GP curriculum: Being a general practitioner

A. Knowing yourself and relating to others

 Fitness to practise

• Demonstrating the attitudes and behaviours expected of a good doctor
• Managing the factors that influence your performance

Maintaining an ethical approach

• Treating others fairly and with respect and acting without discrimination
• Providing care with compassion and kindness

Communication and consultation

• Establishing an effective partnership with patients
• Maintaining a continuing relationship with patients, carers and families

B. Applying clinical knowledge and skill

Data gathering and interpretation

• Applying a structured approach to data gathering and investigation
• Interpreting findings accurately to reach a diagnosis

Clinical examination and procedural skills

• Demonstrating a proficient approach to clinical examination
• Demonstrating a proficient approach to the performance of procedures

Making decisions

• Adopting appropriate decision-making principles
• Applying a scientific and evidence-based approach

Clinical management

• Providing general clinical care to patients of all ages and backgrounds
• Adopting a structured approach to clinical management
• Making appropriate use of other professionals and services
• Providing urgent care when needed

 Managing medical complexity

• Enabling people living with long-term conditions to improve their health
• Managing concurrent health problems within an individual patient
• Adopting safe and effective approaches for patients with complex needs

Working with colleagues and in teams

• Working as an effective team member
• Coordinating a team-based approach to the care of patients

 Improving performance, learning and teaching

• Continuously evaluating and improving the care you provide
• Adopting a safe and scientific approach to improve quality of care
• Supporting the education and development of colleagues

Organisational management and leadership

• Applying leadership skills to improve your organisation's performance
• Making effective use of information and communication systems
• Developing the financial and business skills required for your role

 Practising holistically, promoting health and safeguarding

• Demonstrating the holistic mindset of a generalist medical practitioner
• Supporting people through experiences of health, illness and recovery
• Safeguarding individuals, families and local populations

Community orientation

• Understanding the health service and your role within it
• Building relationships with the communities in which you work

Develop the attitudes and behaviours expected of a good doctor

Manage the factors that influence your performance

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Establish an effective partnership with patients

Maintain a continuing relationship with patients, carers and families

Apply a structured approach to data gathering and investigation

Interpret findings accurately to reach a diagnosis

Demonstrate a proficient approach to clinical examination*

2.3 Demonstrate a proficient approach
to clinical examination*

2.4 Demonstrate a proficient approach to the performance of procedures*

Demonstrate a proficient approach to the performance of procedures*

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Adopt appropriate decision-making principles

Apply a scientific and evidence-based approach

Provide general clinical care to patients of all ages and backgrounds

Adopt a structured approach to clinical management

Make appropriate use of other professionals and services

Provide urgent care when needed

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Enable people living with long-term conditions to improve their health

Manage concurrent health problems in an individual patient

Adopt safe and effective
approaches for patients with
complex health needs

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Work as an effective team member

Coordinate a team-based approach to the care of patients

Continuously evaluate and improve the care you provide

Adopt a safe and scientific
approach to improve quality of care

Support the education and development of colleagues

Apply leadership skills
to help improve your
organisation's performance

Develop the financial and business skills required for your role

Make effective use of information management and communication systems

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Demonstrate the holistic mind-set of a generalist medical practitioner

Support people through individual experiences of health, illness and recovery

Understand the health service and your role within it

Build relationships with the communities with which you work

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Fitness to practise 

This is about professionalism and the actions expected to protect people from harm. This includes the awareness of when an individual’s performance, conduct or health, or that of others, might put patients, themselves or their colleagues at risk.

Generic Professional Capabilities: Professional Values

MRCGP assessments: WPBA (CbD, CAT, QIP, Leadership, PSQ, MSF, CSR)

Insufficient evidence - From the available evidence, the doctor’s performance cannot be placed on a higher point of this developmental scale 

Indicators of potential underperformance

End ST1 – Making progress at the expected rate 

End ST2 - Making progress at the expected rate 

End ST3 - Competent for licensing

End ST3 - Excellent 

Fails to respect the requirements of organisations e.g. Meeting deadlines, producing documentation, observing contractual obligations

Has repeated unexplained or unplanned absence from professional commitments

Prioritises their own interests above those of patients

Fails to cope appropriately with pressure e.g. dealing with stress or managing time

Is the subject of multiple complaints

Complies with statutory professional responsibilities

Fulfils contractual requirements of professional practice and training

Monitors performance and demonstrates insight into personal needs

Demonstrates awareness of the needs of colleagues

Follows appropriate processes to monitor professional practice

Understands the GMC document, “Duties of a Doctor”

Awareness that physical or mental illness, or personal habits, might interfere with the competent delivery of patient care. 

Identifies and notifies an appropriate person when their own or a colleague’s performance, conduct or health might be putting others at risk. 

Responds to complaints or performance issues appropriately. 

Demonstrates the accepted codes of practice in order to promote patient safety and effective team-working. 

Achieves a balance between their professional and personal demands that meets their work commitments and maintains their health. 

Takes effective steps to address any personal health issue or habit that is impacting on their performance as a doctor. 

Demonstrates insight into any personal health issues. 

Reacts promptly, discreetly and impartially when there are concerns about self or colleagues. 

Takes advice from appropriate people and, if necessary, engages in a referral procedure. 

Uses mechanisms to reflect on and learn from complaints or performance issues in order to improve patient care. 

Encourages scrutiny of professional behaviour, is open to feedback and demonstrates a willingness to change. 

Anticipates situations that might damage their work-life balance and seeks to minimise any adverse effects on themselves or their patients. 

Takes a proactive approach to promote personal health. 

Encourages an organisational culture in which the health of its members is valued and supported. 

Provides positive support to colleagues who have made mistakes or whose performance gives cause for concern. 

Actively seeks to anticipate and rectify where systems and practice may require improvement in order to improve patient care. 

Treat others fairly and with respect, acting without discrimination

Learning outcomes

• Demonstrate a non-judgemental approach in your dealings with patients, carers, colleagues and others, respecting the rights and personal dignity of others and valuing diversity 
• Recognise and take action to address prejudice, oppression and unfair discrimination in yourself and others and within teams and systems 
• Compare and justify your views with others by discussing them openly with colleagues, and also with patients if appropriate, seeking their feedback and reflecting on how your values differ from those of other individuals or groups 
• Actively promote equality of opportunity for patients to access healthcare and for individuals to achieve their potential 
• Identify and discuss ethical conflicts in clinical practice and manage the conflicts arising within your roles as a clinician, a patient advocate and a leader in the health service 
• Anticipate and manage situations in which your personal and professional interests might be brought into conflict  
• Contribute to a clinical and working environment where everyone is encouraged to participate and alternative views are considered seriously  
• Take appropriate action when you become aware of people acting in an abusive, bullying or intolerant manner 

Provide care with compassion and kindness

Learning outcomes

• Demonstrate that you relate to people as individuals and challenge attitudes that de-humanise or stereotype others (such as referring to a patient by a disease or characteristic, rather than by name)
• Identify how differences between doctors and patients (for example, social, cultural or educational) may influence the development of therapeutic relationships 
• Take steps to enhance patient understanding when there are communication or cultural barriers that may be limiting a patient’s ability to make an informed decision or to report concerns about the service that you and your team provide 
• Record, share and receive information in an open, honest, sensitive and unbiased manner 
• Recognise that your duty of concern for your patients extends beyond your immediate team and spans across organisations and services (for example, when safeguarding children, caring for vulnerable adults or addressing unsafe services) 
• Apologise openly and honestly to a patient for any failure as soon as it is recognised, explaining the local complaints procedure if appropriate 
• Respond to complaints in a timely and appropriate manner, recognising your duty of candour to patients, carers and families 

Maintaining an ethical approach 

This is about practising ethically with integrity and a respect for equality and diversity.

Generic Professional Capabilities: Professional Values

MRCGP assessments: CSA, WPBA (CbD, CAT, COT, MiniCEX, QIP, Leadership, PSQ, MSF, CSR)

Insufficient evidence - From the available evidence, the doctor’s performance cannot be placed on a higher point of this developmental scale 

Indicators of potential underperformance

End ST1 – Making progress at the expected rate 

End ST2 - Making progress at the expected rate 

End ST3 - Competent for licensing

End ST3 - Excellent 

Does not consider ethical principles, such as good vs harm, and use this to make balanced decisions

Fails to show willingness to reflect on own attitudes

Awareness of the professional codes of practice as described in the GMC document “Good Medical Practice

Complies with public sector duty to uphold the principles of equality, diversity, and inclusion

Recognises that people are different and does not discriminate against them because of those differences. 

Understands that “Good Medical Practice requires reference to ethical practice

Actively applies principles of Good Medical Practice to their work

Understands the need to treat everyone with respect for their beliefs, preferences, dignity and rights. 

Understands the ethical principles of professional practice

Seeks to understand the patient’s viewpoint and their cultural background

Demonstrates the application of “Good Medical Practice” in their own clinical practice. 

Reflects on how their values, attitudes and ethics might influence professional behaviour. 

Demonstrates equality, fairness and respect in their day-to-day practice. 

Values and appreciates different cultures and personal attributes, both in patients and colleagues. 

Reflects on and discusses moral dilemmas encountered in the course of their work. 

Anticipates the potential for conflicts of interest and takes appropriate action to avoid these. 

Anticipates situations where indirect discrimination might occur.  

Awareness of current legislation as it applies to clinical work and practice management. 

Actively supports diversity and harnesses differences between people for the benefit of the organisation and patients alike. 

Able to analyse ethical issues with reference to specific ethical theory. 

Establish an effective partnership with patients

Learning outcomes

• Adopt a person-centred approach in dealing with patients and their problems, in the context of their circumstances 
• Use the general practice consultation to bring about an effective and collaborative doctor–patient relationship, with respect for your patient's autonomy, by: 

• adopting a patient-centred consultation model that explores the patient's ideas, concerns and expectations, integrates your agenda as a doctor, finds common ground and negotiates a mutual plan for the future 
• being aware of subjectivity in the medical relationship, from both the patient's side (feelings, values and preferences) and your side (self-awareness of values, attitudes and feelings) 
• communicating findings in a comprehensible way, helping patients to reflect on their own concepts and finding common ground for further decision-making 
• making decisions that respect each patient's autonomy 
• incorporating the patient's perspective when negotiating the management plan 
• flexibly and efficiently achieving consultation tasks in the context of limited time or challenging circumstances (e.g. with distressed patients or carers) 
• providing explanations that are relevant and understandable to patients and carers, using language appropriate to a patient's understanding 
• exploring the patient's and carer's understanding of what has taken place in the consultation 

• Manage the additional challenge of consultations with patients who have different languages, cultures, beliefs and educational backgrounds to your own by: 

• providing easy access to professional interpreters when required, being aware of their role in the consultation and using a variety of communication techniques and materials to adapt explanations to the needs of the patient and carer  
• enhancing health literacy in patients from a range of backgrounds, by providing tailored information, facilitating communication and checking understanding as appropriate 
• developing a range of communication skills that can be tailored to each patient's age, individual needs and preferences and adapted to the clinical context (e.g. when immediate action is needed), using time effectively within the consultation 
• integrating the patient's and doctor's agenda effectively into the consultation, enabling patients to reflect on their own concepts of health, to assist in shared decision-making and to manage self-care 

Maintain a continuing relationship with patients, carers and families

Learning outcomes

• Recognise the value that many patients, carers and families place on a trusted long-term relationship with 'their' doctor, using the consultation as a means to improve access to care and enhance continuity of care 
• Manage an appropriate emotional proximity to your patients, taking action to re-establish professional boundaries when required  
• Manage the effects of a complaint against you or your team, taking steps to facilitate a positive response and ensuring that the ongoing care of the patient is not compromised 
• Demonstrate the skills and behaviours required to negotiate long-term priorities and plans in partnership with patients, negotiating a mutually acceptable plan that respects autonomy and preference for involvement 
• Adopt counselling, motivational and behaviour change techniques when appropriate, prompting patients to reflect on the benefits of lifestyle change and supporting them to improve their health and self-care
• Develop the skills to involve carers, relatives, friends and other professionals in shared care planning when appropriate, negotiating how to do this while also preserving the patient’s rights to autonomy and privacy 
• Produce management plans that are appropriate to the patient's problems and personal circumstances 
• Recognise when patients may need, or choose, to delegate their decision-making autonomy to others, including when a mental capacity assessment may be required 
• Demonstrate the ability to test mental capacity for specific decisions, in accordance with the legislation 
• Regularly obtain, record and share relevant information about a patient's care, such as care plans, advance directives and 'do not resuscitate' decisions 

Communication and consultation skills 

This is about communication with patients, the use of recognised consultation techniques, establishing patient partnership, managing challenging consultations, third-party consultations and the use of interpreters.

Generic Professional Capabilities: Professional Skills

MRCGP assessments: CSA, WPBA (CbD, CAT, COT, MiniCEX, QIP, Leadership, PSQ, MSF, CSR)

Insufficient evidence - From the available evidence, the doctor’s performance cannot be placed on a higher point of this developmental scale 

Indicators of potential underperformance

End ST1 – Making progress at the expected rate 

End ST2 - Making progress at the expected rate 

End ST3 - Competent for licensing

End ST3 - Excellent 

Does not establish rapport with the patient

Makes inappropriate assumptions about the patient’s agenda

Misses / ignores significant cues

Does not give space and time to the patient when this is needed

Has a blinkered approach and is unable to adapt the consultation despite cues or new information

Is unable to consult within time scales that are appropriate to the stage of training

Uses stock phrases/ inappropriate medical jargon rather than tailoring the language to the patients needs and context

The approach is inappropriately doctor-centred

Develops a relationship with the patient, which works, but is focussed on the problem rather than the patient. 

Uses a rigid or formulaic approach to achieve the main tasks of the consultation. 

The use of language is technically correct but not well adapted to the needs and characteristics of the patient. 

Provides explanations that are medically correct but doctor-centred. 

Communicates management plans but without negotiating with, or involving, the patient. 

Consults to an acceptable standard but lacks focus and requires longer consulting times. 

Adopts a personalised approach to care

Understands the need for effective consulting and developing an awareness of the wide range of consultation models that might be used.

Communicates in a way that seeks to establish mutual understanding

Can describe and explain a clear and appropriate management plan to the patient

Understands the benefits of a constructive and flexible approach to consulting

Takes steps to address barriers to communication

Aware of when there is a language barrier and can access interpreters either in person or by telephone. 

Explores and responds to the patient’s agenda, health beliefs and preferences. 

Utilises the most appropriate mode of communication in the context of pandemic restrictions, shielding and social distancing – e.g. remote consulting via video or phone.

Elicits psychological and social information to place the patient’s problem in context. 

Achieves the tasks of the consultation, responding to the preferences of the patient in an efficient manner. 

The use of language is fluent and takes into consideration the needs and characteristics of the patient, for instance when talking to children or patients with learning disabilities. 

Uses the patient’s understanding to help improve the explanation offered. 

Works in partnership with the patient, negotiating a mutually acceptable plan that respects the patient’s agenda and preference for involvement. 

Consults in an organised and structured way, achieving the main tasks of the consultation in a timely manner. 

Manages consultations effectively with patients who have different languages, cultures, beliefs and educational backgrounds. 

Incorporates the patient’s perspective and context when negotiating the management plan. 

Appropriately uses advanced consultation skills, such as confrontation or catharsis, to achieve better patient outcomes. 

Employs a full range of fluent communication skills, both verbal and non-verbal, including active listening skills. 

Uses a variety of communication techniques and materials (e.g. written or electronic) to adapt explanations to the needs of the patient. 

Whenever possible, adopts plans that respect the patient’s autonomy. 

When there is a difference of opinion the patient’s autonomy is respected and a positive relationship is maintained. 

Consults effectively in a focussed manner moving beyond the essential to take a holistic view of the patient’s needs within the time-frame of a normal consultation. 

Uses a variety of communication and consultation techniques that demonstrates respect for, and values, diversity. 

Apply a structured approach to data gathering and investigation

Learning outcomes

• Selectively gather and interpret information from the patient's history, physical examination and investigations and use this to develop an appropriate management plan in collaboration with the patient, by:

• making appropriate use of existing information about the problem and the patient's context
• knowing the relevant questions to ask based on the patient's history and items of the physical examination that are relevant to the problem presented
• recognising and interpreting relevant information from a wide range of sources, including the patient narrative and context, information from carers and professionals, physical examination findings, records, clinical procedures, laboratory data and ancillary tests
• recognising when a particular examination or investigation will be beyond your ability (such as by reason of a personal physical disability) and ensuring that the patient has access to these interventions in a timely manner to enable the development of an appropriate management plan

• Tailor your approaches to the contexts in which you work, considering factors such as the accessibility of additional sources of information and the cost-effectiveness and predictive value of investigations
• Apply techniques that enable you to examine and investigate incrementally, monitoring and reviewing the patient as needed to preserve safety, allowing diagnostic information to be integrated over time. This may include making a conscious decision with the patient to not undertake further investigations, when this is clinically appropriate
• Enhance your clinical decision-making through effective and timely record-keeping, information sharing, data management and monitoring of care

Interpret findings accurately to reach a diagnosis

Learning outcomes

• Demonstrate proficiency in interpreting the patterns of symptoms, signs and other findings that, in a non-selected population, may signify potentially significant health conditions requiring further investigation or action
• Discuss how the predictive value of symptoms, signs and investigations varies according to the features of your local population and apply this knowledge to your decision-making
• Recognise 'red flags' and other indicators of high risk, responding promptly and effectively when these occur
• Demonstrate proficiency in identifying the self-limiting health conditions that commonly present in an unselected population
• Identify the mechanisms through which apparently simple health problems become chronic, complex and severe (known as 'yellow flags')

Data gathering and interpretation 

This is about the gathering, interpretation, and use of data for clinical judgement, including information gathered from the history, clinical records, examination and investigations

Generic Professional Capabilities: Professional Skills

MRCGP assessments: AKT, CSA, WPBA (CbD, CAT, COT, MiniCEX, QIP, CSR)

Insufficient evidence - From the available evidence, the doctor’s performance cannot be placed on a higher point of this developmental scale 

Indicators of potential underperformance

End ST1 – Making progress at the expected rate 

End ST2 - – Making progress at the expected rate 

End ST3 - Competent for licensing

End ST3 - Excellent 

Has an approach which is disorganised, chaotic, inflexible or inefficient

Does not use significant data as a prompt to gather further information

Does not look for red flags appropriately

Fails to identify normality

Examination technique is poor

Fails to identify significant physical or psychological signs

Accumulates information in a formulaic way covering more than is required for the patient problem

Is aware of information in the patients notes that may be relevant

Employs examinations and investigations but not specifically focused to the patient's problem

Identifies abnormal findings and results. 

Accumulates information from the patient that is mainly relevant to their problem. 

Uses existing information in the patient records. 

Employs examinations and investigations that are broadly in line with the patient’s problems. 

Has appropriate level of knowledge of clinical norms, measurements and investigations and is aware of how these relate to the patient's conditions

Demonstrates a limited range of data gathering styles and methods.

Systematically gathers information, using questions appropriately targeted to the problem without affecting patient safety. 

Understands the importance of, and makes appropriate use of, existing information about the problem and the patient’s context. 

Chooses examinations and targets investigations appropriately and efficiently. 

Understands the significance and implications of findings and results and takes appropriate action. 

Demonstrates different styles of data gathering and adapts these to a wide range of patients and situations

Expertly identifies the nature and scope of enquiry needed to investigate the problem, or multiple problems, within a short time-frame.   

Prioritises problems in a way that enhances patient satisfaction. 

Uses a stepwise approach, basing further enquiries, examinations and tests on what is already known and what is later discovered. 

Able to gather information in a wide range of circumstances and across all patient groups (including their family and representatives) in a sensitive, empathic and ethical manner

Demonstrate a proficient approach to clinical examination

Learning outcomes

• Demonstrate proficiency at performing the scope of examinations necessary to assess, diagnose and monitor the patient's condition within a general practice or home setting (or recognise when an examination may be required but is beyond your physical ability to perform, such as by reason of your own disability, ensuring that the patient has timely and appropriate access to alternative arrangements)
• Adopt a targeted and systematic approach to clinical examination, recognising normal and abnormal findings and tailoring further examinations accordingly
• Recognise that a different range of examinations may be perceived as intimate by each patient, depending on individual and cultural factors
• Demonstrate communication techniques that ensure that the patient understands the purpose of the examination, what will happen and the role of the chaperone
• Identify cultural and ethical issues relating to examinations (such as the removal of clothing) and discuss these sensitively with the patient as appropriate
• Provide an opportunity for the patient to give or decline consent, responding non- judgmentally if consent is declined
• Organise the place of examination to provide the patient with privacy and to respect his or her dignity, arranging for a suitable chaperone when one is requested
• Perform and accurately interpret focused examinations in challenging circumstances (for example, during home visits, in emergencies or when negotiating cultural issues)
• Perform clinical examinations and investigations that are in line with the patient’s problem, identifying abnormal findings and incorporating relevant results
• Explain the findings meaningfully and sensitively to the patient

Demonstrate a proficient approach to the performance of procedure

Learning outcomes

• Communicate the purpose, benefits and risks of a procedure in a meaningful way, giving evidence-based information, checking understanding and obtaining informed consent before proceeding
• Demonstrate the ability to perform a variety of procedures according to your training, working circumstances and physical capability and the patient's preferences
• Communicate throughout a procedure to put the patient at ease, monitor his or her condition, minimise discomfort and ensure that he or she is willing for you to continue
• Use equipment safely and effectively and in accordance with best practice guidelines
• Comply with medico-legal requirements, such as the recording of consent, mental capacity and the involvement of carers and next of kin when appropriate
• Follow infection control measures whenever applicable
• Demonstrate appropriate onward referral for a procedure when this falls outside your area of competence or physical capability
• Arrange aftercare and follow-up as appropriate
• Evaluate the outcomes of your procedures by maintaining a log and auditing the outcomes, discussing adverse incidents with your team and responding promptly to any safety issues

Clinical Examination and Procedural Skills 

This is about clinical examination and procedural skills. By the end of training, the trainee must have demonstrated competence in 5 mandatory skills and a range of other examination and skills relevant to General Practice.

Generic Professional Capabilities: Professional Skills

MRCGP assessments: CSA, WPBA (CEPS, COT, QIP, CSR)

Insufficient evidence - From the available evidence, the doctor’s performance cannot be placed on a higher point of this developmental scale 

Indicators of potential underperformance

End ST1 – Making progress at the expected rate 

End ST2 - Making progress at the expected rate 

End ST3 - Competent for licensing

End ST3 - Excellent 

Patient shows no understanding as to the purpose of the examination

Fails to examine when the history suggests conditions that might be confirmed or excluded by examination

Inappropriate over-examination

Fails to obtain informed consent for the procedure

Patient appears unnecessarily upset by the examination

Chooses examination with a clinically justifiable reason in line with the patient’s problem(s). 

Examination is carried out sensitively and without causing the patient harm

Elicits relevant clinical signs

Shows awareness of personal limitations and boundaries in clinical examination

Observes the professional codes of practice including the use of chaperones. 

Arranges the place of examination to give the patient privacy and respect their dignity

Demonstrates understanding of issues of consent

Undertakes examination when appropriate and demonstrates all the basic examination skills needed as a GP

Identifies abnormal signs 

Suggests appropriate procedures related to the patient’s problem(s). 

Performs procedures and examinations with the patient’s consent with a more focused approach.

Chooses examinations appropriately targeted to the patient’s problem(s). 

Has a systematic approach to clinical examination and able to interpret physical signs accurately? 

Varies procedures options according to circumstances and the preferences of the patient. 

Identifies and reflects on ethical issues with regard to examination and procedural skills. 

Recognises and acknowledges the patient’s concerns before and during the examination and puts them at ease

Shows awareness of the medico-legal background, informed consent, mental capacity and the best interests of the patient. 

Proficiently identifies and performs the scope of examination necessary to investigate the patient’s problem(s). 

Uses a step-wise approach to examination, basing further examinations on what is known already and is later discovered. 

Demonstrates a wide range of procedural skills to a high standard.

Engages with quality improvement initiatives with regard to examination and procedural skills. 

Recognises the verbal and non-verbal clues that the patient is not comfortable with an intrusion into their personal space, especially the prospect or conduct of intimate examinations

Is able to help the patient accept and feel safe during the examination

Helps to develop systems that reduce risk in clinical examination and procedural skills. 

Adopt appropriate decision-making principles

Learning outcomes

• Apply rules or plans and use decision aids (such as algorithms and risk calculators) where appropriate for straightforward clinical decisions
• Use an analytical approach to novel situations in which rules cannot be readily applied, developing your decision-making by forming and testing hypotheses
• Use an understanding of probability, based on the prevalence, incidence, natural history and time course of illness, to aid your decision-making
• Address problems that present early and in an undifferentiated way by integrating available information to make your best assessment of risk to the patient, recognising when to act and when to defer a decision if safe and appropriate to do so
• Recognise the inevitable uncertainty in general practice problem-solving, sharing uncertainty with the patient where appropriate
• Revise hypotheses in the light of new or additional information, incorporating advice from colleagues and experts as needed
• Develop skills in the rapid decision-making required for managing urgent, unfamiliar, unpredictable and other high-risk clinical situations

Apply a scientific and evidence-based approach

Learning outcomes

• Throughout your career, develop and maintain a sufficiently broad and detailed knowledge of the science relevant to your role. This includes (but is not limited to) elements of:
  • epidemiology and the determinants of health and ill health
  • pathology, natural history of disease and prognosis
  • therapeutics, pharmacology and non-drug therapies
  • evidence-based practice, research methodology, statistics and critical appraisal
  • health promotion, preventative healthcare and harm reduction
  • consultation and communication theory
  • adult educational and reflective learning theory
  • decision-making, reasoning and problem-solving theory
  • health economics, financing, commissioning and service design
  • leadership, management and quality improvement science
• Use the best available evidence in your decision-making, applying critical thinking to appraise the literature, recognising the strengths and limitations of evidence-based guidelines
• Apply knowledge of the epidemiology of disease to your decision-making, including the age/sex distribution, risk factors, prevalence, incidence and the relevant characteristics of 'at-risk' groups
• Integrate evidence-based and scientific approaches with patient-centred and shared care – planning approaches to inform judgements on when to initiate, review or discontinue therapeutic interventions
• Identify gaps in current evidence and contribute to recommendations for future research

Making a diagnosis / decisions 

This is about a conscious, structured approach to making diagnoses and decision-making.

Generic Professional Capabilities: Professional Skills

MRCGP assessments: AKT, CSA, WPBA (CbD, CAT, COT, MiniCEX, QIP, Leadership, Prescribing, CSR)

Insufficient evidence - From the available evidence, the doctor’s performance cannot be placed on a higher point of this developmental scale 

Indicators of potential underperformance

End ST1 – Making progress at the expected rate 

End ST2 - Making progress at the expected rate 

End ST3 - Competent for licensing

End ST3 - Excellent 

Is indecisive, illogical or incorrect in decision-making

Fails to consider serious possibilities

Is dogmatic / closed to other ideas

Too frequently has late or missed diagnoses

Demonstrates an appropriate level of clinical knowledge and skills for formulating a diagnosis giving a very broad range

Identifies possible alternative diagnoses but does not filter based on probability

Makes decisions by applying rules, plans or protocols. 

Aware of personal limitations in knowledge and experience

Generates an adequate differential diagnosis based on the information available. 

Generates and tests appropriate hypotheses. 

Justifies chosen options with evidence

Is starting to develop independent skills in decision-making and uses the support of others to confirm that these are correct. 

Makes diagnoses in a structured way using a problem-solving method. 

Uses an understanding of probability based on prevalence, incidence and natural history of illness to aid decision-making. 

Addresses problems that present early and/or in an undifferentiated way by integrating all the available information to help generate a differential diagnosis. 

Revises hypotheses in the light of additional information. 

Thinks flexibly around problems generating functional solutions. 

Has confidence in, and takes ownership of, own decisions whilst being aware of their own limitations. 

Keeps an open mind and is able to adjust and revise decisions in the light of relevant new information. 

Uses pattern recognition to identify diagnoses quickly, safely and reliably. 

Remains aware of the limitations of pattern recognition and when to revert to an analytical approach. 

No longer relies on rules or protocols but is able to use and justify discretionary judgement in situations of uncertainty or complexity, for example in patients with multiple problems. 

Continues to reflect appropriately on difficult decisions.  Develops mechanisms to be comfortable with these choices 

Provide a general clinical care to patients of all ages and backgrounds

Learning outcomes

• Develop the knowledge and skills required to provide general medical care in the community setting to patients of all backgrounds. This includes the appropriate provision of:
  • a primary point of contact for people of all ages with unselected health problems
  • care for people with self-limiting conditions and ailments
  • care for people with chronic illnesses and long-term conditions
  • urgent, unscheduled and emergency care
  • health promotion and preventative care
• Develop the knowledge and skills required to provide high-quality, holistic and comprehensive care to groups of patients who may have health and care needs that require you to adapt your clinical approach. Such groups include (but are not limited to):
  • infants, children and young people
  • people with mental health problems
  • acutely ill people
  • pregnant women, perinatal women and new parents
  • people with intellectual, physical or sensory disabilities
  • people with addictions
  • gay, lesbian and transgender people
  • migrants, refugees and asylum seekers
  • the elderly and those with multimorbidity
  • people nearing the end of life
  • people of different ethnicities and cultures
• Develop the knowledge and skills required to coordinate care for patients of all ages and backgrounds. This includes:
  • shared care planning
  • care of long-term conditions
  • treatment monitoring and surveillance
  • curative and survivorship care for people with cancer and other serious or life-changing illnesses
  • recovery and rehabilitation care
  • community-based palliative and end-of-life care

Adopt a structured approach to clinical management

Learning outcomes

• Develop and implement appropriate management plans for the full range of health conditions that you are likely to encounter in the community, by:
  • considering the likely causes, natural histories, trajectories and impacts of the patient's health problems
  • differentiating between self-limiting and other conditions, encouraging appropriate self-care and reducing inappropriate medicalisation
  • integrating non-drug approaches into treatment plans, such as psychological therapies, physical therapies and surgical interventions
  • offering appropriate evidence-based management options, varying these responsively according to the circumstances, priorities and preferences of those involved
  • monitoring the patient's progress to identify quickly unexpected deviations from the anticipated path
• Demonstrate safe and appropriate prescribing, repeat prescribing, medication review and medication management in the community context, by:
  • making safe and appropriate prescribing decisions
  • routinely using recognised sources of drug information, checking on interactions and side effects and following organisational guidance
  • prescribing cost-effectively and being able to justify your decision when you do not follow this principle
  • seeking advice on prescribing when appropriate
• Give appropriate 'safety-netting advice' on what features the patient should look out for to reduce risk, checking the patient's and carer's understanding of when to seek further medical help and how they should do this
• Implement adequate follow-up arrangements (for example, to facilitate the early diagnosis of evolving problems, assess response to treatment, provide safe monitoring and learn from the outcomes of interventions)
• Contribute to an organisational and professional approach that facilitates continuity of care (for example, through adequate record-keeping and building long-term patient relationships)

Make appropriate use of other professionals and services

As a GP, this means that you should

• Refer appropriately to other professionals and services, by:
  • considering alternatives to formal referral where appropriate (for example, email advice systems)
  • predicting sources of delay and taking steps to avoid these where appropriate (for example, by organising investigations in advance, so that the results are available to your colleagues)
  • writing referral letters that provide relevant information and explaining the reason for referral
  • using the appropriate referral system to avoid unnecessary delays for the patient
  • acting as an advocate for the patient and his or her carers as he or she navigates the health and care system
  • providing ongoing continuity of care for the patient while they wait for their specialist appointment, reviewing progress at suitable intervals
• Organise the follow-up of your patients after referral through multiprofessional, team-based and structured approaches, including monitoring, reviewing and regular care planning

Provide urgent care when needed

Learning outcomes

• Recognise that responding to unscheduled requests for urgent care is a core part of a GP's role as a front-line practitioner
• Respond rapidly, skilfully and safely to emergencies
• Ensure that emergency care is coordinated with other members of the practice team and emergency services, giving due regard to the safety of yourself, other patients and staff
• Develop and maintain skills in basic life support and the use of an automated defibrillator, plus any other emergency procedures specifically required in your working environment
• Follow up patients who have experienced a medical emergency or serious illness appropriately, also considering the needs of their carers and family

Clinical management 

This is about the recognition and management of patients’ problems.

Generic Professional Capabilities: Professional Knowledge; Professional Skills

MRCGP assessments: AKT, CSA, WPBA (CbD, CAT, COT, MiniCEX, QIP, Leadership, CSR)

Insufficient evidence - From the available evidence, the doctor’s performance cannot be placed on a higher point of this developmental scale 

Indicators of potential underperformance

End ST1 – Making progress at the expected rate 

End ST2 - Making progress at the expected rate 

End ST3 - Competent for licensing

End ST3 - Excellent 

Asks for help inappropriately: either too much or too little

Does not think ahead, safety-net appropriately or follow through adequately

Uses appropriate but limited management options without taking into account the preferences of the patient. 

Suggests appropriate interventions, although with a tendency to over investigate.

Arranges definite appointments for follow up for patients but likely to routinely follow up rather than basing on patient need

Demonstrates an appropriate level of safe prescribing

Refers safely, acting within the limits of their competence but may over refer.

Recognises and responds safely to medical emergencies and acutely unwell patients

Demonstrates use of safe management plans

Understands good practice in the use of referral

Demonstrate readiness to work in an urgent care environment.

Recognises that acute management is only part of the wider care of individual patients

Ensures that continuity of care can be provided for the patient’s problem, e.g. through adequate record keeping.

Makes safe prescribing decisions, routinely checking on drug interactions and side effects. 

Varies management options responsively according to the circumstances, priorities and preferences of those involved. 

Considers a “wait and see” approach where appropriate.   

Uses effective prioritisation of problems when the patient presents with multiple issues. 

Suggests a variety of follow-up arrangements that are safe and appropriate, whilst also enhancing patient autonomy. 

In addition to prescribing safely is aware of and applies local and national guidelines including drug and non-drug therapies. 

Maintains awareness of the legal framework for appropriate prescribing. 

Refers appropriately, taking into account all available resources. 

Responds rapidly and skilfully to emergencies, with appropriate follow-up for the patient and their family.  Ensures that care is coordinated both within the practice team and with other services. 

Provides comprehensive continuity of care, taking into account all of the patient’s problems and their social situation. 

Provides patient-centred management plans whilst taking account of local and national guidelines in a timely manner. 

Empowers the patient with confidence to manage problems independently together with knowledge of when to seek further help. 

Able to challenge unrealistic patient expectations and consulting patterns with regard to follow up of current and future problems. 

Regularly reviews all of the patient’s medication in terms of evidence-based prescribing, cost-effectiveness and patient understanding.  

Has confidence in stopping or stepping down medication where this is appropriate. 

Identifies areas for improvement in referral processes and pathways and contributes to quality improvement. 

Contributes to reflection on emergencies as significant events and how these can be used to improve patient care in the future. 

Takes active steps within the organisation to improve continuity of care for the patients. 

Enable people living with long-term conditions to improve their health

Learning outcomes

• Maintain a positive attitude to improving the health of patients living with chronic conditions
• Contribute to strategies to maintain and improve the well-being of patients with long-term conditions, including:
  • encouraging and actively facilitating health promotion
  • supporting them in taking steps to increase their health resilience
  • reducing their treatment burden
  • supporting survivorship, that is, the ability to live with (or following) a serious condition
  • identifying relapse
  • managing their long-term decline
• Identify the impact of a patient's environment on his or her health, including home circumstances, education, occupation, employment and social and family situation. Offer support to the patient in addressing these factors
• Recognise the harm to a patient's health and the costs to the health service that arise when care is inappropriate, fragmented or uncoordinated

Manage concurrent health problems in an individual patient       

Learning outcomes

• Recognise how health conditions commonly coexist and interact
• Demonstrate a problem-based approach to identify, clarify and prioritise the issues to be addressed during an interaction with a patient with multiple problems
• Demonstrate a logical and structured approach to the review of patients with multiple problems, especially the elderly, appreciating that multiple problems are often interconnected
• Demonstrate an ability to prioritise investigations and treatments in partnership with the patient and his or her carers
• Demonstrate responsibility for leading and coordinating the management planning for all of the patient's current health problems
• Recognise the additional impact of multimorbidity on the therapeutic options available to the patient and make allowances for this
• Implement measures to reduce the overall treatment burden and to use resources cost-effectively, considering human resources and economic and environmental impacts
• Demonstrate the ability to effectively 'navigate' patients with multiple problems along and between care pathways, enabling them to access appropriate team members and services in a timely and cost-effective manner

Adopt safe and effective approaches for patients with complex health needs

Learning outcomes

• Recognise that patients often present with problems that cannot be readily labelled or clearly categorised. Evaluate how this uncertainty influences the diagnostic and therapeutic options available to patients
• Recognise the risk of diagnostic overshadowing and clinical stereotyping when dealing with patients who have been labelled with complex diagnoses (for example, learning disability)
• Recognise the limitations and challenges of applying existing clinical evidence to the care of patients with multimorbidity and complex needs
• Recognise the limitations of protocol-driven ways of decision-making when managing patients with complex problems and discuss ways of dealing with these situations with colleagues
• Manage the inevitable uncertainty in complex problem-solving through an enhanced use of risk assessment, surveillance, communication and 'safety-netting techniques'
• Communicate risk in an effective manner to patients with complex conditions and involve them in its management, assisting them to tolerate diagnostic uncertainty when appropriate and to refocus on improving their health and well-being
• Recognise the importance of reflecting on your interactions with complex patients and on the outcomes of their care, in order to integrate this knowledge with your previous experience and improve your capability to provide effective care

Managing medical complexity 

This is about aspects of care beyond the acute problem, including the management of co-morbidity, uncertainty, risk and health promotion.

Generic Professional Capabilities: Professional Skills

MRCGP assessments: CSA, WPBA (CbD, CAT, COT, MiniCEX, PSQ, QIP, Leadership, CSR)

Insufficient evidence - From the available evidence, the doctor’s performance cannot be placed on a higher point of this developmental scale 

Indicators of potential underperformance

End ST1 – Making progress at the expected rate 

End ST2 - Making progress at the expected rate 

End ST3 - Competent for licensing

End ST3 - Excellent 

Inappropriately burdens the patient with uncertainty

Finds it difficult to suggest ways forward in unfamiliar circumstances

Often gives up in complex or uncertain situations

Is easily discouraged or frustrated, for example by slow progress or lack of patient engagement

Although identifies and recognises multi-morbidity, tends to manage health

problems separately, without necessarily considering the implications of co-existing conditions

Identifies potential clinical risk

Demonstrates awareness of evidence-based guidelines

Includes lifestyle information in assessing healthcare needs of patients

Demonstrates awareness and readiness to engage in providing undifferentiated care.

Identifies and tolerates uncertainties in the consultation.

Attempts to prioritise management options based on an assessment of patient risk. 

Manages patients with multiple problems with reference to appropriate guidelines for the individual conditions. 

Considers the impact of the patient's lifestyle on their health. 

Simultaneously manages the patient’s health problems, both acute and chronic.

Is able to manage uncertainty including that experienced by the patient. 

Communicates risk effectively to patients and involves them in its management to the appropriate degree. 

Recognises the inevitable conflicts that arise when managing patients with multiple problems and takes steps to adjust care appropriately. 

Consistently encourages improvement and rehabilitation and, where appropriate, recovery. 

Encourages the patient to participate in appropriate health promotion and disease prevention strategies. 

Accepts responsibility for coordinating the management of the patient’s acute and chronic problems over time. 

Anticipates and employs a variety of strategies for managing uncertainty.

Uses the patient’s perception of risk to enhance the management plan. 

Comfortable moving beyond single condition guidelines and protocols in situations of multi-morbidity and polypharmacy, whilst maintaining the patient’s trust 

Coordinates a team-based approach to health promotion in its widest sense. 

Maintains a positive attitude to the patient’s health even when the situation is very challenging. 

Work as an effective team member

Learning outcomes

• Meet your contractual obligations to be available for patient care, anticipating situations that might interfere with your availability and ensuring that patient care is not compromised
• Comply with the protocols, policies and guidelines agreed within your organisation
• Seek advice from colleagues when encountering problems in following agreed protocols and policies for personal or professional reasons
• Use acquired clinical skills such as active listening, problem-solving and principled negotiation to improve communication with colleagues
• Enhance working relationships by demonstrating understanding, giving effective feedback and maintaining trust
• Routinely prioritise, reprioritise and manage personal workload in an effective and efficient manner, delegating appropriately to other team members
• Provide support to colleagues who are overburdened

Coordinate a team-based approach to the care of patients

Learning outcomes

• Demonstrate the capability to lead and coordinate care at a team level and, when appropriate, at a service level. This includes, but is not limited to, team-based approaches to:
  • supporting patients to self-care
  • harm reduction for those with substance misuse and other risky behaviours
  • shared care planning with patients and carers
  • monitoring and surveillance of long-term conditions
  • recovery and rehabilitation after serious illness or injury
  • palliation and end-of-life care
• Contribute to a team culture that encourages contributions and values cooperation and inclusiveness and which commits to continuing improvement and preserving a patient- centred focus
• Appropriately seek advice from other professionals and team members according to their roles and expertise
• Anticipate and manage the problems that arise during transitions in care, especially at the interfaces between different healthcare professionals, services and organisations. Demonstrate the ability to work across these boundaries (for example, by actively sharing information and participating in processes for multi-agency review)
• Support the transition of responsibility for patient care between professionals and teams through structured planning, coordination and appropriate communication channels
• Use the medical record and other communication systems to facilitate the transfer of information and care between patients, carers and multidisciplinary teams

Working with colleagues and in teams 

This is about working effectively with other professionals to ensure good patient care and includes the sharing of information with colleagues.

Generic Professional Capabilities: Leadership

MRCGP assessments: WPBA (CbD, CAT, COT, MiniCEX, Leadership, MSF, CSR)

Insufficient evidence - From the available evidence, the doctor’s performance cannot be placed on a higher point of this developmental scale 

Indicators of potential underperformance

End ST1 – Making progress at the expected rate 

End ST2 - Making progress at the expected rate 

End ST3 - Competent for licensing

End ST3 - Excellent 

Works in inappropriate isolation ( beyond requirements of shielding and social distancing)

Gives little support to team members

Doesn’t appreciate the value of the team

Inappropriately leaves their work for others to pick up

Feedback (formal or informal) from colleagues raises concerns

Shows basic awareness of working within a team rather than in isolation.

Respects other team members and their contribution but has yet to grasp the advantages of harnessing the potential within the team. 

Is accessible and engages with other members of the team

Recognises individual roles, skills and responsibilities as part of a greater whole, in primary as well as secondary care

Responds to the communications from other team members in a timely and constructive manner. 

Understands the importance of integrating themselves into the various teams in which they participate. 

Is an effective team member, working flexibly with the various teams involved in day to day primary care. 

Understands the context within which different team members are working, e.g. Health Visitors and their role in safeguarding. 

Appreciates the increased efficacy in delivering patient care when teams work collaboratively rather than as individuals.  

Communicates proactively with team members so that patient care is enhanced using an appropriate mode of communication for the circumstances. 

Contributes positively to their various teams and reflects on how the teams work and members interact. 

Helps to coordinate a team-based approach to enhance patient care, with a positive and creative approach to team development. 

Shows awareness of the strengths and weaknesses of each team member and considers how this can be used to improve the effectiveness of a team. 

Encourages the contribution of others employing a range of skills including active listening.   Assertive but doesn’t insist on own views. 

Shows some understanding of how group dynamics work and the theoretical work underpinning this. Has demonstrated this in a practical way, for example in chairing a meeting. 

Adopt a safe and scientific approach to improve quality of care

Learning outcomes

• Use equipment safely and comply with safety protocols and directions
• Follow infection control protocols and demonstrate hand-washing and aseptic techniques
• Identify the potential for spread of infection and take measures to reduce this risk
• Assist with infection control in the local community by communicating effectively with the practice population and liaising with regional and national bodies where appropriate
• Contribute to the assessment of risk across the system of care, involving the whole team in patient safety improvements
• Measure and monitor the outcomes of care and apply quality assurance processes to ensure the safety and effectiveness of the services you provide
• Promote safety behaviours to colleagues and demonstrate awareness of human factors in maintaining safety and reducing risk
• Regularly access the available evidence, including the medical literature, clinical performance standards and guidelines for patient care
• Contribute to organised systems of quality improvement, including completing QIPs based on identified local needs, measuring outcomes, implementing and evaluating changes and sharing your learning
• Understand that taking part in quality improvement work is a learning process and be able to reflect on the quality improvement process and demonstrate learning
• Use professional judgement to decide when to initiate and develop new protocols and when to challenge or modify their use

Maintaining performance, learning and teaching 

This is about maintaining the performance and effective continuing professional development (CPD) of oneself and others. The evidence for these activities should be shared in a timely manner within the appropriate electronic Portfolio.

Generic Professional Capabilities: Education

MRCGP assessments:WPBA (CbD, CAT, PSQ, MSF, leadership, CSR)

Insufficient evidence - From the available evidence, the doctor’s performance cannot be placed on a higher point of this developmental scale 

Indicators of potential underperformance

End ST1 – Making progress at the expected rate 

End ST2 - Making progress at the expected rate 

End ST3 - Competent for licensing

End ST3 - Excellent 

Fails to engage with the portfolio e.g. entries are scant, reflection is poor, plans are made but not acted upon or the PDP is not used effectively

Reacts with resistance to feedback that is perceived as critical

Fails to make adequate educational progress

Demonstrates critical thinking

Demonstrates clinical curiosity and reflective practice

Engages in some study reacting to immediate clinical learning needs.  

Provides evidence of integrating learning into professional practice

Participates in wider learning activities

Knows how to access the available evidence, including the medical literature, clinical performance standards and guidelines for patient care.  

Changes behaviour appropriately in response to the clinical governance activities of the practice, in particular to the agreed outcomes of the practice’s audits, quality improvement activities and learning event analyses.  

Recognises situations, e.g. through risk assessment, where patient safety could be compromised.  

Contributes to the education of others

Judges the weight of evidence, using critical appraisal skills and an understanding of basic statistical terms, to inform decision-making. 

Shows a commitment to professional development through reflection on performance and the identification of personal learning needs.  

Addresses learning needs and demonstrates the application of these in future practice. 

Personally participates in audits and quality improvement activities and uses these to evaluate and suggest improvements in personal and practice performance.  

Engages in learning event reviews, in a timely and effective manner, and learns from them as a team-based exercise.  

Identifies learning objectives and uses teaching methods appropriate to these

Assists in making assessments of learners where appropriate

Uses professional judgement to decide when to initiate and develop protocols and when to challenge their use. 

Moves beyond the use of existing evidence toward initiating and collaborating in research that addresses unanswered questions. 

Systematically evaluates performance against external standards. 

Demonstrates how elements of personal development impact upon career planning and the needs of the organisation.  

Encourages and facilitates participation and application of clinical governance activities, by involving the practice, the wider primary care team and other organisations. 

Evaluates learning outcomes of teaching, seeking feedback on performance and reflects on this

Actively facilitates the development of others

Ensures that students and junior colleagues are appropriately supervised

Apply leadership skills to help improve your organisation's performance

Learning outcomes

• Recognise that leadership and management are core responsibilities of every doctor
• Recognise the importance of distributed leadership within health organisations, which places responsibility on every team member and values the contribution of the whole team
• Acknowledge the importance to patients of having an identified and trusted professional responsible for their care and advocate this by acting as the lead professional when required
• Recognise your responsibilities as a leader when safeguarding children, young people and vulnerable adults, by modelling professional behavior and using appropriate systems for sharing information, recording and raising concerns, obtaining advice and taking action
• Demonstrate best practice when recording, reporting and sharing safety incidents (including 'near misses'), including communicating openly with those affected and ensuring that the lessons learned are implemented
• Analyse relevant patient feedback and health outcome data to identify unmet health needs, identify inappropriate variation in health outcomes and highlight opportunities to reduce health inequalities
• Contribute your experience to the evaluation, redesign and (where relevant) commissioning of care pathways, to achieve a more integrated, effective and sustainable health system

Develop the financial and business skills required for your role

Learning outcomes

• Comply with financial, legal and regulatory systems that monitor and govern NHS health organisations locally and nationally
• Comply with your personal financial obligations by keeping timely and accurate financial records and submitting documentation when required for yourself and your organisation (for example, for tax, pension, employment and insurance purposes)
• Apply your written and verbal communication skills to build good working relationships with staff, colleagues, business partners, patients and clients in the practice setting
• Interpret key financial documents relating to the management of general practice, such as annual accounts, budgets and balance sheets

Make effective use of information management and communication systems

Learning outcomes

• Use records and information systems effectively for the full range of activities required in your role, including (but not limited to):
  • obtaining clinical and biographical information about patients
  • recording patient findings and management plans
  • ordering investigations and interpreting results
  • prescribing, monitoring and reviewing medicines
  • referring patients or seeking advice
  • managing administrative work
  • communicating with patients and colleagues
  • monitoring and managing safety risks
  • searching for evidence and guidance
  • recording learning activities and PDPs

• Develop techniques that enable you to use electronic patient records and other online information systems during a consultation to enhance communication with the patient
• Routinely record and appropriately code each clinical contact in a timely manner and follow the record-keeping and data governance requirements of your organisation
• Produce records that are sufficiently coherent, comprehensive and comprehensible, appropriately and securely sharing these with others who need legitimate access to them
• Contribute to improvements in the quality of the medical record (for example, through development of templates)
• Make effective use of the tools and systems that enable evaluation and improvement of your personal performance (for example, through use of reflective portfolios, patient satisfaction surveys, MSF, learning event analysis and other quality improvement tools)
• Adopt the appropriate use of new communication technologies, such as social media and online access to information, to improve the accessibility and quality of services and to enhance health literacy amongst the public

Organisation, management and leadership 

This is about understanding how primary care is organised within the NHS, how teams are managed and the development of clinical leadership skills.

Generic Professional Capabilities: Leadership

MRCGP assessments: AKT, CSA, WPBA (CbD, CAT, COT, MiniCEX, QIP, Leadership, MSF, Prescribing, PSQ, CSR)

Insufficient evidence - From the available evidence, the doctor’s performance cannot be placed on a higher point of this developmental scale 

Indicators of potential underperformance

End ST1 – Making progress at the expected rate 

End ST2 - Making progress at the expected rate 

End ST3 - Competent for licensing

End ST3 - Excellent 

Consults with the computer rather than the patient

Records show poor entries e.g. too short, too long, unfocused, failing to code properly or respond to prompts

Demonstrates proficiency in using clinical recording and IT systems

Uses the patient record and online information during patient contacts, routinely recording each clinical contact in a timely manner following the record-keeping standards of the organisation. 

Recognises the need for personal organisational skills

Demonstrates awareness of organisational changes

Fulfils workforce responsibilities

Understands the structure of the UK healthcare system

Demonstrates a basic understanding of the organisation of primary care and the use of clinical computer systems. 

Personal organisational and time-management skills are sufficient that patients and colleagues are not unreasonably inconvenienced or come to any harm. 

Responds positively to change in the organisation. 

Manages own workload responsibly. 

Uses the primary care organisational systems routinely and appropriately in patient care for acute problems, chronic disease and health promotion.  This includes the use of computerised information management and technology (IM&T). 

Uses the computer during consultations whilst maintaining rapport with the patient to produce records that are succinct, comprehensive, appropriately coded and understandable. 

Is consistently well organised with due consideration for colleagues as well as patients.  Demonstrates effective time management, hand-over skills, prioritisation, delegation. 

Helps to support change in the organisation.  This may include making constructive suggestions. 

Responds positively when services are under pressure in a responsible and considered way. 

Uses and modifies organisational and IM&T systems to facilitate: Clinical care to individuals and communities, 

Clinical governance and practice administration 

Uses IM&T systems to improve patient care in the consultation, in supportive care planning and communication across all the health care professionals involved with the patient. 

Manages own work effectively whilst maintaining awareness of other people’s workload.  Offers help sensitively but recognises own limitations. 

Actively facilitates change in the organisation.  This will include the evaluation of the effectiveness of any changes implemented. 

Willing to take a lead role in helping the organisation to respond to exceptional demand. 

Demonstrate the holistic mindset of a generalist medical practitioner

Learning outcomes

• Appreciate the value of health in its broadest sense as being more than the absence of disease but also a resource that enables a person to adapt successfully to the challenges of living
• Enquire routinely into physical, psychological and social aspects of the patient’s problem, integrating this information to form a holistic view
• Interpret each patient's personal story in his or her unique context, considering the effects of additional factors that are known to influence an individual's health needs, including:
  • educational and occupational factors
  • environmental and cultural factors
  • spiritual and other existential factors

• Develop the ability to switch from diagnostic and curative approaches to supportive and palliative approaches, as appropriate for the patient's needs
• Integrate a diverse range of evidence-based approaches into treatment plans, according to patient preferences and circumstances, incorporating both conventional and complementary approaches where appropriate
• Make yourself available to your patients as an appropriate means of support, while maintaining professional boundaries and encouraging self-care

Support people through individual experiences of health, illness and recovery

Learning outcomes

• Recognise that every person has a unique set of values and experiences of health and illness that may affect his or her use of the healthcare system and incorporate this perspective into your decisions
• Acknowledge the impact of the problem on the patient, such as how it affects his or her daily functioning, education, occupation and relationships
• Additionally, recognise the impact of the problem on the patient's family and carers, social context and community
• Anticipate the health issues that commonly arise during the expected transitions of life (including childhood development, adolescence, adulthood, ageing and dying)
• Evaluate a patient's fitness to attend education or work and identify the barriers that prevent a return after prolonged absence from these activities
• Provide individually tailored, evidence-based advice and support to enable each patient to optimise his or her lifestyle and well-being
• Demonstrate the skills and assertiveness to challenge unhelpful health beliefs or behaviours while maintaining a continuing and productive relationship
• Identify the people, including the young and elderly, who play an important caring role for others, involving them in management decisions and offering them additional support

Safeguard individuals, families and local populations

Learning outcomes

• Recognise how safeguarding concerns may present in general practice across a range of scales, from individuals (for example, cases of domestic violence or child abuse) to families, identified populations (for example, local schools or care homes) and communities (for example, affected by human trafficking or child sexual exploitation)
• Anticipate the safeguarding issues that commonly arise during different stages of life and the settings or contexts that may increase an individual's vulnerability or risk of harm
• Respond safely, promptly and effectively to the full range of safeguarding needs and risks that you are likely to encounter in practice
• Use appropriate systems for identifying and sharing information, recording and raising concerns, obtaining advice and taking action
• Report concerns to appropriate professionals and authorities and actively participate in discussions, plans and actions to investigate and mitigate identified risks
• Comply with your professional and legal responsibilities in relation to safeguarding, including the reporting of harmful and illegal activities and procedures (for example, female genital mutilation, radicalisation, modern slavery)
• Acknowledge and manage the diverse impacts of safeguarding issues on the individuals affected, including their functioning, education, health, occupation and relationships
• Recognise and respond appropriately to the wider impacts of safeguarding issues on the family, carers and the local community, as well as on the professionals involved
• Demonstrate (as applicable to your role and working environment) the level 3 competences set out in Safeguarding Children and Young People: Roles and Competences for Health Care Staff ²¹

Practising holistically, promoting health and safeguarding

This is about the ability of the doctor to operate in physical, psychological, socio-economic and cultural dimensions. The doctor is able to take into account patient’s feelings and opinions. The doctor encourages health improvement, self-management, preventative medicine and shared care planning with patients and their carers.

Generic Professional Capabilities: Health Promotion; Safeguarding

MRCGP assessments: CSA, WPBA (CbD, CAT, COT, QIP, PSQ, CSR

Insufficient evidence - From the available evidence, the doctor’s performance cannot be placed on a higher point of this developmental scale 

Indicators of potential underperformance

End ST1 – Making progress at the expected rate 

End ST2 - Making progress at the expected rate 

End ST3 - Competent for licensing

End ST3 - Excellent 

Treats the disease, not the patient

Recognises that health is more than the absence of disease

Considers options beyond a biophysical model

Demonstrates awareness of the potential in ‘making every contact count’.

Enquires into physical, psychological and social aspects of the patient’s problem. 

Recognises the impact of the problem on the patient’s life.

Offers treatment and support for the physical, psychological and social aspects of the patient’s problem. 

Recognises the role of the GP in health promotion

Demonstrates understanding of the patient in relation to their socio-economic and cultural background.  The doctor uses this understanding to inform discussion and to generate practical suggestions for the management of the patient. 

Recognises the impact of the problem on the patient, their family and/or carers. 

Utilises appropriate support agencies (including primary health care team members) targeted to the needs of the patient and/or their family and carers. 

Demonstrated the skills and assertiveness to challenge unhelpful health beliefs or behaviours, while maintaining a continuing and productive relationship

Accesses information about the patient’s psycho-social history in a fluent and non-judgemental manner that puts the patient at ease. 

Recognises and shows understanding of the limits of the doctor’s ability to intervene in the holistic care of the patient. 

Facilitates appropriate long-term support for patients, their families and carers that is realistic and avoids doctor dependence. 

Makes effective use of tolls in health promotion, such as decision aids, to improve health understanding.

Understand the health service and your role within it

Learning outcomes

• Describe the current structure of your local healthcare system, including the various roles, responsibilities and organisations within it, applying this understanding to improve the quality and safety of the care you provide
• Identify how local services can be accessed and use this understanding to inform your referral practices
• Demonstrate an understanding of the financial restrictions within which healthcare operates and identify how the limitations of local healthcare resources might impact on patient care
• Optimise your use of limited resources (for example, through cost-effective prescribing)h healthcare operates and identify how the limitations of local healthcare resources might impact on patient care
• Demonstrate approaches that balance the needs of individual patients with the health needs of the local community, within available resources
• Recognise how the roles and influence of the GP span across the healthcare system, including (but not limited to):
  • first-contact clinician
  • personal doctor and family practitioner
  • coordinator of complex and long-term care
  • patient advocate
  • service navigator and gatekeeper
  • clinical leader, commissioner and quality improver
  • employer, employee, contractor, manager and business leader
  • educator, supervisor, appraiser, researcher and mentor
• Identify the opportunities that this expanded role provides for reducing inequalities and improving local, national and global healthcare

Build relationships with the communities with which you work

Learning outcomes

• Recognise that groups or communities of patients may share and value certain characteristics and have common health needs and use this understanding to enhance your care, while continuing to acknowledge that people are individuals
• Analyse and identify the health characteristics of the populations with which you work, including the cultural, occupational, epidemiological, environmental, economic and social factors and the relevant characteristics of 'at-risk' groups
• Explore the interactions of these characteristics and impacts on the health needs and expectations of your community and its use of the services you provide
• Contribute your insights to the development of new services in your organisation or locality
• Acknowledge your professional duty to help tackle health inequalities and resource issues
• Manage the conflicts of interest created by the differing needs of individuals, the requirements of the wider population and the resources available in the community and adopt approaches to manage these tensions in your work
• Recognise that individuals, families and communities form a continuum, with each affecting the other, requiring a system-wide understanding of health and social care

Community orientation 

This is about the management of the health and social care of the practice population and local community.

Generic Professional Capabilities: Professional Knowledge; Health Promotion; Safeguarding

MRCGP assessments: WPBA (CbD, CAT, PSQ, QIP, MSF, CSR)

Insufficient evidence - From the available evidence, the doctor’s performance cannot be placed on a higher point of this developmental scale 

Indicators of potential underperformance

End ST1 – Making progress at the expected rate 

End ST2 - Making progress at the expected rate 

End ST3 - Competent for licensing

End ST3 - Excellent 

Fails to take responsibility for using resources in line with local and national guidance

Demonstrates readiness to understand and engage with the needs of the local population

Has knowledge of local services and care pathways

Adapts their clinical practice to the context of their locality

Demonstrates understanding of important characteristics of the local population, e.g. patient demography, ethnic minorities, socio-economic differences and disease prevalence, etc. 

Understands that local resources may be limited in the  community, e.g. the availability of certain drugs, counselling, physiotherapy or child support services. 

Takes steps to understand local resources in the community – e.g. school nurses, pharmacists, funeral directors, district nurses, local hospices, care homes, social services including child protection, patient participation groups, etc. 

Demonstrates understanding of how the characteristics of the local population shapes the provision of care in the setting in which the doctor is working. 

Shows how this understanding has informed referral practices they have utilised for their patients.  This could include formal referral to a service or directing patients to other local resources. 

Demonstrates how they have adapted their own clinical practice to take into account the local resources, for example in referrals, cost-effective prescribing and following local protocols. 

Demonstrates how local resources have been used to enhance patient care. 

Takes an active part in helping to develop services in their workplace or locality that are relevant to the local population.  

Understands the local processes that are used to shape service delivery and how they can influence them, e.g. through Health Boards and CCGs. 

Reflects on the requirement to balance the needs of individual patients, the health needs of the local community and the available resources.  Takes into account local and national protocols, e.g. SIGN or NICE guidelines. 

Develops and improves local services including collaborating with private and voluntary sectors, e.g. taking part in patient participation groups, improving the communication between practices and care homes, etc. 

Fitness to practise

• Demonstrating the attitudes and behaviours expected of a good doctor
• Managing the factors that influence your performance

Maintaining an ethical approach

• Treating others fairly and with respect, acting without discrimination
• Providing care with compassion and kindness

Communication and consultation

• Establishing an effective partnership with patients
• Maintaining a continuing relationship with patients, carers and families

Data gathering and interpretation

• Applying a structured approach to data gathering and investigation
• Interpreting findings accurately to reach a diagnosis

Clinical examination and procedural skills

• Demonstrating a proficient approach to clinical examination
• Demonstrating a proficient approach to the performance of procedures

Managing medical complexity

• Enabling people living with long-term conditions to improve their health
• Managing concurrent health problems within an individual patient
• Adopting safe and effective approaches for patients with complex needs

Clinical management

• Providing general clinical care to patients of all ages and backgrounds
• Adopting a structured approach to clinical management
• Making appropriate use of other professionals and services
• Providing urgent care when needed

Community orientation

• Understanding the health service and your role within it
• Building relationships with the communities in which you work

Practising holistically, safeguarding and promoting health

• Demonstrating the holistic mindset of a generalist medical practitioner
• Supporting people through experiences of health, illness and recovery
• Safeguarding individuals, families and local populations

Organisational management and leadership

• Applying leadership skills to improve your organisation's performance
• Making effective use of information and communication systems
• Developing the financial and business skills required for your role

Working with colleagues and in teams

• Working as an effective team member
• Coordinating a team-based approach to the care of patients

Making decisions

• Adopting appropriate decision-making principles
• Applying a scientific and evidence-based approach

Improving performance, learning and teaching

• Continuously evaluating and improving the care you provide
• Adopting a safe and scientific approach to improve quality of care
• Supporting the education and development of colleagues

• Establish
  an effective partnership with patients
• Maintain
  a continuing relationship with patients, carers and families

• Treat others fairly and with respect, acting without discrimination
• Provide care with compassion and kindness

• Provide general clinical care to patients of all ages and backgrounds
• Apply a structured approach to data gathering and investigation
• Demonstrate a proficient
  approach to clinical examination
• Demonstrate a proficient approach to the performance of procedures

• Interpret findings accurately to reach a diagnosis
• Adopt a structured approach to clinical management
• Provide urgent care when needed

• Adopt appropriate decision-making principles
• Apply a scientific and evidence-based approach

• Work as an effective team member
• Coordinate
  a team-based approach to the care of patients

• Continuously evaluate and improve the care you provide
• Adopt a safe and scientific approach to improve quality of care

• Support the education and development of colleagues
• Make effective use of information and communication systems

• Support people through experiences of health, illness and recovery
• Safeguarding individuals, families and local populations