How to develop and maintain an extended role in lifestyle medicine

Basic qualifications

• Primary medical qualification from UK or overseas
• MRCGP or equivalent route to UK general practice (e.g., Certificate of Eligibility for GP Registration)
• Full GMC registration with licence to practise on NHS performers list
• A qualification in Lifestyle Medicine; options could include multiple courses which cover the full discipline of lifestyle medicine principles and pillars.

Other qualifications in lifestyle medicine

Containing all 6 pillars:

• The British Society of Lifestyle Medicine Core Accreditation
• International Board of Lifestyle Medicine
• Prescribing Lifestyle Medicine
• Red Whale Lifestyle Medicine

Other qualifications in lifestyle medicine do not contain all 6 pillars, but can be combined to cover the full discipline:

• BSLM courses, e.g. the gut microbiome for clinicians course, low carb course, mediterranean diet course, managing chronic pain course
• Personalised Care Institute free and accredited courses, e.g. health coaching and shared decision-making
• Behaviour change training, e.g. e-learning for health “All Our Health” courses
• Nutrition qualifications, e.g.:
  • MSc Nutritional Medicine from University of Surrey
  • NNEdPro, Global Institute for Food, Nutrition and Health
  • Culinary Medicine UK
  • Nutrition Training for Medical Doctors, Association for Nutrition
  • Plant-based Nutrition, University of Winchester
  • Improving Mental Health Through Diet, FutureLearn
  • Respiratory qualifications, e.g.: High quality and low carbon respiratory care, RCGP
• Sleep medicine qualifications, e.g. PgDip in Sleep Medicine, University of Oxford
• Weight management qualifications, e.g. SCOPE from World Obesity, Postgraduate Diploma in Obesity and Weight Management (online delivery) from the University of South Wales
• Deprescribing/polypharmacy training, RCGP
• Multimorbidity and overprescribing, RCGP: Overprescribing on RCGP eLearning; Multimorbidity on RCGP eLearning

Lifestyle medicine is intricately associated with sustainability and planetary health. GPwERLMs should encourage the adoption of practices which reinforce good human and planet health. Examples may include the encouragement of physical activity during daily commutes and the adoption of healthy balanced and locally sourced diets.  Leading by example through the adoptions of these practices in their own lives. 

GPwERLM may be able to encourage more sustainable practice amongst themselves and their colleagues by supporting clinician wellbeing. Evidence suggests that healthy doctors are more able to deliver safe and effective care, this may result in clinicians sustaining longer careers in service. 

When people play a more collaborative role in managing their health through lifestyle medicine practices such as supported self-care and person-centred care, they are more likely to stick to their treatment plans and less likely to use emergency hospital services. Lifestyle medicine tools like group consultations allow for up to 15 patients to be seen in an hour. They have been shown to be as good or better for some people than 1 to 1 care for Type 2 diabetes, and may deliver cost efficiencies. 

To demonstrate capabilities associated with the extended role, we have taken the five areas of capability described in the RCGP curriculum as a starting point. These are based around the GMC's generic professional capabilities framework.

This section builds on the five areas of capability to explore those which relate to the GPwER in lifestyle medicine.

Caring for the whole person, the wider community, and the environment

• May provide or oversee lifestyle clinics in primary-care, community-based or secondary-care settings.
• May lead a wider lifestyle medicine team.
• May lead or contribute to an integrated care team including health, social care, exercise and third-party providers to address community needs.
• Is primarily a GP that delivers lifestyle medicine as part of their job plan.
• May use their position within communities to advocate for change.

Working well in organisations and systems of care

• May undertake assessments independently or may be with other members of a wider lifestyle team.
• Will manage patients requiring support in adapting their lifestyle or may support another GP in managing patients with (or at risk of) long term conditions related to their lifestyle. Patients may be self-referred or referred by another health professional.
• Will communicate and build relationships on an individual, multi-professional and team basis with all levels of staff.
• Enables collective responsibility.
• May work autonomously.
• Will oversee management, reporting, and analysis.
• May provide a link between healthcare, exercise professionals and third-party providers that promote good health and wellbeing.

Knowing yourself and relating to others

• Change management
• Driving performance / performance management
• Motivating and inspiring
• Coaching and decision-making
• Collaboration and partnership working
• Influencing, negotiating, compassionate leadership, mentoring
• Communication and team building

Managing disease, or risk factors for disease, which manifest from lifestyle factors

• Provides face-to-face consultations with patients requiring lifestyle input and provides extended appointments.
• Understands clinical governance and professionals' accountability.
• Provides a comprehensive assessment of a person's needs in an extended consultation, with good understanding of a lifestyle history, clinical assessment of lifestyle factors and supporting behaviour change.
• The output of appointments with a GPwERLM should be the co-creation of a lifestyle treatment plan with goal setting and follow-up.
• Group consultations may be used to address lifestyle factors in specific populations, continuing to utilise an individual approach whilst fostering a culture of peer-to-peer support and learning.
• Settings for assessments can vary: the surgery, care-home, community-based hall or fitness/sports facilities.
• Shares relevant information among teams involved in the person's care in dedicated time.
• Manages patients in need of lifestyle changes in extended appointments.
• May support GPs to manage patients requiring lifestyle changes or manage these patients on behalf of their registered GPs. This may include the provision of education to fellow GPs and primary health care professionals in lifestyle medicine.
• Through the adoption of a biopsychosocial approach, lifestyle medicine GPwER may look to address societal and cultural practices that may be negatively affecting lifestyle contributing to poorer health outcomes.

Applying clinical knowledge and skills

• Sharing decision-making
• Managing risk
• Supporting behaviour change
• Using a biopsychosocial approach
• Coordinating care

View the above information as diagrams (PDF file, 317 KB).

Demonstrating personal qualities

• Understands and can describe own team working and leadership style, and able to flex and adapt this leadership style to situations, concepts, people and problems for the advancement of lifestyle medicine in local areas.
• Commits to own CPD development and acts to establish local CPD support in the field of lifestyle medicine.
• Acts with integrity and can personally demonstrate a commitment to the principles of lifestyle medicine.
• Acts to ensure inclusion and health-equality is sought through the deliverance of lifestyle medicine, and advocates for lifestyle medicine for all in system wide decision-making.

Working with others

• Supports team development in practice and develops and shares resources for lifestyle medicine specific for the location population.
• Understands the wider system involved in patient care and the deliverance of lifestyle medicine, and able to build and maintain relationships, including providers and integrated care systems, public health, dieticians, nutritionists, psychologists and mental health teams, physical activity, and sport providers.
• Is able to bring colleagues, patients, and interested parties together locally and facilitate the development of a collective leadership approach.

Managing services

• Adopts and advocates for a person-centred lifestyle approach to health and wellbeing across all services.
• Engages in quality improvement, monitoring and research regularly to ensure development and progress, and enhance performance.
• Makes evidence-based decisions for the locality, with a basic understanding of funding implications (and health economics).
• Facilitates others to promote, develop and enhance the delivery of lifestyle medicine.

Improving services

• Adopts and implements policy and monitoring to ensure patient safety.
• Engage with staff, patients and colleagues to critically evaluate services, and advocate for change or investment were appropriate.
• Encourage ongoing quality improvement and innovation, through seeking new ideas and being willing to facilitate and encourage appropriate change.

Setting direction

• May take part in committee structures within organisations and in localities with an interest in health and wellbeing.
• May help determine the priorities for a service.
• May advise management colleagues and provide a clinical perspective on service developments.

This section explains how a GP can develop the skills, knowledge, and experience to undertake the extended role. This includes acquisition of core knowledge and skills relevant to the extended role. A GPwER should have an appropriate balance of practical and theoretical knowledge in relation to their extended role.

Training roles and opportunities are changing rapidly and currently vary in different areas. Opportunities via traditional training routes are currently limited, with an opportunistic approach required to develop skills within the field.

Shadowing any pre-existing lifestyle medicine roles can be valuable. In addition, an understanding of the wider network of health and well-being providers will be valuable, including secondary care, social care, dieticians, nutritionists, exercise professionals, third-party providers, social prescribers, health psychologists, counsellors, drug and alcohol addiction teams and more. 

Engagement with the wider network of health-professionals delivering lifestyle medicine can be provided through association or membership with organisations such as the British Society of Lifestyle Medicine. 

The opportunities above can enhance attitudes, skills, and knowledge in respect to:

• person-centred care and shared decision-making
• team working allowing collective responsibility across different professions and organisations/boundaries
• collaborative working and building relationships and mutual trust
• running a multi-professional meeting
• compassionate leadership
• ability to develop effective working relationships on an individual, multi-professional and team basis with all levels of staff
• ability to communicate effectively
• understanding of clinical governance and the individual responsibilities it implies.

The RCGP’s position is that GPs are expert medical generalists and, as such, do not need formal accreditation in enhanced roles for which they have been trained. However, where formal accreditation is desired by a GP, programmes that offer accreditation should be made available. Refer to the RCGP guide to GP Clinical Extended Roles (PDF file, 440 KB) for further information.

As for all doctors, GPs are required by the GMC to recognise and work within the limits of their competence and should refer to the GMC's Good Medical Practice for a description of what it means to be a good doctor.

It is worth noting that employers and service commissioners may have specific requirements relating to the provision of a GPwER service.

Accreditation (with an ongoing re-certification programme) is offered by:

• The British Society of Lifestyle Medicine core accreditation
• International Board of Lifestyle Medicine

The evidence that a GPwER is keeping their requisite knowledge and skills up to date and maintaining their competencies should be reviewed through the GPwER's annual whole scope of practice appraisal. This should form part of the discussion of all external roles and include quality improvement activity such as case analysis and audit. This has replaced any need for periodic re-accreditation. Please see the "Governance" section or the RCGP guide to GP Clinical Extended Roles (PDF file, 440 KB) for further information.

The RCGP would expect that, for a GP to describe themselves as a GPwER, at least some ‘core’ general practice should be maintained. This is because as a GP they bring important additional skills in practising holistically and dealing with complexity and uncertainty to their GPwER role. Where there is a need for a GPwER to demonstrate at their annual appraisal that they remain safe, competent and up to date in their core general practice role, they may wish to utilise the Academy of Medical Royal Colleges' factors for consideration template (external PDF).