Good Medical Practice 2024 for the MSRA
Last updated 12 October 2026
Every Professional Dilemmas key is a judgement about what a Foundation doctor should do, and the standard for that judgement is the GMC's Good Medical Practice. The 2024 edition has four domains and 101 numbered paragraphs. You do not need to learn them; you need to recognise which ones a scenario is testing.
The four domains
| Domain | Paragraphs | What it covers |
|---|---|---|
| 1. Knowledge, skills and development | 1 to 20 | Being competent and working within your limits, providing good clinical care, keeping up to date, using resources well, treating patients fairly and keeping information confidential |
| 2. Patients, partnership and communication | 21 to 47 | Kindness and respect, consent, sharing information, safeguarding, helping in emergencies, and being open when things go wrong |
| 3. Colleagues, culture and safety | 48 to 80 | Respect for colleagues, a positive working culture, leadership, delegation, accurate records, keeping patients safe, raising concerns, and managing risks from your own health |
| 4. Trust and professionalism | 81 to 101 | Honesty and integrity, professional boundaries, communicating as a doctor including on social media, conflicts of interest, and cooperating with investigations |
The paragraphs the paper keeps returning to
Across the 150 scenarios in MSRA Practice, the explanations cite 71 different paragraphs. A handful do most of the work. If you understand these, you can place most options.
| Paragraph | Duty | How it shows up in a scenario |
|---|---|---|
| 45 | Be open and honest with patients if things go wrong | An error has reached a patient. Options that tell the patient promptly and apologise rank above options that wait, and far above options that conceal |
| 75 | Act promptly if patient safety, dignity or comfort is compromised | A colleague is impaired, a system is unsafe, a result has been missed. Acting now beats raising it at the next meeting; raising it in proportion beats going straight to the top |
| 69 | Keep records clear, accurate and contemporaneous | Being asked to write something you did not see, back-dating, or leaving an error uncorrected |
| 2 | Work within the limits of your competence | Being asked to do a procedure, cover a shift or give advice beyond your level. Seeking help ranks high; declining outright with no alternative ranks lower than declining and arranging someone who can |
| 22 | Treat information about patients as confidential | Relatives, employers, police, friends and social media. Sharing with those who need it for care is fine; sharing for convenience or curiosity is not |
| 48 to 51 | Treat colleagues with kindness, courtesy and respect; be compassionate towards colleagues with problems | A struggling colleague. Speaking to them directly and supportively usually ranks above reporting them, unless patients are at immediate risk |
| 24 and 25 | Involve patients in decisions; make sure you have consent | Proceeding because a senior said so, or because it is quicker, ranks below checking the patient understands and agrees |
| 81 and 82 | Your conduct must justify patients' trust; always be honest about your experience and qualifications | Covering up, embellishing a CV, or letting a patient believe you are more senior than you are |
| 41 and 42 | Consider the needs of people at risk of harm and act promptly on concerns | A child, an adult who lacks capacity or a vulnerable patient. Safeguarding duties override the usual preference for the least escalatory step |
| 77 to 79 | Manage risks posed by your own health; seek independent medical advice | You are ill, exhausted or affected by something personal. Self-prescribing and soldiering on both rank low |
Reading a scenario through the guidance
A reliable way to place options is to ask three questions in order, each of which maps to the guidance:
- Is anyone at risk right now? If so, the most appropriate action is the one that removes the risk soonest (paragraphs 43, 75). Everything else comes after.
- Who needs to know, and who is the right first person to tell? GMP expects concerns to be raised promptly and through an appropriate route (75, 76). The right first step is usually the most direct person who can act: the colleague themselves, your senior, the nurse in charge. Jumping to the medical director or the GMC when a conversation would do ranks lower; staying silent ranks lowest.
- What does honesty require? Candour to patients (45), accurate records (69), and honesty about yourself (82) are rarely outranked by convenience, loyalty or hierarchy. An option that solves the practical problem by being less than honest almost always sits at the bottom.
The remaining judgement is usually between two good options: which is better, speaking to the colleague or informing a senior? Here the paper tends to reward proportion. Where no one is at immediate risk, start with the person involved, then escalate if that fails. Where a patient is at risk, escalate first.
What changed in 2024
The 2024 edition added explicit duties that are now fair game in scenarios: contributing to a positive working culture and not tolerating bullying or harassment (52 to 59), the duty to act if you witness such behaviour (58), a specific prohibition on acting in a sexual way towards colleagues (57), and clearer expectations of anyone with a leadership role (59, 60, 76). Older practice material written to the 2013 edition will not cite these.
Find out which principles cost you marks
MSRA Practice totals your marks lost by Good Medical Practice paragraph across every attempt, then builds a practice set from the scenarios that test your weakest ones.
Try ten scenarios freeSources
- General Medical Council, Good medical practice (2024), effective 30 January 2024. gmc-uk.org/professional-standards.
- Health Education England and Work Psychology Group, MSRA Professional Dilemmas candidate guidance.
- Marking: how the Professional Dilemmas paper is marked.
Frequently asked questions
Do I need to memorise Good Medical Practice for the MSRA?
No. You need to apply it. The paper tests whether you recognise what a conscientious Foundation doctor would do, and the keys are written to the standard GMP sets. Knowing the recurring duties (candour, raising concerns in proportion, honesty in records, working within competence, confidentiality) is enough; paragraph numbers are not tested.
Which version of Good Medical Practice applies?
The 2024 edition, in force since 30 January 2024. It restructured the guidance into four domains and added explicit duties on workplace culture, sexual misconduct and leadership. Our keys and rationales cite the 2024 paragraph numbers.
What is the single most tested principle?
In our bank the duty to be open and honest when things go wrong (paragraph 45) and the duty to act promptly on patient safety risks (paragraph 75) are cited more than any others, followed by accurate record keeping (69), working within your competence (2) and confidentiality (22).