GPICS (Guidelines for the Provision of Intensive Care Services)

Contents

Overview

GPICS is the joint publication of the Faculty of Intensive Care Medicine (FICM) and the Intensive Care Society (ICS). First published in 2015 (building on Core Standards for ICUs, 2013), it has become the definitive reference for the planning, commissioning, peer review and regulation of adult intensive care services across the UK.

Version 3 (GPICS V3) was published in January 2026. It is not a clinical guideline — it addresses service provision: infrastructure, workforce, governance and high-level processes.

Terminology (key V3 change)

V3 sharpened the distinction between its two types of statement:

Term Meaning Regulatory alignment
Minimum standard "Must do" — expected of all ICUs; unmet standards must appear on a risk register CQC: Inadequate / Requires Improvement
Recommendation to provide a quality service "Should do" — hallmarks of a high-quality service; aspirational but not mandatory CQC: Good / Outstanding

Structure of GPICS V3

The document is divided into five sections:

Section Topics
1. Structure Levels of care, physical facilities, equipment, ultrasound, outreach, specialist units (neuro, cardiothoracic, burns), networks
2. Workforce Consultant staffing, trainees, ACCPs, nursing, pharmacy, AHP teams, education, wellbeing, EDI
3. Clinical Care Admission/discharge, airway, respiratory/cardiovascular/renal/neuro support, infection control, end-of-life care, rehabilitation
4. Service Development Research, audit, clinical governance, patient safety, sustainability
5. Preparedness Surge planning, major incidents, HCID management, fire/evacuation

Levels of Care

GPICS V3 defines intensive care as Level 2 and Level 3:

  • Level 3 — patients requiring advanced respiratory support or two or more organ support
  • Level 2 — patients requiring single-organ support or detailed monitoring (step-down/step-up)
  • Level 1 (Enhanced Care) — a new dedicated chapter in V3; patients at risk of deterioration but not yet meeting Level 2 criteria; emphasis on interface with intensive care services

Key Workforce Standards

Consultant staffing (Chapter 2.1)

  • A consultant in ICM must lead care daytime, 7 days a week
  • Consultant:patient ratio must not normally exceed 1:8–1:12
  • Ward rounds twice daily (one face-to-face), 7 days a week
  • Consultant/specialist immediately available 24/7 — if non-resident, able to attend within 30 minutes
  • Any consultant with ICU commitment must have ≥2 PAs in acute ICM in their job plan
  • Daytime DCCs in ICM must be exclusively in ICM (no simultaneous second specialty)

Nurse staffing (Chapter 2.5)

  • Level 3 patients: minimum 1:1 nurse:patient ratio
  • Level 2 patients: minimum 1:2 nurse:patient ratio
  • Supernumerary clinical shift leader 24/7 in all ICUs
  • ≥50% of registered intensive care nurses must hold a post-registration critical care award
  • Maximum 20% bank/agency nurses (not substantively employed) on any one shift
  • Dedicated professional nurse advocates (PNAs) within establishment
  • Dedicated supernumerary clinical educator (minimum 1 WTE per 75 registered nurses/HCSWs)

Advanced Critical Care Practitioners (Chapter 2.3)

ACCPs are recognised as a core part of the ICU medical workforce. A 24/7 dedicated on-site medical doctor and ACCP rota is a minimum standard.

Outcomes and Governance (Chapters 1.2, 4.2–4.3)

Minimum standards include:

  • MDT clinical governance meetings with M&M analysis
  • Participation in a national audit programme (e.g. ICNARC Case Mix Programme)
  • Participation in a mortality review programme
  • Healthcare-associated infection surveillance
  • Robust surge and business continuity plans
  • Declaration of capacity and unit stress data through networks

What's New in V3

  • Sharpened terminology: minimum standards vs. recommendations to provide a quality service (see above)
  • Sustainability chapter (4.5): first time environmental sustainability has appeared in GPICS
  • EDI chapter (2.18): equity, diversity and inclusion as a dedicated standard
  • Four-nations scope: explicit recognition of Scotland, Wales, Northern Ireland frameworks alongside England/CQC
  • Patient and lay representative involvement in the editorial process for the first time
  • Enhanced care (Level 1) now has its own chapter
  • Trainee involvement on the Editorial Board

Viva Questions

1. What is GPICS and why does it matter clinically?

GPICS is the FICM/ICS guideline for the provision of intensive care services in the UK — not a clinical guideline, but a framework for how ICUs should be structured, staffed and governed. It matters clinically because it sets the standards against which ICUs are peer-reviewed and assessed by regulators such as the CQC. Failure to meet minimum standards must be recorded on a risk register and can result in a "Requires Improvement" or "Inadequate" rating. For trainees, understanding GPICS helps contextualise the staffing ratios, governance requirements and multidisciplinary team structures they work within. It also provides a basis for raising concerns: if your unit falls short of a minimum standard, GPICS gives you the framework to escalate it.

2. What are the consultant staffing minimum standards in GPICS V3?

A consultant in ICM must lead patient care on the ICU during the daytime, seven days a week. The consultant:patient ratio must not normally exceed 1:8 to 1:12. Ward rounds must occur twice daily, with at least one face-to-face round, 7 days a week. A consultant or specialist must be immediately available 24/7 — if non-resident, able to attend within 30 minutes. Any consultant with any clinical ICU commitment must have at least 2 PAs in acute ICM in their job plan, and daytime direct clinical care PAs must be exclusively in ICM with no concurrent second-specialty responsibility.

3. What nurse:patient ratios does GPICS V3 mandate, and what other nursing standards are required?

Level 3 patients require a minimum registered nurse:patient ratio of 1:1. Level 2 patients require a minimum of 1:2. Beyond ratios, GPICS also mandates a supernumerary clinical shift leader on duty 24/7, that at least 50% of registered ICU nurses hold a post-registration critical care award, a maximum of 20% bank/agency nurses not substantively employed by the unit on any shift, and a dedicated supernumerary clinical educator at a ratio of at least 1 WTE per 75 registered nurses and HCSWs.

4. How did GPICS V3 change the terminology from previous versions, and why does this matter?

Previous versions used "standards" and "recommendations." V3 replaced these with "minimum standards" (must do — essential safety markers) and "recommendations to provide a quality service" (should do — quality markers). The distinction matters because minimum standards are now explicitly aligned with CQC regulatory ratings: failing to meet them places an ICU in "Requires Improvement" or "Inadequate" territory, and unmet minimum standards must appear on the risk register. Recommendations, by contrast, represent what a good or outstanding service looks like, and most ICUs are expected to achieve them over time. This shift makes GPICS more auditable and gives ICUs clearer accountability language when building business cases or responding to inspections.

5. What governance and outcome standards does GPICS V3 require of an ICU?

ICUs must hold regular MDT clinical governance meetings with M&M analysis, participate in a national audit programme (in practice, ICNARC Case Mix Programme), and have a structured mortality review programme. They must also participate in healthcare-associated infection surveillance, maintain robust surge and business continuity plans, and declare capacity and unit stress data through their networks. GPICS V3 also introduced a sustainability chapter — the first time ICUs are expected to consider environmental impact as part of their governance obligations — and an EDI chapter requiring active attention to equity, diversity and inclusion in staffing and service delivery.