Area of capability: Working well in organisations and systems of care

This capability covers continuously improving performance, self-directed adult learning and effective continuing professional development (CPD), both for yourself and to support the learning of others. It includes leading clinical care and service development, as well as participating in quality improvement and research activity.

Although general practice is a highly context-dependent and individually focused discipline, it should be informed by a solid foundation of evidence. The management of your patients should, wherever possible, be supported by sound evidence that has been peer-reviewed and published. As a GP you should be able to search, collect, understand and critically appraise scientific research. You should also understand when it is appropriate to apply such evidence to your clinical practice or educational activities, and when to consider a more flexible approach that includes other types of knowledge, such as knowledge acquired from experience.

Critically reflecting on your experience in practice should become a habit that is maintained over the whole of your professional career. Knowing and applying the principles of lifelong learning and quality improvement are essential capabilities for every GP.

Continuously evaluating and improving the care you provide

Learning outcomes:

• Show commitment to continuing professional development through critical reflection and the addressing of learning needs.
• Routinely engage in targeted study and self-assessment to keep abreast of evolving clinical practice. 
• Identify new learning needs through developing targeted personal development plans (PDPs).
• Regularly obtain and act on feedback from patients and colleagues on your own performance as a practitioner.
• Systematically evaluate personal performance and learning processes against external standards and markers, using this information to inform your learning.
• Participate in personal and team performance monitoring activities and use these tools to evaluate practice and suggest improvements.
• Engage in structured, team-based reviews of significant or untoward events and apply the learning resulting from them.
• Recognise, report and actively manage situations in which patient safety has been or could be compromised.
• Adapt your behaviour appropriately in response to the outcomes of clinical governance activities, also supporting colleagues to change.

Adopting a safe and evidence-informed approach to improve quality of care

Learning outcomes:

• Use equipment safely and comply with safety protocols and directions.
• Follow infection-control protocols and demonstrate handwashing 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 and work environment 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.

Supporting the education and professional development of others

Learning outcomes:

• Recognise that it is the duty of every doctor to contribute to the education and professional development of colleagues and team members.
• When teaching individuals or groups, identify learning objectives and preferences, adopting teaching methods appropriate to these.
• Construct educational plans and evaluate the outcomes of your teaching activities, seeking feedback on your performance.
• Ensure that students and junior colleagues are appropriately supervised in their clinical roles, and raise concerns through appropriate channels when necessary.
• Participate in the evaluation and personal development of team members as appropriate to your role and level of expertise, providing constructive feedback when required.

Progression point descriptors – Performance, learning and teaching

This capability involves understanding organisations and systems, including the appropriate use of administration systems, the importance of effective record-keeping and the use of data and information technology for the benefit of patient care. It includes using structured care planning as well as modern technologies to access and deliver care, and the development of relevant business and financial management skills.

As a GP you must be prepared to work as a team member but also, when appropriate, as a leader in your organisation. This includes improving care quality and effectiveness and ensuring that your services are relevant and responsive to patient needs. You must learn the importance of supporting patients’ decisions about the management of their health problems and be able to communicate to them how the NHS team will deliver their care.

You will also be increasingly challenged by the ethical and financial need to be conscious of healthcare costs. Gaining an understanding of cost-efficiency and workforce sustainability, and how this has an impact on patient care, is a key learning issue during training. This involves participating in the running of your organisation as a business and contributing appropriately to its financial management, based on the roles, structures and processes adopted by your organisation.

The capabilities described in this section, as throughout the whole curriculum, are transferable to a growing number of extended GP roles and innovative service models in the UK NHS that provide patients with an increasing range of access to general practice care.

Advocating for medical generalism in healthcare

Learning outcomes:

• Recognise the importance of generalism in co-ordinating patient care and providing a point of contact bridging all parts of the NHS.
• Demonstrate skill in incorporating all aspects of health affecting patients, including physical, mental, psychological and social factors.
• Demonstrate a person-centred approach to ill health and promoting wellness.
• Acknowledge that generalism involves a high degree of uncertainty and the need to accept and balance risk at individual, community and systems levels.
• Recognise the principles of generalism, including (but not limited to) providing patient-centred care that considers external influences such as population health, environmental factors, health inequality and understanding the impact of broader organisational influences.

Applying 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, modelling professional behaviour 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 variations 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.
• Recognise your responsibility in advocating for yourself and (such as through ‘Freedom to speak up’), applying appropriate complaints principles and procedures when required.

Developing 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, patients and relevant external agencies in the practice setting.
• Interpret relevant financial documents relating to your work as a GP.

Making effective use of data, technology and communication systems to provide better patient care

Learning outcomes:

• Use data, technology and information communication 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 and teaching 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. GPs now have a contractual obligation to patients to provide access prospectively to medical record made after November 2023.
• Be aware of information standards.
• Contribute to improvements in the quality of the medical record (such as through development of templates).
• Make effective use of the technology, 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 technologies, such as social media and online access to information, to improve the accessibility and quality of services and to enhance health literacy among the public. 
• Recognise the benefits and limitations of emerging technologies that sit within the public domain, and the professional responsibility for using them safely and securely.

Progression point descriptors – Organisation, management and leadership