriate, you 
should transfer the patient to another colleague or unit where the required 
resources and skills are available.
»  Be satisfied that patients are cared for in an appropriate environment where 
adequate resources, facilities and suitable equipment are available for safe surgery 
and any special patient needs are taken into account. If such resources are not 
available, you should consider postponing planned procedures. If patient safety 
and effective care may be compromised by lack of resources, you should record 
this and communicate it to the medical director.
»  Make efficient use of the resources available. Any requests to hospital management 
for the allocation of resources for patient care should be sensible, realistic and 
proportionate to the needs of the patient.
»  Ensure that patients receive satisfactory postoperative care and that relevant 
information is promptly recorded and shared with the relevant teams, the patient 
and their supporters.
»  Proactively support and participate in your organisation’s provisions to ensure 
that patients in hospital are reviewed by an on-site consultant with appropriate 
skills and knowledge at least once every 24 hours, 7 days a week, unless it has been 
determined that this would not affect the patient’s care pathway.
»  Proactively support and participate in your organisation’s provisions to ensure that 
consultant-supervised interventions and investigations (along with accompanying 
reports) are provided seven days a week if the results may change the status of the 
patient’s care pathway before the next working day. This includes interventions 
that may determine additional care needs or enable a shortened length of stay or 
immediate discharge.
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Good Surgical Practice: Knowledge, skills and performance
»  Where appropriate for the patient’s care pathway, be satisfied that support services 
can be accessed seven days a week to ensure that the next steps in the patient’s care 
can be taken, as determined by the daily consultant-led review. If effective care 
may be compromised by lack of support services, this lack should be recorded and 
communicated to the medical director.
»  Ensure that, when the patient is discharged from hospital, appropriate information 
is shared with the patient, the patient’s supporters and the extended care team. In 
addition, unless the patient requests otherwise, all relevant information should be 
sent to the patient’s GP, where possible in electronic form, within 24 hours. For 
complex cases, consideration should be given to a telephone communication with 
the patient’s GP. 
»  Accept patients on referral by GPs, consultant colleagues or as emergency through 
the accident and emergency department. If you agree to see a patient directly 
without referral, the patient should be informed that the GP will receive a report 
unless the patient requests otherwise.
»  Provide adequate time for patients and their supporters prior to surgery to discuss 
the proposed procedures and implications, risks and benefits, and allow the patient 
to make a fully informed decision before signing a consent form as described in 
section 3.5.1.
1.2.2  Emergency surgery
When carrying out emergency work, you should:
»  Proactively support your organisation’s provisions to ensure that patients receive 
high quality emergency care. 
»  Be familiar with formalised pathways for unscheduled care set out by your trust or 
health board, including risk-grading strategies.
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The Royal College of Surgeons of England
»  Accept responsibility for the assessment and continuing care of every emergency 
patient admitted under your name unless, or until, they are formally transferred to 
the care of another doctor.
»  Be available either within the hospital or within a reasonable distance of the 
hospital to give advice throughout your duty period.
»  Ensure that you are able to respond promptly to a call to attend to an emergency 
patient. If you are on call in a specialty with a high emergency workload you 
should be free of all other commitments, including elective commitments and 
private sector responsibilities. This arrangement should be formally reflected in 
your job plan.
»  Ensure that there are written protocols for the initial management of emergency 
patients and for the subsequent safe transfer to another team or unit when the 
complexity of the patient’s condition is beyond the experience of the admitting 
surgeon or beyond the resources available for the proper care of the patient.
»  Ensure that the risk of complication and mortality is fully assessed and understood 
and effectively communicated to the patient and the wider care team before 
delegating to another colleague. When there is high risk of mortality and 
complication, ensure that a consultant surgeon is present and closely involved in 
the patient’s care.
»  Delegate assessment of emergency surgical operations only when you are sure of 
the competence of those to whom the patient’s operative care will be delegated.
»  Ensure that emergency patients are reviewed by an on-site consultant surgeon at 
least once every 24 hours and more often if the patient is at high risk.
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Good Surgical Practice: Knowledge, skills and performance
»  Ensure that rotas are published well in advance and cooperate with colleagues so 
that any alternative cover arrangements are specifically made, clearly understood 
and adequate to provide equivalent care.
»  Ensure the formal handover of patients to an appropriate colleague following 
periods on duty, as described in section 3.4.
»  Taking into account the patient’s best interest ensure that, in an emergency, you 
only perform unfamiliar operative procedures if there is no safe clinical alternative, 
if there is no colleague available who is more experienced, or if, after consultation 
with the nearest specialist unit, transfer is considered a greater risk to the patient.
»  If unexpected circumstances require colleagues to act beyond their practised 
competencies, you should provide support in making the care of the patient the 
first concern.
1.2.3  Clinical and basic science research
High quality surgical research has been instrumental in expanding the range 
of procedures that can be performed safely. It has made operations safer, less 
invasive and more effective. Surgeons are in a unique position to undertake 
clinical research vital for surgical innovation and improvement of patient 
care, and should strive to participate in research and innovation initiatives 
related to their practice. Surgeons must be able to understand the relevance 
of research, critically appraise published research and apply it to practice. If 
you undertake research, you should: 
»  Submit full protocols of proposed research and details of intended new technical 
procedures to the local NHS research/ethics committee before starting. All clinical 
trials should be registered and all trial results should be published, including 
negative results or results where the outcome is different to what was expected.
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»  Treat patients participating in research as partners, respecting their dignity 
and unique clinical circumstances and ensuring that research outweighs any 
anticipated risks. 
»  Fulfil the regulations of the World Medical Association Declaration of Helsinki 
1964/2013 on the ethical principles for medical research involving human 
subjects.
»  Fully inform research participants about the aims, intentions, values, relevance, 
methods, hazards and discomforts of the proposed research. Inform participants 
how their confidentiality will be respected and protected.
»  Fully inform patients in randomised trials about the procedures being compared 
and their risks and benefits, and record this in your notes.
»  Accept that a patient may refuse to participate or withdraw during the 
programme, in which case their treatment should not be adversely influenced. 
»  Seek guidance from the local ethics committee regarding the need for consent for 
the use of tissue removed during an operation for research purposes (as opposed 
to routine histopathology). Seek permission to remove tissue beyond that excised 
diagnostically and therapeutically. Acquire specific permission to use any removed 
tissue for commercial purposes, for growing cell lines or for genetic research.
»  Discourage the publication of research findings in non-scientific media before 
reporting them in reputable scientific journals or clinical meetings. Ensure that 
any information regarding the research project that may be published on the 
internet or elsewhere follows ethical principles.
»  Disclose any personal affiliation or other financial or commercial interest relating 
to your research and its funding. This includes, for example, private healthcare 
companies, pharmaceutical companies or instrument manufacturers. 
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Good Surgical Practice: Knowledge, skills and performance
»  Report any fraud that is detected or suspected to the local research/ethics 
committee.
»  Recognise and be familiar with the Human Tissue Act 2004 regulations and 
obtain appropriate licences where necessary.
»  Ensure that you have a good understanding of the standards regarding clinical 
trials on human subjects. It is best practice to have obtained a certificate of Good 
Clinical Practice.
»  For surgical research that involves animals, fulfil the strict regulations of the 
Animals (Scientific Procedures) Act 1986/2013.
1.2.4  Introduction of new techniques
Introduction of new clinical interventions and surgical techniques 
(including equipment) that deviate significantly from established practice 
and are not part of an NHS local ethics committee research programme 
must be underpinned by rigorous clinical governance processes, having the 
patient’s interests as the paramount consideration. If you are introducing 
new surgical techniques and technologies you should:
»  Discuss the technique with colleagues who have relevant specialist experience and 
seek formal approval from your medical director.
»  Follow local protocols with regard to obtaining approval by the local ethics 
committee or the local clinical governance committee. These should include the 
provision of evidence that the new technique is safe and that all clinical staff who 
plan to use the new technique will undertake relevant training, mentorship and 
assessment.
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»  Contact the Interventional Procedures Programme at the National Institute for 
Health and Care Excellence (NICE) to learn the status of the procedure and/or 
register it, and liaise with the relevant surgical specialty association.
»  Obtain appropriate training in the new technique, take part in regular educational 
activities that maintain and develop competence and performance, and enable the 
training of other surgeons.
»  Ensure that any new device complies with European standards and is certified by 
the competent body.
»  Ensure that patients and their supporters know that a technique is new before 
seeking consent and that all the established alternatives are fully explained prior to 
recording their agreement to proceed.
»  Be open and transparent about the sources of funding for the development of any 
new technique.
»  Contribute to the evaluation of the new procedure by auditing outcomes and 
reviewing progress with a peer group, and by complying with guidelines by 
NICE or by the Scottish Intercollegiate Guidelines Network (SIGN). 
 
Further reading
Seven Day Consultant Present Care (AoMRC, 2012)
Emergency Surgery – Standards for unscheduled surgical care (RCS, 2011)
Delegation and referral (GMC, 2013)
Consent: patients and doctors making decisions together (GMC, 2008)
Good Practice in Research (GMC, 2010)
From Innovation to Adoption (RCS, 2014)
Improving surgical practice: Learning from the experience of RCS invited 
reviews (RCS, 2013)
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Good Surgical Practice: Knowledge, skills and performance
1.3  Record your work clearly, accurately and legibly  
Surgeons must ensure that accurate, comprehensive, legible and 
contemporaneous records are maintained of all their interactions with 
patients. In meeting the standards of Good Medical Practice you should:
»  Be fully versed in the use of the electronic health record system used in your 
organisation and record clinical information in a way that can be shared with 
colleagues and patients and reused safely in an electronic environment.
»  Take part in the mandatory training on information governance offered by your 
organisation, including training on data protection and access to health records.
»  Ensure that all medical records are accurate, clear, legible, comprehensive and 
contemporaneous and have the patient’s identification details on them.
»  Ensure that when members of the surgical team make case note entries these are 
legibly signed and show the date, and, in cases where the clinical condition is 
changing, the correct time.
»  Ensure that a record is made of the name of the most senior surgeon seeing the 
patient at each postoperative visit.
»  Ensure that a record is made by a member of the surgical team of important events 
and communications with the patient or supporter (for example, prognosis or 
potential complication). Any change in the treatment plan should be recorded.
»  Ensure that there are clear (preferably typed) operative notes for every procedure. 
The notes should accompany the patient into recovery and to the ward and should 
give sufficient detail to enable continuity of care by another doctor. The notes 
should include:
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»  Date and time
»  Elective/emergency procedure
»  Names of the operating surgeon and assistant
»  Name of the theatre anaesthetist
»  Operative procedure carried out
»  Incision
»  Operative diagnosis
»  Operative findings
»  Any problems/complications
»  Any extra procedure performed and the reason why it was performed
»  Details of tissue removed, added or altered
»  Identification of any prosthesis used, including the serial numbers of prostheses  
and other implanted materials
»  Details of closure technique
»  Anticipated blood loss
»  Antibiotic prophylaxis (where applicable)
»  DVT prophylaxis (where applicable)
»  Detailed postoperative care instructions
»  Signature  
»  Ensure that sufficiently detailed follow-up notes and discharge summaries are 
completed to allow another doctor to assess the care of the patient at any time.
»  Ensure that you are familiar and fully compliant with the guidelines of the Data 
Protection Act 1998 around the use and storage of all patient identifiable 
information. 
Further reading
Standards for the clinical structure and content of patient records  
(Health and Social Care Information Centre, 2013)
Data Protection Act 1998
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Good Surgical Practice: Safety and quality
Domain 2: Safety and quality
2.1  Contribute to and comply with systems to protect patients 
Surgeons have a duty to contribute to and comply with systems and 
processes that aim to reduce risk of harm to patients by measuring and 
monitoring performance and quality of care. The use of outcome measures 
should be a regular part of day-to-day clinical practice. In meeting the 
standards of Good Medical Practice, you should:
2.1.1  Ensuring consistency in patient safety
»  Comply with standardisation and reliability processes that promote patient safety, 
such as national and local standard operating procedures.
»  Be fully versed in the principles and practice of the WHO Surgical Safety Checklist 
(World Health Organization, 2008) and its adaptation through the Five Steps 
to Safer Surgery (National Patient Safety Agency, 2010) and apply those as an 
essential part of your operating work wherever this takes place, including private 
practice. The checklist can be adapted to suit local clinical environments and 
different specialties but the following broad tasks should be included:
»  Team briefing: All members of the surgical team should attend the team 
briefing at the beginning of the list to ensure a shared understanding of 
the requirements of that list, identify skill levels, staffing and equipment 
requirements, and prepare for anticipated problems. 
»  Sign in before the administration of anaesthesia allows the team to ensure 
that the patient’s known allergies have been checked and that the surgical 
site on the patient’s body has been properly marked and will be visible in the 
operative field after draping. 
»  Time out before the first incision allows members of the wider theatre team to 
introduce themselves if they have not previously done so and encourages them 
to speak out if they identify any concerns at this stage.
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»  Sign out before the patient leaves the theatre guarantees that instruments, 
sponges and needles have been counted to ensure that none have been left 
behind in the patient’s body. 
»  Debriefing: wherever possible, all members of the surgical team should 
participate in a discussion at the end of the operating list or at the end of 
the session, to consider good points of the operating process and teamwork, 
review any issues that occurred, answer concerns that the team may have, and 
identify areas for improvement. 
»  Recognise the risk of surgical site infection and the potential for cross-infection 
and follow local infection control procedures.
2.1.2  Measuring quality and outcomes
»  Be committed to quality improvement in the interest of patient care as a core part 
of your clinical duties. You should contribute to clinical governance systems that 
strengthen day-to-day quality management and effective service delivery.
»  Submit all your activity data to national audits and databases relevant to your 
practice and present the results at appraisal for review against the national 
benchmark. 
»  Take prompt action to understand the risks and ensure patient safety when your 
patient outcome results through audit, peer review or routinely collected data fall 
outside the accepted norm. Engage in conversation with your appraiser to identify 
the nature and basis of the concern and cooperate in relevant local investigations. 
You should follow the audit provider’s policy for managing outliers.
»  Keep an accurate and accessible record of all your surgical activity wherever 
this takes place, including outcomes and complications, bearing in mind patient 
confidentiality and complying with the Data Protection Act 1998. Where available, 
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you should liaise with your hospital to obtain an analysis of routinely collected data 
for index procedures identified by the relevant surgical specialty association.
»  Play an active role in ensuring that your audit returns and outcome results 
accurately reflect your practice by being routinely involved in checking and 
quality-assuring the data attributed to you and your team.
»  Take part regularly in morbidity and mortality and audit meetings.
»  Be familiar with local processes and agreed thresholds for recording adverse 
incidents and keep a record of incidents in which you have been directly involved. 
You should report such incidents to those responsible in your hospital and, where 
relevant, to a local audit meeting.
»  Make full use of local electronic systems for reporting incidents and adverse 
events. You should reflect on adverse incidents in which you have been directly 
involved and present them for discussion at appraisal. 
»  Take part in national enquiries, for example the National Confidential Enquiry 
into Patient Outcome and Death. You should submit your patient outcome data 
to relevant national databases. 
Further reading
WHO Surgical Safety Checklist & Implementation (World Alliance for Patient 
Safety, 2008).
Five Steps to Safer Surgery (National Patient Safety Agency, 2010).
Standardise, Educate, Harmonise: Commissioning the Conditions for Safer Surgery 
(NHS England Never Events Taskforce, 2013).
Surgical Site Infection (NICE, 2008)
Maintaining Patients’ Trust: Modern Medical Professionalism (SCTS, 2011)
Using Outcomes Information for Revalidation (RCS, 2013)
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2.2  Respond to risks to safety 
It is the cornerstone of professionalism and the primary duty of every 
surgeon, regardless of seniority or grade, to put the care and safety of 
patients above all other considerations and take action or ‘speak up’ through 
the appropriate channels when concerns arise. In meeting the standards of 
Good Medical Practice, you should:
»  Recognise that your primary accountability is to the patient and support a culture 
of openness, honesty and objectivity where concerns can be raised safely by all 
staff members.
»  Act promptly to rectify, or notify those responsible for rectifying, any incidents 
of poor quality of care or shortfalls in resources that might compromise safe care, 
including suitable facilities, equipment and support services. 
»  Raise concerns at the earliest opportunity when you have reasonable belief that 
the care and wellbeing of patients may be put in jeopardy for any reason. Such 
a reason may include the conduct, performance or health of a colleague, as 
well as inadequate resources, systems and policies. You should not assume that 
someone else will take action. If you have concerns about patient safety, it is your 
responsibility to establish whether action is already being taken.
»  Use local policies and resources for raising concerns in the first instance. 
Normally, you should raise your concerns to your immediate superior, followed 
by the medical director and the chief executive.
»  Escalate your concern to the appropriate regulator if you have not been satisfied 
that your concern has been adequately addressed through local channels. Concerns 
around the organisational standards of quality and safety should be escalated to the 
Care Quality Commission*. Concerns about the fitness to practise of colleagues 
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should be raised with the GMC or other appropriate regulator (for example, the 
Nursing and Midwifery Council). 
»  As a final recourse, if neither local nor regulatory processes have appropriately 
addressed your concern, bring your concern to general public attention. You 
should seek advice before going public with your concern as outlined in the GMC 
guidance Raising and Acting on Concerns about Patient Safety (GMC, 2012). 
»  Support others who are taking steps to raise valid concerns on patient safety. 
You must ensure that your own knowledge, understanding and any evidence 
of wrongdoing available to you is put at the service of the person leading the 
response to a concern.
»  Keep a dated and verifiable record of how you have raised your concerns, 
including notes of any supporting evidence, taking into account patient 
confidentiality.
»  Not conflate a legitimate concern around patient safety with a personal grievance. 
If you have both a concern around care quality and a personal employment 
grievance, you should pursue these separately.  
Further reading
Raising and Acting on Concerns about Patient Safety (GMC, 2012)
Acting on Concerns: Your Professional Responsibility (RCS, 2013)
Improving surgical practice: Learning from the experience of RCS invited reviews 
(RCS, 2013)
* In Scotland the role of the Care Quality Commission is fulfilled by the Scottish Care Inspectorate and by 
Health Improvement Scotland. In Wales the same role is carried out by the Care Standards Inspectorate 
for Wales and in Northern Ireland by the Regulation and Quality Improvement Authority.
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2.3  Protect patients and colleagues from any risk posed by your health 
Surgeons have a duty to maintain safe care at all times and not to work 
in any health state that might impair judgment and/or jeopardise patient 
safety. You should:
»  Not work when your health is adversely influenced by fatigue, disease, drugs or 
alcohol.
»  Recognise when your health state might impair judgment or jeopardise patient 
safety. You should promptly seek independent medical advice and devolve clinical 
responsibility to an appropriately qualified colleague. 
»  Take precautions against the transmission of blood-borne viruses by following 
established guidelines when operating on high risk patients or in the event of a 
needlestick injury. 
»  Exercise a duty of care in terms of reporting serious communicable disease or 
health states in yourself or colleagues that might jeopardise safe patient care.
»  Be aware of health and safety regulations with respect to your practice and 
follow relevant legislation and local guidelines, including local vaccination and 
immunisation requirements.
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Good Surgical Practice: Communication, partnership and teamwork
Domain 3: Communication, 
partnership and teamwork
3.1  Communicate effectively 
Effective communication and clarity of information exchange is essential for 
quality of care and patient safety. In meeting the standards of Good Medical 
Practice, you should:
3.1.1  Communication with patients
»  Communicate clearly and compassionately with patients and, with the patient’s 
consent, with their supporters, and, in the case of children, with their parents/
responsible adults.
»  Recognise and respect the varying needs of patients, including children, for 
information and explanation and give them the information they want or need 
using appropriate language in a way that they can understand.
»  Ensure that enough time is available for a detailed explanation of the clinical 
problem and the treatment options.
»  Listen to and respect the views and preferences of patients and their supporters and 
respond to their concerns.
»  Encourage patients to discuss the proposed treatment with their supporters.
»  Fully inform the patient and their supporter of progress during treatment. 
»  Explain any complications of treatment as they occur and explain the possible 
solutions.
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3.1.2  Communication with colleagues
»  Listen to and respect the views of other members of the team involved in the 
patient’s care, and respond to any concerns they may have. Communicate 
effectively with colleagues within and outside your team as described in section 
3.2.
»  When handing over the care of a patient for whom you are responsible, share all 
necessary information about the patient’s care pathway with the oncoming team, 
as described in section 3.4. 
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3.2 
Work collaboratively with colleagues to maintain and improve patient care 
The provision of high quality surgical services requires effective 
teamworking within and between teams. Good practice rests upon 
collegiality, personal responsibility and a culture of openness, supportive 
discussion and accountability to offer safe and effective care to patients. 
Surgeons have a duty to promote a positive working environment and 
effective surgical teamworking that enhances the performance of their team 
and results in good outcomes for patients. In meeting the standards of Good 
Medical Practice, you should:
3.2.1  Individual behaviour
»  Be aware of the impact of your own behaviour on the people around you, and 
particularly junior doctors and trainees.
»  Be mindful that your behaviour serves as a role model to junior doctors and set 
an example to other colleagues in your team by behaving professionally and 
respectfully towards all team members.
»  Communicate respectfully with colleagues and refrain from dismissive or 
intimidating behaviour and inappropriate, offensive or pejorative language, 
including swearing.
»  Be accessible and approachable to colleagues.
»  Support colleagues who have problems with performance, conduct or health.
»  Challenge counterproductive behaviour in colleagues constructively, objectively 
and proportionately.
»  Encourage and be open to feedback from colleagues, including junior colleagues, 
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and be willing to reflect on feedback about your own performance and behaviour 
and acknowledge any mistakes.
»  Willingly and openly participate in regular appraisal of yourself, trainee surgeons 
and other staff.
»  Develop and maintain effective relationships and respectful communication 
with non-clinical management. Ensure that you understand and fulfill your 
responsibilities as an employee in addition to your duties as a professional.
»  Take responsibility to act as a mentor to less experienced colleagues. You should 
also take responsibility to seek a mentor to improve your own skills at any point in 
your career and particularly when taking on a new role. 
3.2.2 Teamworking 
»  Attend multidisciplinary team meetings and morbidity and mortality meetings, 
and engage in systematic review and audit to the standards and performance of the 
team.
»  Work effectively and amicably with colleagues in the multidisciplinary team, 
arrive at meetings on time, share decision making, develop common management 
protocols where possible and discuss problems with colleagues.
»  Engage in and encourage reflection and learning from the activity of the 
multidisciplinary team and take appropriate action in response.
»  Understand and respect the roles and views of other members in the team. 
You should promote well structured and inclusive processes that encourage 
contributions of all members and ensure that the views of new and junior 
members are taken into account.
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»  Encourage a culture of safety, candour and constructive challenge in your team, 
where difficulties and problems that may cause harm to the patient can surface and 
be openly discussed and mitigated.
»  Ensure that each member of your team understands his or her own and each 
other’s role and responsibilities. 
»  Ensure that new members of the team, including locum surgeons, are not isolated. 
Ensure that they are fully conversant with the routines and practices of the team 
and know from whom to seek advice on clinical or managerial matters.
»  Be mindful of the risks of diffusion of responsibility in the multidisciplinary 
team setting and the wider trust setting and ensure that shared and corporate 
responsibility does not interfere with or diminish your own professional 
responsibility to your patient.
»  Always respond to calls for help from trainees, colleagues and other members in 
the surgical team. If unexpected circumstances require staff to act beyond their 
practised competencies, you should provide support for colleagues in making the 
care of the patient the first concern. 
Further Reading
Leadership and Management for All Doctors (GMC, 2012)
The Leadership and Management of Surgical Teams (RCS, 2007)
Five Steps to Safer Surgery (NPSA, 2010)
WHO Surgical Safety Checklist and Implementation (World Alliance for Patient 
Safety, 2008).
Improving surgical practice: Learning from the experience of RCS invited reviews 
(RCS, 2013)
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3.3  Teaching, training, supporting and assessing 
Surgeons should be willing, as part of their professional practice, to engage 
in the training and supervision of students, trainees and other members 
of the surgical team. They have a responsibility to create a learning 
environment suitable for teaching, training and supervising students, 
trainees and others. In meeting the standards of Good Medical Practice, you 
should:
»  Support those under your supervision to carry out learning and development 
activities identified by appraisals or performance systems.
»  Ensure that you provide appropriate supervision whether through close personal 
supervision or through a managed system with clear reporting structures.
»  Be satisfied that those under your supervision have the necessary knowledge, skills 
and training to carry out their roles.
»  Ensure that consultant surgeons who join your team for a short period of time for 
the purpose of furthering their skills comply with appropriate local regulations. 
This includes obtaining a Certificate of Fitness for Honorary Practice and 
complying with other HR requirements. 
3.3.1  Medical students 
As part of your responsibilities to medical students, you should:
»  Encourage and support medical students.
»  Involve yourself actively in teaching if students are attached to your team.
»  Be aware of the professional competencies to be achieved by the students.
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»  Explain to patients that they have the right to refuse to participate in student 
teaching and reassure patients that such a refusal will not prejudice their treatment 
in any way.
»  Ensure that students are introduced to patients.
»  Ensure that patient privacy and confidentiality are maintained and that students 
understand and respect this requirement.
»  Ensure that when a student is involved in specific examinations or procedures on 
patients under general anaesthesia, written consent has been obtained on the full 
extent of the student’s involvement.
3.3.2  Surgeons in training
Consultant surgeons must accept overall responsibility for any duties that are 
delegated to a trainee or other doctor. You should:
»  Delegate duties and responsibilities only to those specialist trainees and foundation 
doctors or other doctors whom you know to be competent in the relevant area of 
practice.
»  Indicate to trainees when more senior advice and assistance should be sought.
»  Be present throughout an operation until you are satisfied that the trainee is 
competent to carry out the procedure without immediate supervision.
»  When on duty, be available to advise or assist the trainee at all times unless specific 
arrangements have been made for someone else to deputise.
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»  If you have a supervisory role, ensure that the trainee maintains an up-to-date 
portfolio that complies with the Data Protection Act 1998 and is accurate, legible 
and frequently updated. 
»  Take reasonable steps to ensure that trainees are fit to undertake their 
responsibilities, particularly with reference to fatigue, ill health or the influence of 
alcohol or drugs. 
»  Ensure that assessment and appraisal of trainees is carried out regularly, 
thoroughly, honestly, openly and with courtesy, taking care that feedback 
regarding unsatisfactory progress is constructive and offered promptly, without 
waiting until their annual appraisal meeting.
»  Not assign as competent someone who has not reached or maintained a 
satisfactory standard of practice.
If you are a surgeon in training, in addition to following the requirements of 
all surgeons set out in this document, you should:
»  Take responsibility for your training and proactively seek opportunities that will 
help you meet the requirements of your specialty’s syllabus to a high standard.
»  Maintain full, accurate and up-to-date records relating to your training.
»  Recognise the circumstances in which you should seek advice and assistance from 
a more senior member of the team. Know which consultant is on call and seek 
advice or assistance when appropriate.
»  Inform the responsible consultant before a patient is taken to theatre for a surgical 
procedure.
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3.3.3  Staff grades, associate specialists and specialty surgeons
If you are a staff grade, associate specialist or specialty surgeon, in addition 
to following the requirements of all surgeons set out in this document, you 
should:
»  Be accountable for your activities to a named lead consultant.
»  Identify and agree the extent of your delegated responsibilities with a named lead 
consultant, including the level of the expected independent activity.
»  Take responsibility for your continuing professional development, accessing 
support from your employer where appropriate.
3.3.4  Locum surgeons
If you are a locum surgeon, in addition to following the requirements of all 
surgeons set out in this document, you should:
»  If not on the specialist register, be under the supervision of a named substantive 
consultant in the same specialty. 
Further reading
Certificate of Fitness for Honorary Practice (NHS Employers)
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3.4  Continuity and coordination of care 
Effective continuity of care is vital in protecting patient safety. It is the 
duty of every surgeon to convey high quality and appropriate clinical 
information to oncoming healthcare professionals to allow the safe transfer 
of responsibility for patients. In meeting the standards of Good Medical 
Practice, you should:
»  Ensure that the patient knows the name of the person responsible for their care. 
If the responsible person changes, this should be promptly communicated to the 
patient.
»  Whenever possible, ensure that there is a clear line of responsibility for the 
patient’s care at any one time.
»  Work together with other members of the healthcare team in a professional and 
supportive manner to maintain continuity of patient care, regardless of patient 
location. Where possible, make full use of electronic handover systems available in 
your hospital.
»  Ensure that there is a formal and explicit handover for the assessment, treatment 
and continuing care of patients for whom you are responsible to another named 
colleague following periods of duty or when you are unavailable for any reason.
»  Ensure that sufficient protected time within working hours is set aside for 
handover.
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»  When transferring care to an oncoming team, ensure that team members have 
access to all necessary clinical information about the patient. The patient’s 
notes should be clear and sufficiently detailed, taking into account the level of 
knowledge of the oncoming team members. All notes should be traceable to the 
referring surgeon.
»  Be prepared to take responsibility for patients under the care of an absent 
colleague even if formal arrangements have not been made.
»  Continue to participate in the care and decisions concerning your patients when 
they are in the intensive care unit or the high dependency unit. 
Further reading
Delegation and referral (GMC, 2013)
Safe Handovers (RCS, 2007)
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3.5  Establish and maintain partnerships with patients  
Surgeons must establish and maintain effective relationships with patients 
and, where appropriate, with their supporters. Before surgery, surgeons 
should strive to have an honest and sensitive discussion with patients about 
their options for treatment that leads to informed and deliberate consent. 
They should reflect on their patients’ feedback about the care they received, 
and act appropriately and promptly when harm has occurred. In addition to 
the standards of Good Medical Practice, you should:
3.5.1 Consent
»  Recognise that seeking consent for surgical intervention is not merely the signing 
of a form. It is the process of providing the information that enables the patient 
to make a decision to undergo a specific treatment. Consent should be considered 
informed decision making, or informed request. It requires time, patience and 
clarity of explanation.
»  Establish whether a patient has a supporter as early as possible in the relationship 
and record this in your notes. If the patient agrees, you should involve the patient’s 
supporter in the consent discussion. 
»  Establish that your patient has capacity to give consent as per the requirements of 
the Mental Capacity Act 2005. If your patient does not have capacity (including, 
for example, when he or she is unconscious or ventilated) you must act in your 
patient’s best interests and, where relevant, seek consent from a person authorised 
with a lasting power of attorney to give consent on behalf of your patient. The 
Mental Capacity Act 2005 sets out how you should assess your patient’s capacity 
and best interests.
»  In case you have to act in your patient’s best interests without the patient’s 
consent, where possible seek affirmation from a consultant colleague and discuss 
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your intended actions with the patient’s supporter. 
»  Involve young people and children in discussions and decisions around their care 
as outlined in the GMC guidance 0–18 years: guidance for all doctors. According to 
the GMC, young people are presumed to have capacity to give consent at 16 years 
of age. You should assess the capacity of children under 16 years to give consent 
on a case by case basis, depending on their maturity and capacity to understand 
the different courses of action involved in their treatment. 
»  Ensure that consent is obtained either by the person who is providing the 
treatment or by someone who is actively involved in the provision of treatment. 
The person obtaining consent should have clear knowledge of the procedure and 
the potential risks and complications. 
»  Obtain the patient’s consent prior to surgery and ensure that the patient has sufficient 
time and information to make an informed decision. The specific timing and duration 
of the discussion should take into account the complexity and risks of the proposed 
procedure. A patient’s consent should not be taken in the anaesthetic room.
»  At the consent discussion, provide information on the procedure and its 
implications. In particular, you should discuss information about:
»  The patient’s diagnosis and prognosis
»  Options for treatment, including non-operative care and no treatment
»  The purpose and expected benefit of the treatment
»  The likelihood of success
»  The clinicians involved in their treatment
»  The risks inherent in the procedure, however small the possibility of their 
occurrence, side effects and complications. The consequences of non-operative 
alternatives should also be explained.
»  Potential follow up treatment. 
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The Royal College of Surgeons of England
»  Where possible, you should provide written information to patients to enable 
them to reflect on and confirm their decision. You should also provide advice on 
how they can obtain further information to understand the procedure and their 
condition. This can include information such as patient leaflets, decision aids, 
websites and educational videos.
»  Make patients aware of national guidelines on treatment choices (such as NICE 
and SIGN guidelines). If your recommended treatment is not in keeping with 
current guidelines, you must explain your reason for not following current 
standard guidelines.
»  Sign the consent form at the end of the consent discussion, allowing the patient to 
take a copy for reference and reflection. On the day of the procedure, check with 
the patient if anything has changed since the consent discussion. If there has been 
a significant delay since the original signing, sign the relevant section on the form 
to confirm consent. The patient does not need to sign again.
»  In addition to completing the consent form, record in writing the details of the 
consent discussion with your patient. Any discussions around consent with the 
patient’s supporter and your colleagues should also be recorded in the patient’s 
notes. 
»  In the case of cosmetic surgery, follow the requirements for consent set out by the 
Cosmetic Surgical Practice Working Party in Professional Standards for Cosmetic 
Practice (2013). For invasive cosmetic procedures, the consent requirements 
include a two-stage process of consent with a period of at least two weeks 
between the stages to allow the patient to reflect on the decision. You should 
demonstrate capacity to identify the psychologically vulnerable patient and ensure 
that there is rapid and easy access to mental health services for help with the 
assessment and management of problem cases.
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Good Surgical Practice: Communication, partnership and teamwork
»  Make sure that the patient understands, and is agreeable to, the participation of 
students and other professionals in his or her operation.
»  Gain agreement from the patient if video, photographic or audio records are to be 
made for purposes other than the patient’s records (for example, teaching, research, 
or public transmission).
»  Follow appropriate guidance for the retention of tissue, as set out in the Human 
Tissue Act 2004.
3.5.2  Preoperative checks
»  Clearly mark the site to be operated on with the patient’s agreement while the patient 
is awake and prior to premedication. Ensure that the mark is visible when draped.
»  Verify the operation to be undertaken by checking the records, including images 
and consent form and, where possible, with the patient, rather than relying solely 
on the printed operating list for the procedure being performed.
»  Ensure that the written consent and the notes include, when appropriate, the side 
to be 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 patient’s agreement while they are awake and prior to 
premedication.
»  Ensure that any instruction to withhold or withdraw treatment (for example, 
resuscitation categorisation) is taken in consultation with the patient or family and 
authorised by the appropriate senior clinician.
»  Establish the views held by individual patients about transfusion, in case certain 
forms of transfusion may be unacceptable to them.
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The Royal College of Surgeons of England
3.5.3  Patient feedback
»  Promote a culture that treats patient experience and patient feedback as a driver of 
quality improvement and a fundamental measure of service quality.
»  Be proactive in seeking information from your patients on their experience of 
care and respond appropriately. Reflect meaningfully on feedback received from 
patients and use this information to improve your practice.
»  In each revalidation cycle, undertake at least one patient feedback exercise using 
a validated tool and present the results for discussion at appraisal, demonstrating 
actions taken and learning achieved.
3.5.4  Responding to harm and duty of candour
»  Inform patients promptly and openly of any significant harm* that occurs during 
their care, whether or not the information has been requested and whether or not 
a complaint has been made.
»  Act immediately when patients have suffered harm, promptly apologise and, 
where appropriate, offer reassurance that similar incidents will not reoccur.
»  Report all incidents where significant harm has occurred through the relevant 
governance processes of your organisation.
»  Reflect on any unanticipated events in a patient’s care that you have been directly 
involved in and present them for discussion at appraisal.
»  Treat complaints from patients or their supporters with courtesy and respect, and 
recognise the value of complaints for monitoring and improving care quality. 
You should respond to complaints promptly, openly and honestly and cooperate 
fully with local complaints procedures, acknowledging harm and offering redress 
44

Good Surgical Practice: Communication, partnership and teamwork
where appropriate. If you consider that a complaint is unjustified or vexatious, you 
should refer it to the medical director or an appointed arbitrator for independent 
review and early resolution.
»  Participate fully, openly and promptly to any investigations relating to the 
occurrence of significant harm, following local guidelines. If you appear to the 
Coroner’s Court, you should provide prompt and complete evidence including 
comprehensive and truthful reports. 
Further reading:
Consent: patients and doctors making decisions together (GMC, 2008)
Reference guide to consent for examination or treatment (DH, 2009)
Mental Capacity Act 2005
Being open: Communicating patient safety incidents with patients, their families and 
carers (NPSA, 2009)
Mid Staffordshire NHS Foundation Trust Public Inquiry Report (Robert Francis 
QC, 2013)
Professional Standards for Cosmetic Practice (Cosmetic Surgical Practice Working 
Party 2013)
Standardise, Educate, Harmonise: Commissioning the Conditions for Safer Surgery 
(NHS England Never Events Taskforce, 2013).
Building a culture of candour: A review of the threshold for the duty of candour and 
of the incentives for care organisations to be candid (Department of Health, 2014).
Saying Sorry (NHS Litigation Authority)
*The term ‘significant harm’ is understood as defined in the 2014 document Building a Duty of 
Candour by the Department of Health. It covers the National Reporting and Learning System 
categories of ‘moderate’, ‘severe’ and ‘death’, harm that is notifiable to the Care Quality Commission, 
and ‘prolonged psychological harm’.
45

The Royal College of Surgeons of England
Domain 4: Maintaining trust
4.1  Show respect for patients 
Surgeons must treat their patients as individuals, respectfully and 
considerately, and make every effort to establish and maintain their trust at 
all times. In addition to the standards of Good Medical Practice you should:
»  Observe the relevant legislation and guidance to honor the wishes of a patient in 
your care. This includes carefully considering any advance decision (living will) 
that the patient may have written under the Mental Capacity Act 2005.
»  Support any request for a second opinion and give assistance in making the 
appropriate arrangements.
»  Ensure that a patient’s dignity is respected at all times, for example with 
unconscious patients and in clinical demonstrations.
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Good Surgical Practice: Maintaining trust
»  Obtain the patient’s verbal consent before carrying out any clinical examination, 
and support a patient’s request for a third person to be present while he or she is 
undergoing a clinical examination.
»  Explain the purpose and nature of any examination of the breast, genitalia or 
rectum and observe GMC guidance on intimate examinations.
»  Respect patients’ rights to privacy and confidentiality at all times, particularly 
when communicating publicly, including in the media. You should take particular 
care to protect patients’ confidentiality when using social media. 
Further reading
Confidentiality (GMC, 2009)
Intimate Examinations and Chaperones (GMC, 2013)
Doctor’s Use of Social Media (GMC, 2013)
Using Social Media: Practical and Ethical Guidance for Doctors and Medical 
Students (British Medical Association)
47

The Royal College of Surgeons of England
4.2  Treat patients and colleagues fairly and without discrimination 
In line with GMC guidance on the duties of doctors in the workplace, 
surgeons must promote an environment which is free from unfair 
discrimination, bearing in mind that colleagues and patients come from 
diverse backgrounds. The following principles are laid out in Good Medical 
Practice and associated GMC guidance but are of particular relevance to 
surgeons. You should:
»  Ensure that your conduct towards patients and colleagues is fair, culturally 
sensitive and non-discriminatory.
»  Ensure that decisions about patient treatment are based on clinical need and the 
likely effectiveness of treatment and not on lifestyle choices and social, managerial 
or financial factors that may introduce discriminatory access to care.
»  End the relationship with a patient only when the surgeon–patient relationship 
has irrevocably broken down and the interests of the patient are best served by 
ending the current relationship and ensuring an appropriate handover to another 
doctor for continuing care. 
Further reading
Leadership and Management for All Doctors (GMC, 2012)
Ending Your Professional Relationship with a Patient (GMC, 2012)
48

Good Surgical Practice: Maintaining trust
4.3  Act with honesty and integrity 
4.3.1  Provision of information about surgeons’ practice
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. You should adhere to all the principles 
set out in Good Medical Practice (GMC, 2013, pars. 65–80). In addition, you 
should:
»  Ensure that any information about your knowledge, skills and services is truthful, 
factual and serves the interests of patients.
»  Ensure that your name or practice is not used inappropriately in the promotion 
of personal commercial advantage. Avoid any material that could be interpreted 
as designed to promote your own expertise, either in general or in a particular 
procedure.
»  Declare any commercial involvement that might cause a conflict of interest.
»  Ensure that the literature provided by the institution where you work and any 
interview you give to the media does not make unreasonable claims.
»  Demonstrate honesty and objectivity in your dealings with others, including 
when providing references for colleagues and team members, or when providing 
evidence to courts and tribunals.
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The Royal College of Surgeons of England
4.3.2  Private practice
Surgeons working in the private sector, including independent sector 
treatment centres (ISTCs), must ensure transparency in their dealings with 
patients in respect of costs for services and any actual or potential limitations 
of clinical care. You should:
»  Make arrangements for the continuity of care of inpatients.
»  Maintain the standard of record keeping as indicated in section 1.3 and audit all 
surgical activity as indicated in section 2.1.
»  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.
»  Inform patients if any part of the fee goes to any other healthcare professional.
»  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.
»  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 
continuing professional development.
»  Ensure that you are a member of a medical defense organisation or that you have 
other appropriate indemnity and insurance cover for your practice.
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Good Surgical Practice: Maintaining trust
»  If you work both in the NHS and the private sector, you should:
»  Undertake similar types of procedures in both settings.
»  Not allow your private commitments to interfere with the fulfillment of your 
NHS contracted duties. 
»  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.
»  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. 
4.3.3 Probity
Surgeons must be honest in financial and commercial matters relating to 
their work. In particular, you should:
»  Not allow commercial incentives or hospitality to influence treatment given to a 
patient.
»  Disclose any personal affiliation or other financial or commercial interest relating 
to your practice including other private healthcare companies, pharmaceutical 
companies or instrument manufacturers.  
Further reading
Acting as a Witness in Legal Proceedings (GMC, 2013)
Bribery Act 2010
Financial and Commercial Arrangements and Conflicts of Interest (GMC, 2013)
51

Useful contacts
Surgical royal colleges in Great 
Surgical specialty associations and 
Britain and Ireland
societies
The Royal College of Physicians and 
All the surgical specialty associations and 
Surgeons of Glasgow
societies are based at the Royal College of 
232-242 St Vincent Street, Glasgow,  
Surgeons of England, 35–43 Lincoln’s Inn 
G2 5RJ
Fields, London WC2A 3PE
Tel 0141 221 6072
www.rcpsg.ac.uk
Association of Surgeons of Great Britain 
and Ireland
The Royal College of Surgeons of 
Tel 0207 973 0300
Edinburgh
Email xxxxx@xxxxx.xxx.xx
Nicolson Street, Edinburgh, EH8 9DW
www.asgbi.org.uk
Tel 0131 527 1600
Email: xxxx@xxxxx.xx.xx 
British Association of Oral and 
www.rcsed.ac.uk
Maxillofacial Surgeons
Tel 0207 405 8074
The Royal College of Surgeons of England
Email xxxxxx@xxxxx.xxx.xx
35-43 Lincoln’s Inn Fields, London, 
www.baoms.org.uk
WC2A 3PE
Tel 0207 405 3474
British Association of 
www.rcseng.ac.uk 
Otorhinolaryngologists – Head and Neck 
Surgeons
The Royal College of Surgeons in Ireland
Tel 0207 404 8373
123 St Stephens Green, Dublin 2, Ireland
Email xxxxx@xxxxx.xxx
Tel 00353 1 402 2100
www.entuk.org
Email: xxxx@xxxx.xx
www.rcsi.ie 
British Association of Paediatric Surgeons
Tel 0207 869 6915
Email xxxx@xxxx.xxx.xx
www.baps.org.uk

Good Surgical Practice: Useful contacts
British Association of Plastic, 
Other contacts
Reconstructive and Aesthetic Surgeons
Tel 0207 831 5161
Academy of Medical Royal Colleges
Email xxxxxxxxxxx@xxxxxx.xxx.xx
10 Dallington Street, London EC1V 0DB
www.bapras.org.uk
Tel 0207 490 6810
Email xxxxxxx@xxxxx.xxx.xx 
British Association of Urological Surgeons
www.aomrc.org.uk
Tel 0207 869 6950
www.baus.org.uk
Association of Surgeons in Training
35–43 Lincoln’s Inn Fields, London  
British Orthopaedic Association
WC2A 3PE
Tel 0207 405 6507
Tel 0207 973 0302
www.boa.ac.uk
Email xxxx@xxxx.xxx 
www.asit.org
Society for Cardiothoracic Surgery in 
Great Britain and Ireland
British Association of Day Surgery
Tel 0207 869 6893
35–43 Lincoln’s Inn fields, London  
Email xxxxxxxxx@xxxx.xxx.xx
WC2A 3PE
www.stcs.org 
Tel 0207 973 0308
Email xxxx@xxxx.xx.xx
Society of British Neurological Surgeons
http://daysurgeryuk.net
Tel 0207 869 6892
Email xxxxx@xxxx.xxx.xx
British Medical Association
www.sbns.org.uk
BMA House, Tavistock Square, London 
WC1H 9JP
Vascular Society of Great Britain and 
Tel 0207 387 4499
Ireland
www.bma.org.uk
Tel 0207 869 6936
Email xxxxxx@xxxxxxxxxxxxxxx.xxx.xx 
www.vascularsociety.org.uk 
53

The Royal College of Surgeons of England
British Orthopaedic Trainees Association
Department of Health, Social Services and 
35–43 Lincoln’s Inn Fields, London  
Public Safety (Northern Ireland)
WC2A 3PE
Castle Buildings, Stormont Estate, Belfast, 
Tel 0207 405 6507
BT4 3SQ
www.bota.org.uk 
www.dhsspsni.gov.uk 
British Transplantation Society
Faculty of Medical Leadership and 
www.bts.org.uk 
Management
2nd Floor, 6 St Andrews Place, London  
Care Quality Commission 
NW1 4LB
Citygate, Gallowgate, Newcastle upon 
Tel 0203 075 1471 
Tyne, NE1 4PA
Email xxxxxxxxx@xxxx.xx.xx 
Tel 03000 61 61 61
www.fmlm.ac.uk
Email xxxxxxxxx@xxx.xxx.xx 
www.cqc.org.uk 
Federation of Independent Practitioner 
Organisations
Care Standards Inspectorate for Wales 
80 Harley Street, London W1G 7HL
Welsh Government office, Rhydycar 
Tel 020 7580 1211
Business Park, Merthyr Tydfil, CF48 1UZ
www.fipo.org.uk
Tel 0300 7900 126
Email xxxxx@xxxxx.xxx.xxx.xx 
General Medical Council
www.cssiw.org.uk
Regent’s Place, 350 Euston Road, London 
NW1 3JN
Department of Health (England)
Tel 0161 923 6602
Richmond House, 79 Whitehall,  
Email xxx@xxxxxx.xxx 
London SW1A 2NS
www.gmc-uk.org 
Tel 0207 210 4850
Email xxxxxx@xx.xxx.xxx.xx
www.dh.gov.uk
54

Good Surgical Practice: Useful contacts
Healthcare Improvement Scotland
Independent Doctors Federation
Gyle Square, 1 South Gyle Crescent, 
27 Nesta Road, Woodford Green, Essex 
Edinburgh, EH12 9EB
IG8 9RG
Tel 0131 623 4300
Tel 020 8090 2433
Email xxxxxxxx.xxx@xxx.xxx 
Email xxxx@xxx.xx.xxx 
www.healthcareimprovementscotland.org
www.idf.uk.net
Healthwatch England
Medical Defence Union 
Skipton House, 80 London Road, London,  230 Blackfriars Road London SE1 8PJ 
SE1 6LH
Tel 0800 716 646 
Tel 03000 683 000
Email xxxxxxxx@xxxxxx.xxx 
Email xxxxxxxxx@xxxxxxxxxxx.xx.xx 
www.themdu.com 
www.healthwatch.co.uk 
Medical and Dental Defence Union 
Health Research Authority
Scotland
Skipton House, 80 London Road,  
Mackintosh House, 120 Blythswood Street, 
London SE1 6LH
Glasgow G2 4EA
Tel 020 797 22545
Tel 0845 270 2034 
Email xxxxxxx.xxx@xxx.xxx 
Email xxxx@xxxxx.xxx 
www.hra.nhs.uk
www.mddus.com 
Health and Social Care Information Centre Medical Protection Society
1 Trevelyan Square, Boar Lane, Leeds,  
33 Cavendish Square, London W1G 0PS
LS1 6AE
Tel 020 7399 1300
Tel 845 300 6016
Email xxxx@xxx.xxx.xx 
Email xxxxxxxxx@xxxxx.xxx.xx 
www.medicalprotection.org/uk
www.hscic.gov.uk
Medical Protection Society (Leeds Office)
Victoria House, 2 Victoria Place, Leeds, 
LS11 5AE.
Tel 0113 243 6436
55

The Royal College of Surgeons of England
Medical Protection Society (Edinburgh 
NHS Health Scotland
Office)
Gyle Square, 1 South Gyle Crescent, 
39 George Street, Edinburgh EH2 2HN
Edinburgh, EH12 9EB
Tel 0131 240 1840
Email nhs.healthscotland-
xxxxxxxxxxxxxxxx@xxx.xxx
National Clinical Assessment Service 
www.healthscotland.com
(England Office)
Area 1C, Skipton House, 80 London Road,  NHS England
London SE1 6LH
PO Box 16738, Redditch, B97 9PT
Tel 020 7972 2999
Tel 0300 311 22 33
Email xxxxxxxxxxxxxxxx@xxxx.xxx.xx
Email xxxxxxx.xxxxxxxxx@xxx.xxx 
www.ncas.nhs.uk
www.england.nhs.uk
National Clinical Assessment Service 
NHS Trust Development Authority
(Northern Ireland Office)
Southside, 105 Victoria Street, London 
Office Suite 3, Lisburn Square House, 
SW1E 6QT
Haslem’s Lane, Lisburn BT28 1TW
Tel 0207 932 1980
Tel 028 9266 3241
www.ntda.nhs.uk
Email xxxxxxxxxxxxxxx.xxxx@xxxx.xxx.xx National Institute of Health and Care 
National Clinical Assessment Service 
Excellence
(Wales Office)
10 Spring Gardens, London SW1A 2BU
First Floor, 2 Caspian Point, Caspian Way,  Tel 0300 323 0140
Cardiff Bay, Cardiff CF10 4DQ
Email xxxx@xxxx.xxx.xx 
Tel 029 2044 7540
www.nice.org.uk
Email xxxxx.xxxx@xxxx.xxx.xx 
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Good Surgical Practice: Useful contacts
NHS Blood and Transplant
Regulation and Quality Improvement 
Oak House, Reeds Crescent, Watford 
Authority 
Hertfordshire WD24 4QN
9th Floor Riverside Tower, 5 Lanyon 
Tel 0300 123 23 23
Place, Belfast, BT1 3BT 
Email xxxxxxxxx@xxxxx.xxx.xx 
Tel 028 9051 7500
www.nhsbt.nhs.uk
Email xxxx@xxxx.xxx.xx 
www.rqia.org.uk
NHS Litigation Authority
2nd Floor, 151 Buckingham Palace Road, 
Scottish Care Inspectorate
London SW1W 9SZ
Tel 0845 600 9527
Tel 020 7811 2700
Email xxxxxxxxx@xxxxxxxxxxxxxxxx.xxx 
Email xxxx.xxxxxxxx@xxxxx.xxx 
www.careinspectorate.com
www.nhsla.com 
Scottish Government Health Directorate
National Institute for Health Research
St Andrew’s House, Regent Road, 
Room 132, Richmond House,  
Edinburgh EH1 3DG
79 Whitehall, London SW1A 2NS
Tel 0131 244 2636
Email xxxxxxxxx@xxxx.xx.xx 
Email xxx@xxxxxxxx.xxx.xxx.xx
www.nihr.ac.uk 
www.scotland.gov.uk 
National Confidential Enquiry into Patient  Scottish Intercollegiate Guidance Network
Outcome and Death
Gyle Square, 1 South Gyle Crescent, 
Ground Floor, Abbey House, 74–76 St 
Edinburgh EH12 9EB
John Street, London EC1M 4DZ
Tel 0131 623 4720
Tel 020 7251 9060
Email xxxx@xxxx.xx.xx 
Email xxxx@xxxxxx.xxx.xx 
www.sign.ac.uk 
www.ncepod.org.uk 
Welsh Assembly Government
Cathays Park, Cardiff, CF10 3NQ
Tel 0300 0603300
www.wales.gov.uk
57


The Royal College of Surgeons of England
35-43 Lincoln’s Inn Fields
London
WC2A 3PE
©The Royal College of Surgeons of England 2014
Registered charity number 212808
All rights reserved. No part of this publication may be 
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