Scope of practice

The GMC says

Whole scope of practice: You must declare all the places you have worked and the roles you have carried out as a doctor since your last appraisal. You must collect supporting information that covers the whole of this practice. It's important you identify your whole scope of practice so you can make sure your supporting information covers all aspects of your work. Your supporting information must cover any work you do in:
  • Clinical (including voluntary work) and non-clinical (including academic) roles
  • NHS, independent sector and private work.
You have a professional obligation to give an honest and comprehensive picture of your whole practice for revalidation. You must make your responsible officer and appraiser aware of all the places you have worked as a licensed doctor since your last appraisal.

As a GP, you need to clarify your scope of practice because you are required to provide supporting information to demonstrate the quality of your work against the standards in good medical practice (GMC, 2013). This is for the scope of practice that you actually do, not what you qualified for. It is important to think broadly and include all clinical roles, whether in:

  • The NHS or private practice.
  • Working for a charity or in a voluntary capacity, paid or unpaid.
  • You also need to include all non-clinical roles for which you need a UK licence to practise, such as teaching and training, academic, leadership, management and medico-political roles.

Any separate role which requires a licence to practise for a different organisation, employer, or as an individual, needs to be included so that the responsible officer (RO) knows where to seek assurance that you are fit to practise. Include the contact details, where applicable, for each organisation to facilitate the transfer of information to the RO, and to be aware of the clinical governance arrangements in place. The RO may request confirmation from each part of your scope of practice, outside the designated body, that there are no outstanding clinical governance issues, concerns or investigations before making your revalidation recommendation.

The requirement to provide details of all the places you have worked as a licensed doctor since your last appraisal has been clarified and will be important, particularly to locum GPs who may work in many practices. The RCGP recommends that you keep a log of all the places that you work and provide the contact details in your appraisal portfolio. If you undertake any additional work that goes beyond the core GP curriculum, then you need to consider this as a separate scope of practice and provide supporting information about how you remain up-to-date in that work.

In those circumstances where you have had a separate internal in-post performance review, or 'appraisal' for a specific part of your scope of practice, it is normal to include the outputs from this review, and your reflections, as 'additional supporting information' in your main annual medical appraisal for revalidation.

Where you have several different responsibilities within the same part of your scope of practice, it is appropriate to reflect on these elements with your appraiser, but they do not need to be declared as separate 'scopes of practice'. They do not require separate supporting information, or clinical governance review, because they are not provided for a different organisation, or independently. Reflection on appropriate supporting information over the five-year cycle needs to take place at the level of separate posts for different employers, or independently, not every responsibility that you may have.

Over the five-year revalidation cycle, you need to reflect on how you keep up-to-date, review what you do and what feedback you have had, as well as declaring all GMC-level significant events and complaints, for every role that forms a separate part of your scope of practice.

The RCGP recommends that you reflect on any unusual or exceptional circumstances that may affect your ability to demonstrate your continued competence in the usual way and discuss it at your appraisal. For example, GPs doing low volumes of clinical work (less than 40 sessions over 12 months in work) or unusual or restricted scopes of practice should complete structured reflection that supports them in demonstrating how they remain up-to-date and safe. Where appropriate, additional mitigating factors should be planned and included in the new PDP.

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