Area of capability: Knowing yourself and relating to others

This capability concerns your development of professional values and behaviours and preparation for revalidation. It highlights the importance of maintaining your own health and wellbeing. It also includes having insight into when your own performance, conduct or health, or that of others, might put patients at risk, as well as taking action to protect yourself and patients.

Demonstrating the attitudes and behaviours expected of a good doctor

Learning outcomes:

• Follow the duties, principles and responsibilities expected of every doctor, as set out in the GMC’s Good medical practice guidance.
• Demonstrate compliance with accepted codes of professional practice, showing awareness of your own values and attitudes and how these affect your behaviour.
• Apply the relevant ethical, financial, legal and regulatory frameworks within which you provide healthcare, both at practice level and in the wider NHS.
• Continuously evaluate the care you provide, encouraging scrutiny and being able to justify your actions to patients, colleagues and professional bodies.
• Demonstrate an approach that shows curiosity, diligence and caring in your encounters with patients and carers.
• Recognise the limits of your own abilities and expertise as a GP.
• Regularly obtain and review feedback on your performance from a variety of sources.
• Adopt a self-directed approach to learning, engaging with agreed processes for assessment (and for continuing professional development, appraisal and revalidation).
• Apply and revisit the outcomes described in this curriculum throughout your career to maintain and develop your generalist expertise.

Managing the factors that influence your performance

Learning outcomes:

• Manage professional demands while showing awareness of the importance of addressing personal needs, achieving a balance that meets your professional obligations and preserves your own health and wellbeing.
• Anticipate and manage the factors in your work, home and wider environment that influence your day-to-day performance, including your ability to perform under pressure, and seek to minimise any adverse effects.
• Attend to any physical or mental illness or health behaviours that might interfere with the safe delivery of patient care, seeking support and advice from appropriate others as required.
• Be aware of potential effects of unexpected or upsetting events, such as complaints, on your wellbeing and undertake measures for self-care and appropriate support to mitigate such effects.
• Seek appropriate support and engage with remedial action whenever there are concerns about your personal performance.
• Provide support and constructive feedback to colleagues who have made mistakes or whose performance gives cause for concern.
• Take appropriate action whenever you become aware of any poor or unsafe practice, even if this involves raising concerns about senior colleagues or ‘whistle-blowing’.

Promoting health and wellbeing in yourself and colleagues

Learning outcomes:

• Adopt a proactive approach to managing your own physical and mental health and wellbeing.
• Promote an organisational culture in which your health and wellbeing, and that of colleagues and staff, are valued and supported.

Progression point descriptors – Fitness to practise

This capability involves practising ethically, with integrity and a respect for diversity.

There will be cultural (including religious) differences between you and many of your patients. Your own values, attitudes and feelings are important determinants of how you practise medicine. This is especially true in general practice, where you as a doctor will be involved as a person in a one-to-one and continuing relationship with your patient, not merely as a medical provider.

As a GP, you should aim to understand and learn to use your own attitudes, strengths and weaknesses, values and beliefs in a partnership with your individual patients. This requires a reflective approach and the development of insight and an awareness of self. Being honest and realistic about your own abilities, strengths, weaknesses and priorities will help you in dealing with your patients and their problems.

Treating others fairly and with respect, acting without discrimination or prejudice

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 embracing 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 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 respectfully.
• Take appropriate action when you become aware of people acting in an abusive, bullying or intolerant manner.

Providing care with compassion and kindness

Learning outcomes:

• Demonstrate that you relate to people as individuals and challenge attitudes that dehumanise 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 organisations and services (such as 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.

Promoting an environment of inclusivity, safety, cultural humility and freedom to speak up

Learning outcomes:

• Actively promote a culture of inclusion where everyone is welcome in general practice, regardless of background or any protected characteristics.
• Consciously self-assess your own perspectives such as ethnocentric, biased or prejudiced beliefs towards others.
• Be willing to explore new cultural ideas and information and their implication for health provision and behaviours.
• Provide culturally sensitive and appropriate healthcare to people from diverse backgrounds.

Progression point descriptors – An ethical approach

This capability covers communicating with patients, the use of recognised consultation techniques, establishing and maintaining patient partnerships, managing challenging consultations, third-party consulting, the use of interpreters and consulting modalities across the range of in-person and remote methods (including online, telephone and video).

McWhinney’s Textbook of Family Medicine² identifies three central elements of family practice: committing to the person rather than to a particular body of knowledge; seeking to understand the context of the illness; and attaching importance to the subjective aspects of medicine. A person-centred approach is about more than the way you act. It is about the way you think. It means always seeing the patient as a unique person in a unique context and considering patient preferences and expectations at every step in a patient-centred consultation. Sharing the management of problems with your patients and, if appropriate, addressing any disagreement over how to use limited resources in a fair manner may raise ethical issues that challenge the doctor. Your ability to resolve these issues without damaging the doctor–patient relationship is all important.

Partnership in the context of the doctor–patient relationship means a relationship based on participation and patient responsiveness, avoiding paternalism and dominance. Patient-reported quality of primary care and satisfaction with care are strongly linked with the person-focused model and confirm its value. Person-centred care places great emphasis on the continuity of the relationship process.

Establishing an effective partnership through a range of in-person and remote consulting modalities

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
  • developing communication skills tailored to the range of consulting modalities you may encounter, including in-person, telephone, video and online consultations.
  • building rapport and trust, for example through empathy and active listening
  • acknowledging and respecting the diversity of the patients you see
  • being aware of subjectivity in the medical relationship (such as personal feelings, values and attitudes), both those of the patient and your own
  • 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 (for example, 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

Managing the additional challenge of consultations with patients who have communication needs or who have different languages, cultures, beliefs and educational backgrounds to your own

Learning outcomes:

• Provide easy access to professional interpreters when required, be aware of their role in the consultation and use a variety of communication techniques and materials to adapt explanations to the needs of the patient and carer.
• Adapt to patients’ needs and preferences regarding choice of consultation modality (for example because of lack of technological confidence, language differences or poor access to the internet).
• Adapt communication approaches or use appropriate communication aids for people with, for example, visual or hearing loss or learning disability.
• Enhance health literacy in patients from a range of backgrounds by providing tailored information, facilitating communication and checking understanding, as appropriate.
• Develop a range of communication skills that can be tailored to each patient’s individual needs and preferences and adapted to the clinical context (such as when immediate action is needed), using time effectively within the consultation.
• Integrate 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 manage self-care.

Maintaining continuing relationships 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.
• Use a range of consulting modalities appropriately, both in-person and remote (such as via video, telephone or online), to optimise both access to care and continuity of care.
• Manage an appropriate emotional proximity to your patients, taking action to re-establish professional boundaries when required.
• Manage the effects of complaints (whether against you or your team, or your patient) taking steps to facilitate a constructive approach 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 or 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 relevant legislation.
• Regularly obtain, record and share relevant information about a patient’s care, such as care plans, advance directives and ‘do not resuscitate’ decisions.

Progression point descriptors – Communicating and consulting

References

1. As found in “Good medical practice”
2. Freeman, Thomas R., McWhinney's Textbook of Family Medicine, 4 edn (New York, 2016; online edn, Oxford Academic, 1 Apr. 2016), https://doi.org/10.1093/med/9780199370689.001.0001, accessed 4 Jan. 2025.