Area of capability caring for the whole person and the wider community

By routinely applying a holistic approach to your growing experience of providing care at the individual, team, organisation and health system levels, you can greatly improve the quality of care you provide to patients and families.

The capabilities described in this theme are the most challenging to develop to a high level, as they can feel less tangible to the learner. They rely on the integration and enhancement of the more straightforward capabilities developed earlier in training. They also require you to further study and promote the use of approaches that extend beyond a disease-based focus of biomedical science to incorporate the physical, emotional, social, spiritual, cultural and economic aspects of well-being, in order to successfully achieve 'whole-person care'.

GPs must work with an increasingly diverse population with a wide range of global influences. This requires a holistic understanding of the person within society, including the context of his or her family, work, culture and wider community. It also requires the doctor to consider international aspects of health.

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Practising holistically, promoting health, and safeguarding

This area is about considering physical, psychological, socioeconomic and cultural dimensions of health. It includes taking into account feelings as well as thoughts, encouraging health improvement, self-management, preventative medicine and shared care planning with patients and their carers.

Medicine, like any cultural practice, is based on a set of shared beliefs and values and is an intrinsic part of the wider culture. According to Kemper, it involves 'caring for the whole person in the context of the person's values, their family beliefs, their family system, and their culture in the larger community, and considering a range of therapies based on the evidence of their benefits and cost'.

Another key aspect of holistic care is safeguarding the health and welfare of the patient, family and community. As a community-based practitioner, you will need to be alert and ready to respond to the full range of safeguarding concerns and the diverse contexts in which they present, taking appropriate and effective action when required.

Holistic care can be interpreted only in relation to an individual's perception of holism. This means that, even if you offer the same health advice, therapies or interventions, they will have different meanings to different people. This view acknowledges objective scientific explanations of physiology, but also admits that people have inner experiences that are subjective, mystical and, for some, religious, which may also affect their health and well-being.

Demonstrate the holistic mindset of a generalist medical practitioner

Learning outcomes

  • Appreciate the value of health in its broadest sense as being more than the absence of disease but also a resource that enables a person to adapt successfully to the challenges of living
  • Enquire routinely into physical, psychological and social aspects of the patient’s problem, integrating this information to form a holistic view
  • Interpret each patient's personal story in his or her unique context, considering the effects of additional factors that are known to influence an individual's health needs, including:
    • educational and occupational factors
    • environmental and cultural factors
    • spiritual and other existential factors
  • Develop the ability to switch from diagnostic and curative approaches to supportive and palliative approaches, as appropriate for the patient's needs
  • Integrate a diverse range of evidence-based approaches into treatment plans, according to patient preferences and circumstances, incorporating both conventional and complementary approaches where appropriate
  • Make yourself available to your patients as an appropriate means of support, while maintaining professional boundaries and encouraging self-care

Support people through individual experiences of health, illness and recovery

Learning outcomes

  • Recognise that every person has a unique set of values and experiences of health and illness that may affect his or her use of the healthcare system and incorporate this perspective into your decisions
  • Acknowledge the impact of the problem on the patient, such as how it affects his or her daily functioning, education, occupation and relationships
  • Additionally, recognise the impact of the problem on the patient's family and carers, social context and community
  • Anticipate the health issues that commonly arise during the expected transitions of life (including childhood development, adolescence, adulthood, ageing and dying)
  • Evaluate a patient's fitness to attend education or work and identify the barriers that prevent a return after prolonged absence from these activities
  • Provide individually tailored, evidence-based advice and support to enable each patient to optimise his or her lifestyle and well-being
  • Demonstrate the skills and assertiveness to challenge unhelpful health beliefs or behaviours while maintaining a continuing and productive relationship
  • Identify the people, including the young and elderly, who play an important caring role for others, involving them in management decisions and offering them additional support

Safeguard individuals, families and local populations

Learning outcomes

  • Recognise how safeguarding concerns may present in general practice across a range of scales, from individuals (for example, cases of domestic violence or child abuse) to families, identified populations (for example, local schools or care homes) and communities (for example, affected by human trafficking or child sexual exploitation)
  • Anticipate the safeguarding issues that commonly arise during different stages of life and the settings or contexts that may increase an individual's vulnerability or risk of harm
  • Respond safely, promptly and effectively to the full range of safeguarding needs and risks that you are likely to encounter in practice
  • Use appropriate systems for identifying and sharing information, recording and raising concerns, obtaining advice and taking action
  • Report concerns to appropriate professionals and authorities and actively participate in discussions, plans and actions to investigate and mitigate identified risks
  • Comply with your professional and legal responsibilities in relation to safeguarding, including the reporting of harmful and illegal activities and procedures (for example, female genital mutilation, radicalisation, modern slavery)
  • Acknowledge and manage the diverse impacts of safeguarding issues on the individuals affected, including their functioning, education, health, occupation and relationships
  • Recognise and respond appropriately to the wider impacts of safeguarding issues on the family, carers and the local community, as well as on the professionals involved
  • Demonstrate (as applicable to your role and working environment) the level 3 competences set out in Safeguarding Children and Young People: Roles and Competences for Health Care Staff 21

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Progression point descriptors

Practising holistically, promoting health and safeguarding

This is about the ability of the doctor to operate in physical, psychological, socio-economic and cultural dimensions. The doctor is able to take into account patient’s feelings and opinions. The doctor encourages health improvement, self-management, preventative medicine and shared care planning with patients and their carers.

 

Generic Professional Capabilities: Health Promotion; Safeguarding

MRCGP assessments: CSA, WPBA (CbD, CAT, COT, QIP, PSQ, CSR)

 

Insufficient evidence - From the available evidence, the doctor’s performance cannot be placed on a higher point of this developmental scale 

Indicators of potential underperformance

 

End ST1 – Making progress at the expected rate 

End ST2 - Making progress at the expected rate 

End ST3 - Competent for licensing

End ST3 - Excellent 

Treats the disease, not the patient

Recognises that health is more than the absence of disease

Considers options beyond a biophysical model

Demonstrates awareness of the potential in ‘making every contact count’.

Enquires into physical, psychological and social aspects of the patient’s problem. 

Recognises the impact of the problem on the patient’s life.

Offers treatment and support for the physical, psychological and social aspects of the patient’s problem. 

Recognises the role of the GP in health promotion

Demonstrates understanding of the patient in relation to their socio-economic and cultural background.  The doctor uses this understanding to inform discussion and to generate practical suggestions for the management of the patient. 

Recognises the impact of the problem on the patient, their family and/or carers. 

Utilises appropriate support agencies (including primary health care team members) targeted to the needs of the patient and/or their family and carers. 

Demonstrated the skills and assertiveness to challenge unhelpful health beliefs or behaviours, while maintaining a continuing and productive relationship

 

Accesses information about the patient’s psycho-social history in a fluent and non-judgemental manner that puts the patient at ease. 

Recognises and shows understanding of the limits of the doctor’s ability to intervene in the holistic care of the patient. 

Facilitates appropriate long-term support for patients, their families and carers that is realistic and avoids doctor dependence. 

Makes effective use of tolls in health promotion, such as decision aids, to improve health understanding.


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Community orientation

This area is about management of the health and social care of the local population. It includes understanding the need to build on community engagement and resilience and the relationship between family and community-based interventions, as well as the global and multicultural aspects of delivering evidence-based, sustainable healthcare.

Your work as a family doctor is determined by the make-up of the community in which your practice is based. Therefore, you must understand the potentials and limitations of the community in which you work and its character in terms of socioeconomic and health features. The GP is in a position to consider many of the issues and how they interrelate, and the importance of this within the practice and the wider community. The negative influence of poor socioeconomic status on health has been clearly demonstrated by Tudor-Hart.22 He described the 'inverse care law', which observes how people with the greatest need for care have the greatest difficulty accessing it.

GPs have traditionally formed a part of the community in which they work. Patterns of general practice delivery are changing, however, and many GPs live in different districts to their patients. As a result, GPs may need to take additional steps to understand the issues and barriers affecting their communities.

At the same time, the tension between the needs of an individual patient and the needs of the wider community is becoming more pronounced and it is necessary to work within this. For example, healthcare systems are being rationed in all societies and doctors are inevitably involved in the rationing decisions. As a GP, you have an ethical and moral duty to influence health policy in the community and to work with patients and carers whose needs are not being met. Furthermore, you need to have an awareness of global health issues and to display a responsibility towards global sustainability, both as a citizen and in your professional role.

Understand the health service and your role within it

Learning outcomes

  • Describe the current structure of your local healthcare system, including the various roles, responsibilities and organisations within it, applying this understanding to improve the quality and safety of the care you provide
  • Identify how local services can be accessed and use this understanding to inform your referral practices
  • Demonstrate an understanding of the financial restrictions within which healthcare operates and identify how the limitations of local healthcare resources might impact on patient care
  • Optimise your use of limited resources (for example, through cost-effective prescribing)h healthcare operates and identify how the limitations of local healthcare resources might impact on patient care
  • Demonstrate approaches that balance the needs of individual patients with the health needs of the local community, within available resources
  • Recognise how the roles and influence of the GP span across the healthcare system, including (but not limited to):
    • first-contact clinician
    • personal doctor and family practitioner
    • coordinator of complex and long-term care
    • patient advocate
    • service navigator and gatekeeper
    • clinical leader, commissioner and quality improver
    • employer, employee, contractor, manager and business leader
    • educator, supervisor, appraiser, researcher and mentor
  • Identify the opportunities that this expanded role provides for reducing inequalities and improving local, national and global healthcare

Build relationships with the communities with which you work

Learning outcomes

  • Recognise that groups or communities of patients may share and value certain characteristics and have common health needs and use this understanding to enhance your care, while continuing to acknowledge that people are individuals
  • Analyse and identify the health characteristics of the populations with which you work, including the cultural, occupational, epidemiological, environmental, economic and social factors and the relevant characteristics of 'at-risk' groups
  • Explore the interactions of these characteristics and impacts on the health needs and expectations of your community and its use of the services you provide
  • Contribute your insights to the development of new services in your organisation or locality
  • Acknowledge your professional duty to help tackle health inequalities and resource issues
  • Manage the conflicts of interest created by the differing needs of individuals, the requirements of the wider population and the resources available in the community and adopt approaches to manage these tensions in your work
  • Recognise that individuals, families and communities form a continuum, with each affecting the other, requiring a system-wide understanding of health and social care

Progression point descriptors 

Community orientation 

This is about the management of the health and social care of the practice population and local community.

 

Generic Professional Capabilities: Professional Knowledge; Health Promotion; Safeguarding

MRCGP assessments: WPBA (CbD, CAT, PSQ, QIP, MSF, CSR)

 

Insufficient evidence - From the available evidence, the doctor’s performance cannot be placed on a higher point of this developmental scale 

Indicators of potential underperformance

 

End ST1 – Making progress at the expected rate 

End ST2 - Making progress at the expected rate 

End ST3 - Competent for licensing

End ST3 - Excellent 

Fails to take responsibility for using resources in line with local and national guidance

 

Demonstrates readiness to understand and engage with the needs of the local population

Has knowledge of local services and care pathways

Adapts their clinical practice to the context of their locality

Demonstrates understanding of important characteristics of the local population, e.g. patient demography, ethnic minorities, socio-economic differences and disease prevalence, etc. 

Understands that local resources may be limited in the  community, e.g. the availability of certain drugs, counselling, physiotherapy or child support services. 

Takes steps to understand local resources in the community – e.g. school nurses, pharmacists, funeral directors, district nurses, local hospices, care homes, social services including child protection, patient participation groups, etc. 

 

Demonstrates understanding of how the characteristics of the local population shapes the provision of care in the setting in which the doctor is working. 

Shows how this understanding has informed referral practices they have utilised for their patients.  This could include formal referral to a service or directing patients to other local resources. 

Demonstrates how they have adapted their own clinical practice to take into account the local resources, for example in referrals, cost-effective prescribing and following local protocols. 

Demonstrates how local resources have been used to enhance patient care. 

Takes an active part in helping to develop services in their workplace or locality that are relevant to the local population.  

Understands the local processes that are used to shape service delivery and how they can influence them, e.g. through Health Boards and CCGs. 

Reflects on the requirement to balance the needs of individual patients, the health needs of the local community and the available resources.  Takes into account local and national protocols, e.g. SIGN or NICE guidelines. 

Develops and improves local services including collaborating with private and voluntary sectors, e.g. taking part in patient participation groups, improving the communication between practices and care homes, etc. 


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