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Every psychiatrist in the UK follows a well‑worn sequence when assessing a patient. Rapport first. History. Mental state. Formulation. Risk. Treatment plan. It is a clinical rhythm that is learned, refined, and eventually practised almost without thinking. But when professional standards are rewritten, updated, or re‑emphasised, it is worth pausing to ask: how exactly does each component of everyday assessment and treatment align with the GMC’s expectations?

That question sits at the back of many a clinician’s mind. But some do not bother about it.

Nonetheless four guidance documents are central to psychiatric practice – Good medical practice (2024), Good practice in proposing, prescribing, providing and managing medicines and devices, Decision making and consent, and Confidentiality: good practice in handling patient information. Each one circles the work, but none of them maps directly onto the steps that most psychiatrists follow. So, the mapping was undertaken anyway.

This article presents the result. It breaks down a comprehensive psychiatric assessment into its individual steps, then identifies – with 100% paragraph‑level accuracy – which GMC standard applies where. After weeding out mismatches, what remains is a professional referencing system that shows, for example, that introducing yourself by name and role is a requirement set out in GMCRx Para 22a, while discussing future care preferences lands squarely in DMC Paras 35‑37.

The exact wording of every valid reference is reproduced in the Appendix, so the GMC’s own language can be seen showing what is expected. Whether someone is a trainee preparing for a CBD, a consultant writing a report, or a responsible officer checking a colleague’s practice, having these links to hand can turn vague “guidance says…” statements into precise, defensible citations.

How to use the references

Every citation in this post is given as [Document, Para number].

• GMP – Good medical practice (2024)
• GMCRx – Good practice in proposing, prescribing, providing and managing medicines and devices (2021, updated 2024)
• DMC – Decision making and consent (2020, updated 2024)
• GMCCx – Confidentiality: good practice in handling patient information (2017, updated 2024)

The exact GMC wording of each cited paragraph is reproduced in the Appendix.

The force of “must” in GMC guidance

The word “must” carries significant weight in the GMC’s professional standards. As Good medical practice explains:

“We use the terms ‘you must’ and ‘you should’ in the following ways.
– ‘You must’ is used for a legal or ethical duty you’re expected to meet (or be able to justify why you didn’t).” [GMP, “How to use Good medical practice”]

This definition applies across all the core guidance documents – it is not a suggestion or an aspiration. When a paragraph says “you must”, the GMC is describing an obligation that either flows directly from the law (such as mental capacity or data protection legislation) or is a fundamental ethical duty that the profession will hold you accountable for, unless you can produce a sound, documented justification for acting differently.

A clear illustration of how this works in everyday practice is the GMC’s expectation that prescribers follow national prescribing resources:

“You must keep up to date with guidelines and developments that affect your work.” [GMP, Para 3]

“You must be familiar with the guidance in the British National Formulary (BNF) and British National Formulary for Children (BNFC), which contain essential information to help you prescribe, monitor, supply, and administer medicines.” [GMCRx, Para 12]

On obeying the law, the GMC states: “You must follow the law, our guidance on professional standards, and other regulations relevant to your work.” [GMP, Para 4] ‘The law’ does not mean only Statute; it means any form of law including relevant case law. In essence doctors must act lawfully and not breach the law of tort e.g. negligence law. [Be very careful with Bolam.]

“Must” here ties the professional obligation directly to named and unnamed national publications. It tells clinicians that consulting national guidance is not an optional exercise in providing care and treatment; it is a requirement that forms part of safe prescribing, and any departure from it would need to be justified. But some doctors believe that howsoever they justify what they do, that’s enough. They may have a surprise because justifications must be within the requirements of law. Which law (or laws) is for the doctor to find out and know.

The same principles runs through every domain covered by the GMC’s standards: “must” signals the floor, not the ceiling.

Quick‑reference summary

The Psychiatric Assessment

The following is not a ‘rule’. It is an example.

1. Introduction and Rapport

• Introduce yourself by name and role [GMCRx, Para 22a].
• Explain the purpose, format, and likely duration of the assessment [GMCRx, Para 22b].
• Clarify confidentiality and its limits (e.g., risk, safeguarding) [GMP, Para 22; GMCCx, Paras 28‑31].
• Be honest about your experience, qualifications, and current role [GMP, Para 82].

2. Establishing the Patient’s Goals and Priorities

• Ask the patient what they hope to achieve from the assessment and any treatment, functionally and personally [GMP, Para 6; DMC, Para 17].

3. Elicitation of Background History

• Obtain a full psychiatric, medical, social, family, developmental, and forensic history [GMP, Para 7a].
• Take account of symptoms and relevant psychological, spiritual, social, economic, and cultural factors [GMP, Para 7a].

4. Collateral History

• With consent, seek information from family, carers, the GP, and other involved professionals to address gaps in insight or memory and to ensure continuity of care [GMP, Para 65a; GMCCx, Paras 27‑28].

5. Physical Health Review

• Take a brief physical health screen and review recent bloods, GP records, or liaise to rule out organic causes [GMP, Para 7b].
• Ask about any other care and treatments the patient is receiving [GMP, Para 39; GMCRx, Para 34b].

6. Cultural Formulation

• Explore how the patient understands their distress within their cultural framework, any culturally specific syndromes, and how culture may affect engagement with services [GMP, Para 7a; GMP, Para 34].

7. Mental State Examination (MSE)

• Conduct a systematic MSE, recording verbatim snippets where diagnostically or risk‑relevant [GMP, Para 7a; GMP, Para 70a].

8. Analysis of MSE Findings

• Synthesise the observed phenomena and reported experiences into a coherent clinical picture.

9. Formulation

• Develop a biopsychosocial formulation explaining predisposing, precipitating, perpetuating, and protective factors [GMP, Para 6; GMP, Para 7a].

10. Insight Assessment

• Explicitly document the patient’s awareness of illness, attribution of symptoms, and acceptance of need for treatment.

11. Risk Analysis

• Assess risk to self, risk to others, risk from others, and risks of self‑neglect or exploitation [GMP, Para 7a].

12. Strengths and Protective Factors

• Document what keeps the patient well, what has worked previously, and their personal and social resources.

13. Safeguarding Review

• Actively consider whether the patient or any dependents are vulnerable to abuse, neglect, or exploitation, and act promptly on any concerns [GMP, Para 41; GMP, Para 42].

14. Supporting Informed Decision‑Making

• Give the patient clear, accurate, and up‑to‑date information about diagnosis, prognosis, and treatment options, including the option to take no action [GMP, Para 28; DMC, Para 10].
• Explain benefits, risks, uncertainties, and the likelihood of success for each option, including what to do in the event of side effects, the likely duration of treatment, and arrangements for monitoring and follow‑up [DMC, Para 10e; DMC, Para 21; GMCRx, Para 39].
• Check the patient’s understanding and offer time and support [DMC, Para 30; DMC, Para 27].

15. Assessing Capacity and Obtaining Consent

• Start from the presumption that every adult patient has capacity [GMP, Para 24; DMC, Para 81].
• If capacity is in question, assess it specifically for the decision at hand using the relevant legal test [DMC, Para 83; DMC, Para 84].
• For any proposed medication, discuss the information needed for valid consent in line with the Montgomery principle (material risks a reasonable person would want to know, and risks you should reasonably know this particular patient would consider significant) [DMC, Para 22; DMC, Para 23a; DMC, Para 23c]. For most prescribing decisions, verbal consent is sufficient provided the patient has had the opportunity to consider the relevant information [GMCRx, Para 49].

16. Advance Statements and Future Care Preferences

• For recurrent or progressive conditions, sensitively encourage discussion and recording of preferences for future care, including advance statements or decisions [DMC, Para 35; DMC, Para 36; DMC, Para 37].

Recording consent and treatment proposal – a worked example

The GMC requires that the dialogue leading to consent is documented, not merely that consent was obtained. As Decision making and consent makes clear, keeping an accurate record of the exchange of information leading to a decision will inform future care and help you explain and justify your decisions and actions [DMC, Para 50]. A bare statement such as “consent obtained” gives no evidence of the substance of that dialogue and is unlikely to satisfy a Coroner, a judge, or a fitness‑to‑practise panel that the patient was truly informed.

Below is an example of what a meaningful entry might look like for a patient with treatment-resistant schizophrenia being started on clozapine. It is detailed because the risks are significant, the monitoring is burdensome, and the decision is seldom straightforward. The entry is written as it would appear in the clinical notes.

Consent to treatment: clozapine initiation

I discussed the diagnosis of treatment‑resistant schizophrenia with Mr A and explained that clozapine is the only antipsychotic licensed for this indication when two other conventional antipsychotics have been tried without adequate response [DMC, Para 10a‑c; GMCRx, Para 39]. The chances of improvement with a third antipsychotic are around 7 to 10%. I informed Mr A that he met criteria for treatment‑resistant schizophrenia and that studies show that delaying clozapine beyond 2–3 years after treatment resistance is established is associated with a substantially lower response rate; therefore, clozapine was recommended without further delay.

Information given about benefits: I explained that approximately 60 % of patients who have not responded to other antipsychotics show a meaningful improvement on clozapine after a year of treatment.[DMC, Para 10e; DMC, Para 21].

Information given about risks and side effects (material risks discussed):

• Neutropenia and agranulocytosis: I explained that clozapine can cause a drop in white blood cells, which in rare cases (approximately 0.8 %) can be severe (agranulocytosis) and life‑threatening if not detected early. For this reason, weekly blood tests are mandatory for the first 18 weeks, then fortnightly up to one year, then monthly thereafter. I explained that if the neutrophil count falls below a safe threshold, clozapine must be stopped immediately [GMCRx, Para 39a‑b; DMC, Para 23a].
• Myocarditis and cardiomyopathy: I explained there is a risk of inflammation of the heart muscle (myocarditis), most commonly in the first two months, which can be serious. Symptoms to report include persistent tachycardia, chest pain, breathlessness, and fever. I explained that baseline troponin and CRP would be checked and that physical monitoring (pulse, blood pressure, temperature) is required at each blood test [DMC, Para 23a; DMC, Para 23c]. I told him that cardiomyopathy is is a potentially dangerous enlargement of the heart that happens in a minority of patients after about 9 months. I said that he would be offered a baseline echocardiogram and repeats after 6 months to ensure that that late onset adverse effect was detected early.
• Seizures: I explained the risk of seizures is dose‑dependent (approximately 1–5 %), and that the dose is titrated slowly to minimise this risk.
• Constipation and gastrointestinal hypomotility: I explained this is common and can become serious, leading to bowel obstruction or perforation if not managed proactively. I advised him to report any change in bowel habit and explained that laxatives may be needed [DMC, Para 23c].
• Metabolic effects: I discussed the risks of weight gain, diabetes, and lipid abnormalities, and explained that regular monitoring of weight, HbA1c, and fasting lipids would be arranged.
• Sedation and hypersalivation: I explained these are common, especially early in treatment, and discussed practical strategies to manage them [GMCRx, Para 39a‑b].

All the above was explained in non-clinical language. He was able to discuss this information interactively; demonstrating his understanding.

Information given about monitoring and practical arrangements:

• Weekly full blood count for 18 weeks, then fortnightly to one year, then monthly.
• Physical observations (pulse, blood pressure, temperature) at each blood test.
• Baseline and then regular ECG, troponin, CRP, weight, HbA1c, fasting lipids.
• I explained the clozapine monitoring service arrangements and gave him the contact number [GMCRx, Para 39f].

Discussion of uncertainties: I explained that response can take several months and that it is not possible to predict with certainty whether he will respond or experience particular side effects. I also explained that if clozapine is stopped abruptly for any reason, re‑titration from a low starting dose may be necessary [DMC, Para 10b; DMC, Para 26].

Patient’s questions: Mr A asked whether the blood tests were painful and whether the weight gain was inevitable. I answered these questions honestly, explaining that the blood test is a brief needle prick and that weight gain can be managed by dietary choices with the help of a dietician, and physical activity, with support from the team [DMC, Para 25].

Capacity assessment: Mr A was able to understand the information about his diagnosis, the proposed treatment, the risks and benefits, and the alternatives (including continuing his current medication or taking no medication). He retained the key information, weighed up the pros and cons (acknowledging that the monitoring was burdensome but that his current symptoms were intolerable), and communicated a clear decision. I concluded that he has capacity to consent to this treatment [DMC, Para 83; DMC, Para 84; GMP, Para 24; DMC, Para 81].

The patient’s choice: Mr A gave free-willing agreement to proceed with clozapine. He understood that consent can be withdrawn at any time and that treatment would be reviewed regularly [DMC, Para 31; DMC, Para 59].

Consent: Valid consent obtained. Written consent is not legally required for this prescribing decision but I have offered a copy of this record to Mr A [GMCRx, Para 49].

Initial treatment plan:

1. Register with clozapine monitoring service today.
2. Baseline bloods, ECG, physical observations.
3. As soon as I have checked and confirmed that all in (2) are within acceptable parameters, I will prescribe.

Appendix – Exact GMC Paragraph Wording

This appendix reproduces verbatim the GMC guidance paragraphs that underpin each step of the comprehensive psychiatric assessment described in Part 1. Quotations are taken directly from the four core documents and are presented here for ready reference.

GMP – Good medical practice (2024)

Paragraph 6

You must provide a good standard of practice and care. If you assess, diagnose, or treat patients, you must work in partnership with them to assess their needs and priorities. The investigation or treatment you propose, provide or arrange must be based on this assessment, and on your clinical judgement about the likely effectiveness of the treatment options.

Paragraph 7a

a. adequately assess a patient’s condition(s), taking account of their history, including
i. symptoms
ii. relevant psychological, spiritual, social, economic, and cultural factors
iii. the patient’s views, needs, and values

Paragraph 7b

b. carry out a physical examination where necessary

Paragraph 22

You must treat information about patients as confidential, including after a patient has died. You must follow our more detailed guidance on Confidentiality: good practice in handling patient information.

Paragraph 24

All patients have the right to be involved in decisions about their treatment and care, and be supported to make informed decisions if they are able to. You must start from the presumption that all adult patients have capacity to make decisions about their treatment and care.

Paragraph 28

The exchange of information between medical professionals and patients is central to good decision making. You must give patients the information they want or need in a way they can understand. This includes information about: a. their condition(s), likely progression, and any uncertainties about diagnosis and prognosis
b. the options for treating or managing the condition(s), including the option to take no action
c. the potential benefits, risks of harm, uncertainties about, and likelihood of success for each option.

Paragraph 34

You must treat each patient as an individual. You must not rely on assumptions about the treatment options or outcomes a patient will prefer, or the factors they will consider significant.

Paragraph 39

You should ask patients about any other care or treatment they are receiving – including over‑the‑counter medications – and check that any care or treatment you propose, provide or prescribe is compatible.

Paragraph 41

You must consider the needs and welfare of people (adults, children and young people) who may be vulnerable, and offer them help if you think their rights are being abused or denied. You must follow our more detailed guidance on Protecting children and young people and 0‑18 years.

Paragraph 42

You must act promptly on any concerns you have about a patient – or someone close to them – who may be at risk of abuse or neglect, or is being abused or neglected.

Paragraph 65a

a. You must promptly share all relevant information about patients (including any reasonable adjustments and communication support preferences) with others involved in their care, within and across teams, as required.

Paragraph 70a

a. relevant clinical findings

Paragraph 82

You must always be honest about your experience, qualifications, and current role.

GMCRx – Good practice in proposing, prescribing, providing and managing medicines and devices (2021, updated 2024)

Paragraph 22a

a. tell the patient your name, role and, if online, your GMC registration number

Paragraph 22b

b. explain how the consultation is going to work and what they should do if they have any concerns or questions

Paragraph 34b

b. current and recent use of other medicines, including non‑prescription and herbal medicines, illegal drugs and medicines purchased online or face to face

Paragraph 39

You should reach agreement with the patient on the proposed treatment, explaining:
a. the likely benefits, risks and impact, including serious and common side effects
b. what to do in the event of a side effect or recurrence of the condition
c. how and when to take the medicine and how to adjust the dose if necessary
d. how to use a medical device
e. the likely duration of treatment
f. any relevant arrangements for monitoring, follow‑up and review, including further consultation, blood tests or other investigations, processes for adjusting the type or dose of medicine and for issuing repeat prescriptions.

Paragraph 49

You should be proportionate when obtaining a patient’s consent. For most prescribing decisions or proposals, you can rely on a patient’s verbal consent, as long as you are satisfied that they’ve had the opportunity to consider any relevant information and decided to go ahead. Sometimes a patient’s signature is required on a form, for example to comply with an MHRA drug safety alert about a medicine with serious side effects.

DMC – Decision making and consent (2020, updated 2024)

Paragraph 10

You must give patients the information they want or need to make a decision.
This will usually include:
a. diagnosis and prognosis
b. uncertainties about the diagnosis or prognosis, including options for further investigation*
c. options for treating or managing the condition, including the option to take no action
d. the nature of each option, what would be involved, and the desired outcome
e. the potential benefits, risks of harm, uncertainties about and likelihood of success for each option, including the option to take no action.
By ‘harm’ we mean any potential negative outcome, including a side effect or complication.*

Paragraph 17

You should try to find out what matters to patients about their health – their wishes and fears, what activities are important to their quality of life, both personally and professionally – so you can support them to assess the likely impact of the potential outcomes for each option.

Paragraph 21

You must give patients clear, accurate and up‑to‑date information, based on the best available evidence, about the potential benefits and risks of harm of each option, including the option to take no action.

Paragraph 22

It wouldn’t be reasonable to share every possible risk of harm, potential complication or side effect. Instead, you should tailor the discussion to each individual patient, guided by what matters to them, and share information in a way they can understand. *

Paragraph 23a

a. Recognised risks of harm that you believe anyone in the patient’s position would want to know. You’ll know these already from your professional knowledge and experience.

Paragraph 23c

c. Risks of harm and potential benefits that the patient would consider significant for any reason. These will be revealed during your discussion with the patient about what matters to them.

Paragraph 27

Patients need relevant information (see paragraph 10) to be shared in a way they can understand and retain, so they can use it to make a decision. To help patients understand and retain relevant information you should:
a. share it in a place and at a time when they are most likely to understand and retain it
b. anticipate whether they are likely to find any of it distressing and, if so, be considerate when sharing it
c. accommodate a patient’s wishes if they would like to record the discussion*
d. accommodate a patient’s wishes if they would like anyone else – a relative, partner, friend, carer or advocate – to be involved in discussions and/or help them make decisions
e. use an interpreter or translation service if they have difficulty understanding spoken English
f. share it in a format they prefer – written, audio, translated, pictures or other media or methods
g. give them time and opportunity to consider it before and after making a decision.

Paragraph 30

You must check whether patients have understood the information they have been given, and if they would like more information before making a decision.

Paragraph 35

If a patient has a condition that is likely to impair their capacity as it progresses, you should sensitively encourage them to think about what they might want to happen if they become unable to make healthcare decisions. You should bear in mind that some patients may not be ready to talk about these issues. Such discussions might include:
a. the patient’s wishes and fears, their preferences about future options for care, and the values and priorities that influence their decision making
b. any treatment or care the patient might want to refuse, and in what circumstances
c. any interventions that might become necessary in an emergency, such as cardiopulmonary resuscitation (CPR)3
d. whether the patient would like anyone else – relatives, friends, carers or representatives – to be involved in decisions about their care.

Paragraph 36

A patient may want to nominate someone to make decisions on their behalf if they lose capacity or they may want to make an advance statement about refusing or requesting a particular treatment. In these circumstances, you should let patients know that there are ways to formalise their wishes and suggest that they seek support and independent advice about this.*

Paragraph 37

You must record a summary of your discussion with the patient about their future care and any decisions they make, including as much detail as practical about the patient’s wishes and fears, their preferences about future options for care, and the values and priorities that influence their decision making. If possible, you should make this record while the patient has capacity to review and understand it.

Paragraph 81

You must start from the presumption that every adult patient has capacity to make decisions about their treatment and care. You must not assume a patient lacks capacity to make a decision solely because of their age, disability, appearance, behaviour, medical condition (including mental illness), beliefs, their apparent inability to communicate, or because they choose an option that you consider unwise.

Paragraph 83

A person has capacity if they can do all the following:
a. understand information relevant to the decision in question
b. retain that information
c. use the information to make their decision
d. communicate a decision.

Paragraph 84

If you believe that a patient may lack capacity to make a decision, you must assess their capacity using the test set out in the relevant legislation, taking account of the advice in the relevant guidance. If you find it difficult to judge whether a patient has capacity to make a decision, you should seek support from someone who knows the patient well, for example, another member of the healthcare team or someone close to the patient.*

GMCCx – Confidentiality: good practice in handling patient information (2017, updated 2024)

Paragraph 27

Most patients understand and expect that relevant information must be shared within the direct care team to provide their care. You should share relevant information with those who provide or support direct care to a patient, unless the patient has objected (see paragraphs 30 and 31).11

Paragraph 28

The usual basis for sharing information for a patient’s own care is the patient’s consent, whether that is explicit or implied (see paragraph 13 for definitions). You may rely on implied consent to access relevant information about the patient or to share it with those who provide (or support the provision of) direct care to the patient if all of the following are met.
a. You are accessing the information to provide or support the individual patient’s direct care, or are satisfied that the person you are sharing the information with is accessing or receiving it for this purpose.
b. Information is readily available to patients, explaining how their information will be used and that they have the right to object. This can be provided in leaflets and posters, on websites, and face to face. It should be tailored to patients’ identified communication requirements as far as practicable.
c. You have no reason to believe the patient has objected.
d. You are satisfied that anyone you disclose personal information to understands that you are giving it to them in confidence, which they must respect.

Paragraph 29

If you suspect a patient would be surprised to learn about how you are accessing or disclosing their personal information, you should ask for explicit consent unless it is not practicable to do so (see paragraph 14). For example, a patient may not expect you to have access to information from another healthcare provider or agency on a shared record.

Paragraph 30

If a patient objects to particular personal information being shared for their own care, you should not disclose the information unless it would be justified in the public interest,12 or is of overall benefit to a patient who lacks the capacity to make the decision. You can find further guidance on disclosures of information about adults who lack capacity to consent in paragraphs 41‑49.

Paragraph 31

You should explain to the patient the potential consequences of a decision not to allow personal information to be shared with others who are providing their care. You should also consider with the patient whether any compromise can be reached. If, after discussion, a patient who has capacity to make the decision still objects to the disclosure of personal information that you are convinced is essential to provide safe care, you should explain that you cannot refer them or otherwise arrange for their treatment without also disclosing that information.

The wording above is taken verbatim from the GMC’s published guidance and contains the cross‑references, asterisks, and footnotes as they appear in the original documents. Minor typographic adjustments have been made for consistency but no meaning has been altered.