How the curriculum is structured – Capabilities in practice

The learning outcomes of the RCGP curriculum are organised into five areas of capability and are supported by a series of topic guides that explore professional and clinical capabilities in more depth and provide examples in practice.

The capabilities serve as developmental threads throughout the GP training programme, and link earlier medical training with GP licensing assessments and post-licensing GMC revalidation standards. While separated for conceptual reasons, these areas of capability should be considered as part of an integrated whole.

Although it is possible to define other capabilities of relevance to general practice, these five key areas have been selected because of their importance to GP training and assessment in the context of the NHS in the UK.

The three MRCGP assessments – Workplace-based Assessment (WPBA), Applied Knowledge Test (AKT) and Simulated Consultation Assessment (SCA) – are used to evaluate these capabilities to the standard required for successful completion of training.

The five areas of capability are composed of 13 specific capabilities that a doctor is expected to acquire during GP specialty training. These capabilities map directly to the GMC’s generic professional capabilities framework (see Appendix 2 for a detailed map).

Table 1: The 13 specific capabilities a doctor should acquire during GP training.

The curriculum is supplemented by a series of topic guides that explore specific capabilities in more depth, applying them in an appropriate professional or clinical context.

Each topic guide is intended to illustrate important aspects of everyday general practice rather than provide a comprehensive overview of that topic. They should not be viewed as a complete list of every topic practising GPs need to learn.

Professional topic guides

• Consulting in general practice
• Equality, diversity and inclusion
• Evidence in practice, research, teaching and lifelong learning
• Continuity and quality of care, safety and prescribing
• Leadership, management and administration
• Population and planetary health

Life Stages topic guides

• Children and young people
• People living with long-term conditions including cancer
• Older adults
• People at the end of life

Clinical topic guides

• Allergy and clinical immunology
• Cardiovascular health
• Dermatology
• Ear, nose and throat, speech and hearing
• Eyes and vision
• Gastroenterology
• Genomic medicine
• Gynaecology and breast health
• Haematology
• Infectious diseases and travel health
• Learning disability
• Maternity and reproductive health
• Mental health
• Metabolic problems and endocrinology
• Musculoskeletal health
• Neurodevelopmental conditions and neurodiversity
• Neurology
• Renal and urology
• Respiratory health
• Sexual health
• Smoking, alcohol and substance misuse
• Urgent and unscheduled care

The training you undertake in the earlier stages of GP specialty training (that is, ST1 and ST2) should be sufficiently supervised to ensure that you develop a proficient, safe and appropriate approach to clinical assessment and management from the outset. This may be increasingly undertaken in a primary care or practice setting that provides innovative and blended learning approaches to training.

In the later stages of training, you will need to adjust your mindset to the different health needs, disease prevalence and range of clinical environments encountered in the general practice setting. This involves transferring the expertise gained from your earlier training experiences, when you may have encountered a ‘filtered’ population in which certain conditions may be more prevalent, to the ‘unfiltered’ general population presenting to general practice.

To deliver the broad base of capabilities required for the NHS GP role, your training pathway should be configured to provide you with adequate supervised exposure to the patients you will encounter when you are working in independent professional practice. For this reason, it is important that your training in non-primary care environments is grounded in the capabilities that apply to the GP’s role and typical working environment.

Attachments in non-primary care environments can provide you with a concentration of clinical experience that might have taken a long time to achieve solely in a general practice setting. In other settings, you will see and manage people with serious illness and study their pathway from presentation and admission to discharge, as well as participating in planning their rehabilitation. Such opportunities should include appropriate outpatient and community outreach experiences.

The RCGP recommends that all GP training programmes should be configured to provide GP registrars with adequate opportunities to gain skills in the assessment and management of the general UK population, as well as providing more targeted training in the care of certain patient groups that require a specific clinical approach and skill set. Examples of additional relevant training opportunities are given in Table 2.

Table 2: Examples of training opportunities in services for different patient groups.

The majority of your learning for general practice will occur in the workplace. A key element of professional behaviour requires you to reflect actively on your everyday experiences and incorporate your learning into your daily work and encounters with patients.

Despite the challenges of an extremely busy specialty, there will also be many opportunities for you to learn in and outside the workplace through planned educational activities with other healthcare professionals and formal teaching sessions.

Your training practice, and the patient contacts you make while working there, will provide the foundation for your career-long development as a generalist medical practitioner.

Initially, you will work closely with your GP trainer (educational supervisor) or clinical supervisor when consulting with patients. As you gain experience, you will work with less direct supervision and take more responsibility, until you are able to work safely and independently.

Your learning environment could involve:

• exploring local community resources
• home visits
• out-of-hours services
• GP with a special interest (GPwSI) clinics
• voluntary work
• being supported with less than full time (LTFT) training to adjust to change (for example, being new to the NHS) or to balance work and life demands
• remote vs in-person working
• balancing work and time for learning against maintaining mental and physical wellbeing

In every placement, the patients and carers you meet will educate you about how they approach and manage their own illnesses and, if you are open to it, they will help you to become a better GP. Patients with long-term health conditions are often experts in managing their illness and experienced at negotiating their way through the healthcare system. You should also make the most of learning from the wide range of other colleagues in the multidisciplinary team who are involved in caring for your patients, both in hospital and in the community.

Placements can include opportunities for:

• learning with and from patients
• case discussions and reflections
• observation
• clinical encounters
• practical skills
• prescribing reviews.

As an adult learner you will have your own distinct learning style and preferences. These will influence how you make use of learning opportunities both during your training programme and in your lifelong learning as a GP.

The mainstay of training is through experience of consulting with patients and learning from those encounters. The recommended working week in GP training includes time for personal study and you might use this time in a variety of ways, depending on your needs, to ensure that you meet the curriculum requirements. Developing strong capabilities in independent self-directed learning is an important part of your professional development.

You are encouraged to record your self-directed learning activities in your portfolio, which in itself will help you reflect on your training and identify new learning needs. These activities could include:

• significant event analysis group discussion
• discussing and reflecting on complaints
• keeping your own personal reflective diary
• peer support groups where you can share experiences
• reflecting on feedback from patients, supervisors and colleagues
• the doctor as patient
• recognising and acting on patients’ unmet needs (PUNs) and doctors’ educational needs (DENs)
• self-directed learning online.

Of course, becoming a qualified GP does not mean that your learning stops. Being a doctor is a process of lifelong learning, not only to keep up to date on medical developments but also to develop expertise and to improve the application of your knowledge and skills as you take on more senior and challenging roles.

Your learning needs will differ at various stages of your career, and you need to be able to continuously review, identify and meet those needs. By linking explicitly with the GMC’s Good medical practice guidance¹, the RCGP curriculum can help you with this process, providing a useful educational framework for the discipline of general practice.

The life skills you might need to develop as a GP could include:

• managing stress and life events outside work
• supporting colleagues
• not being afraid to ask for help or share weaknesses
• dealing with practical challenges such as coming across a road traffic accident in the community
• forward planning
• time management
• multitasking.

Half-day or whole-day release allows GP registrars at various stages of training to come together for small group sessions and can have a powerful influence on shaping attitudes and enhancing personal professional development. Peer learning groups to prepare for examinations and assessments have a long tradition and are highly valued by GP registrars. There are many examples of GP registrars learning to learn with their peers, with and without the need for facilitation. The half-day release schemes are a vehicle for:

• shared experiences
• learning together and action learning sets
• self-directed learning groups
• geographically based ‘cluster’ groups.
• learning from ‘virtual’ groups and social media.

The broad knowledge and skills required by a GP are not provided solely by medical colleagues. Many aspects of the curriculum are taught by other professionals, such as clinical nurse specialists, advanced nurse practitioners, practice nurses and administrative colleagues.

Primary care is a multidisciplinary activity, and this will be reflected in the training programmes for future GPs. Practice-based education is of increasing importance and greater numbers of GP registrars entering the specialty have been promoted in the NHS Long Term Workforce Plan². GP registrars will be involved both as learners and as teachers.

Short attachments to other primary healthcare team workers and other professionals, such as practice-based or community-based pharmacists, are helpful. Non-clinical staff, such as receptionists and managers, make key decisions on prioritising patient requests and have expertise in the administration and management of the practice both as a business and a healthcare organisation.

Learning outside the health sector (such as spending time in social care or voluntary sector organisations) is also invaluable, for example in understanding the wider social determinants of health.

Your practice-based training could include:

• ‘just another day in general practice’ – learning from everyday clinical encounters and supporting patients and colleagues
• team discussions to help manage complexity and uncertainty
• daily huddle
• informal discussions over coffee
• peer learning groups
• learning from experienced GPs and allied healthcare professionals
• practice teaching sessions and presentations
• finding or being a good mentor or supervisor
• concise summaries shared by multidisciplinary team colleagues, including infographics and visual summaries

There are many resources for learning that are organised at both the regional and the national level. Access to these opportunities is provided through the study leave allowance process and is subject to the criteria of personal professional development and appropriateness for GP training. They most commonly include:

• SCA and AKT preparation courses
• clinical and non-clinical topic courses
• attendance at national conferences such as the RCGP Annual Conference
• regional teaching and residential days
• conferences
• getting involved in quality improvement activities
• learning from teaching
• developing a specialist interest
• attending courses on leadership or management.

There may be opportunities for you to join other healthcare professionals in joint educational events, learning together through in-house or locality-based programmes.

Technology-enhanced learning opportunities can include:

• virtual simulated cases
• webinars and online teaching
• podcasts
• reflections on video consultations.

References

1. General Medical Council. Good medical practice. GMC, 2024. www.gmc-uk.org/professional-standards/the-professional-standards/good-medical-practice
2. NHS England. The NHS Long Term Workforce Plan. NHSE, 2023. www.england.nhs.uk/publication/nhs-long-term-workforce-plan. The plan is an NHS England initiative, and does not apply to all four UK nations.