Area of capability working well in organisations and systems of care

As a GP, you care for patients at numerous levels in the health service: in consultations with individual patients, in your work within teams and organisations, and through the services and systems of care that are available and which you help to coordinate. These wider perspectives of influence and responsibility emerge as your expertise and leadership skills progress from the individual patient–doctor consultation, to team – and practice – based care provision and then to system-level and interorganisational activity.

As a professional learner, you will need to develop systems to manage your own performance, education and career-long development, as well as contributing to the development of multiprofessional teams.

Increasingly, GPs in all UK nations are participating in the development of care pathways and services, advising on how existing services can be improved, what changes are needed to meet a particular demand and how to set up more integrated systems of care. You will also need to develop the transferrable skills and flexible mindset to enable you to work in and lead a wide range of provider organisations that extend beyond the traditional medical partnership, such as federations, collaborative networks and integrated care systems.

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Improving performance, learning and teaching

This area is about continuously improving performance and undertaking self-directed adult learning and effective continuous professional development, both learning for oneself and supporting the learning of others. It also includes leading clinical care and service development, as well as participating in quality improvement and research activity. In England, this capability may be applied to local commissioning activity.

Although general practice is a highly context-dependent and individually focused discipline, it should be based on a solid foundation of scientific evidence. Using experience in the management of your patients remains very important, but should wherever possible be supported by sound evidence that has been peer reviewed and published in the medical literature and guidelines. As a GP you should be able to search, collect, understand and interpret scientific research critically and use such evidence as much as possible.

Critically reviewing 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 should be considered an essential capability for every GP.

Continuously evaluate and improve the care you provide

Learning outcomes

  • Show commitment to a process of 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 and evaluate your process of learning
  • Regularly obtain and act on feedback from patients and colleagues on your own performance as a practitioner
  • Systematically evaluate personal performance 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 arising 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

Adopt a safe and scientific approach to improve quality of care

Learning outcomes

  • Use equipment safely and comply with safety protocols and directions
  • Follow infection control protocols and demonstrate hand-washing 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 safety 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

Support the education and development of colleagues

Learning outcomes

  • Recognise that it is the duty of every doctor to contribute to the education and development of colleagues and team members, for the benefit of the health service
  • 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, raising 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

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Progression point descriptors

Maintaining performance, learning and teaching 

This is about maintaining the performance and effective continuing professional development (CPD) of oneself and others. The evidence for these activities should be shared in a timely manner within the appropriate electronic Portfolio.

 

Generic Professional Capabilities: Education

MRCGP assessments:WPBA (CbD, CAT, PSQ, MSF, leadership, 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 engage with the portfolio e.g. entries are scant, reflection is poor, plans are made but not acted upon or the PDP is not used effectively

Reacts with resistance to feedback that is perceived as critical

Fails to make adequate educational progress

Demonstrates critical thinking

Demonstrates clinical curiosity and reflective practice

Engages in some study reacting to immediate clinical learning needs.  

Provides evidence of integrating learning into professional practice

Participates in wider learning activities

Knows how to access the available evidence, including the medical literature, clinical performance standards and guidelines for patient care.  

Changes behaviour appropriately in response to the clinical governance activities of the practice, in particular to the agreed outcomes of the practice’s audits, quality improvement activities and learning event analyses.  

Recognises situations, e.g. through risk assessment, where patient safety could be compromised.  

Contributes to the education of others

Judges the weight of evidence, using critical appraisal skills and an understanding of basic statistical terms, to inform decision-making. 

Shows a commitment to professional development through reflection on performance and the identification of personal learning needs.  

Addresses learning needs and demonstrates the application of these in future practice. 

Personally participates in audits and quality improvement activities and uses these to evaluate and suggest improvements in personal and practice performance.  

Engages in learning event reviews, in a timely and effective manner, and learns from them as a team-based exercise.  

Identifies learning objectives and uses teaching methods appropriate to these

Assists in making assessments of learners where appropriate

Uses professional judgement to decide when to initiate and develop protocols and when to challenge their use. 

Moves beyond the use of existing evidence toward initiating and collaborating in research that addresses unanswered questions. 

Systematically evaluates performance against external standards. 

Demonstrates how elements of personal development impact upon career planning and the needs of the organisation.  

Encourages and facilitates participation and application of clinical governance activities, by involving the practice, the wider primary care team and other organisations. 

Evaluates learning outcomes of teaching, seeking feedback on performance and reflects on this

Actively facilitates the development of others

Ensures that students and junior colleagues are appropriately supervised


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Organisation, management and leadership

This area is about understanding organisations and systems, including the appropriate use of administration systems, the importance of effective record-keeping and the use
of information technology for the benefit of patient care. It also includes using structured care planning as well as new 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 as a whole 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, which provide patients with an increasing range of access to general practice care.

Apply 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, by modelling professional behavior 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 variation 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

Develop 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, business partners, patients and clients in the practice setting
  • Interpret key financial documents relating to the management of general practice, such as annual accounts, budgets and balance sheets

Make effective use of information management and communication systems

Learning outcomes

  • Use records and information 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 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
  • Contribute to improvements in the quality of the medical record (for example, through development of templates)
  • Make effective use of the tools and systems that enable evaluation and improvementof 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 new communication technologies, such as social media and online access to information, to improve the accessibility and quality of services and to enhance health literacy amongst the public

Progression point descriptors

Organisation, management and leadership 

This is about understanding how primary care is organised within the NHS, how teams are managed and the development of clinical leadership skills.

 

Generic Professional Capabilities: Leadership

MRCGP assessments: AKT, CSA, WPBA (CbD, CAT, COT, miniCEX, QIP, Leadership, MSF, Prescribing, 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 

 

 

Consults with the computer rather than the patient

Records show poor entries e.g. too short, too long, unfocused, failing to code properly or respond to prompts

 

 

 

 

 

Demonstrates proficiency in using clinical recording and IT systems

Uses the patient record and on-line information during patient contacts, routinely recording each clinical contact in a timely manner following the record-keeping standards of the organisation. 

Recognises the need for personal organisational skills

Demonstrates awareness of organisational changes

Fulfils workforce responsibilities

Understands the structure of the UK healthcare system

Demonstrates a basic understanding of the organisation of primary care and the use of clinical computer systems. 

Personal organisational and time-management skills are sufficient that patients and colleagues are not unreasonably inconvenienced or come to any harm. 

Responds positively to change in the organisation. 

Manages own workload responsibly. 

Uses the primary care organisational systems routinely and appropriately in patient care for acute problems, chronic disease and health promotion.  This includes the use of computerised information management and technology (IM&T). 

Uses the computer during consultations whilst maintaining rapport with the patient to produce records that are succinct, comprehensive, appropriately coded and understandable. 

Is consistently well organised with due consideration for colleagues as well as patients.  Demonstrates effective time management, hand-over skills, prioritisation, delegation. 

Helps to support change in the organisation.  This may include making constructive suggestions. 

Responds positively when services are under pressure in a responsible and considered way. 

Uses and modifies organisational and IM&T systems to facilitate: Clinical care to individuals and communities, 

Clinical governance and practice administration 

Uses IM&T systems to improve patient care in the consultation, in supportive care planning and communication across all the health care professionals involved with the patient. 

Manages own work effectively whilst maintaining awareness of other people’s workload.  Offers help sensitively but recognises own limitations. 

Actively facilitates change in the organisation.  This will include the evaluation of the effectiveness of any changes implemented. 

Willing to take a lead role in helping the organisation to respond to exceptional demand. 


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