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2 01 Knowledge and skills guide

This is one of four Professional Modules (2.01 – 2.04) which cover important professional areas of practice such as consulting, patient safety, leadership, quality improvement and self-directed learning.

The learning outcomes in these modules are in addition to those detailed in the core statement, Being a General Practitioner. The core statement and this module should be used in conjunction with the other curriculum modules. In order to demonstrate the core competences in this module you will require knowledge, skills and attitudes in the following areas:

Fitness to practise

This concerns the development of professional values, behaviours and personal resilience and preparation for career-long development and revalidation. It includes having insight into when your own performance, conduct or health might put patients at risk, as well as taking action to protect patients.

This means that as a GP you should:

  • Understand that your attitudes, feelings and values are important determinants of how you practice
  • Recognise your roles and responsibilities towards your patients as a GP
  • Recognise the limits of your own abilities and expertise
  • Recognise how personal emotions, lifestyle and ill-health can affect your consultation performance and the doctor–patient relationship
  • Use the skills typically associated with good doctor–patient communication

Maintaining an ethical approach

This addresses the importance of practising ethically, with integrity and a respect for diversity.

This means that as a GP you should:

  • Demonstrate a non-judgmental approach, treating your colleagues, patients, carers and others equitably and with respect
  • Value people’s beliefs and preferences in clinical and everyday working
  • Recognise and take action to address discrimination and oppression by yourself and others
  • Challenge behaviour that infringes the rights of others
  • Reflect on how particular clinical decisions have been informed by ethical concepts and values such as consent, confidentiality, truth telling and justice
  • Be able to clarify and justify your personal ethics to patients and to external reviewers
  • Recognise that patients are diverse: that their behaviour and attitudes vary as individuals and with age, gender, ethnicity and social background, and that you should not discriminate against people because of those differences
  • Be aware of the range of values that may influence your patient’s behaviour or decision-making in relation to his or her illness
  • Apply ethical guidance on consent and confidentiality to the particular context of an individual patient
  • Apply the law relating to making decisions for people who lack capacity to the particular context of an individual patient
  • Apply ethical and legal frameworks to analyse issues and resolve conflicts of values
  • Understand how the social context of primary care frames the identification and resolution of ethical issues by general practitioners

Communication and consultation

This is about communication with patients, the use of recognised consultation techniques, establishing patient partnership, managing challenging consultations, third-party consulting and the use of interpreters.

This means that as a GP you should:

  • Respond flexibly to the needs and expectations of different individuals
  • Demonstrate how to use the computer in the consultation while maintaining rapport with your patient
  • Demonstrate effective and safe telephone, email and online consultations, applying an awareness of their uses and limitations while mitigating risks
  • Share information with patients in an honest and unbiased manner, in order to educate them about their health (doctor as teacher)
  • Negotiate a shared understanding of the problem and its management with patients, so that they are empowered to look after their own health
  • Adapt communication skills to meet the needs of the patient, including working with interpreters to deal with patients from diverse backgrounds
  • Achieve meaningful consent to a plan of management by seeing the patient as a unique person in a unique context
  • Understand the importance of continuity of care and long-term relationships with your patient and their family in identifying and understanding the values that influence a patient’s approach to healthcare
  • Demonstrate techniques to limit consultation length when appropriate

Data gathering and interpretation

This is about interpreting the patient’s narrative, clinical record and biographical data. It also concerns the use of investigations and examination findings, plus the adoption of a proficient approach to clinical examination and procedural skills.

This means that as a GP you should:

  • Demonstrate focused questioning and examination to obtain sufficient relevant information to diagnose, manage and refer appropriately

Making decisions

This is about having a conscious, structured approach to decision-making; within the consultation and in wider areas of practice.

This means that as a GP you should:

  • Formulate appropriate diagnoses, rule out serious illness and manage clinical uncertainty
  • Base treatment and referral decisions on the best available evidence
  • Make timely and appropriate referrals, using relevant information
  • Demonstrate the ability to communicate risks and benefits in a way that is meaningful to patients
  • Demonstrate the skills to offer patients health choices based on evidence so that an informed discussion can occur, taking into account patients’ values and priorities
  • Recognise that the efficacy of evidence-based interventions depends on concordance with agreed therapeutic aims
  • Understand the value of continuity of care recognizing that a long-term relationship can improve concordance with evidence-based interventions
  • Recognise the scarcity of evidence derived from a patient’s perspective
  • Recognise the range of values that influence decisions by your patients, their families and health professionals, and where these values conflict

Clinical management

This concerns the recognition and management of common medical conditions encountered in generalist medical care. It includes safe prescribing and medicines management approaches.

This means that as a GP you should:

  • Demonstrate sufficient knowledge of the breadth of scientific evidence in order to provide the best information for patients about their illness
  • Use time and resources effectively during the consultation
  • Understand local referral pathways and services to ensure appropriate and efficient provision of care

Managing medical complexity

This is about aspects of care beyond managing straightforward problems. It includes multi-professional management of co-morbidity and poly-pharmacy, as well as uncertainty and risk. It also covers appropriate referral, planning and organising complex care, promoting recovery and rehabilitation.

This means that as a GP you should:

  • Use the consultation to educate patients about self-management of acute and chronic disease and be able to direct them to appropriate sources for further education
  • Demonstrate a commitment to health promotion within the consultation, while recognising the potential tension between this role and a patient’s own agenda
  • Understand that co-morbidity or disease progression may affect a patient’s decision-making capacity
  • Recognise and respond to a patient entering a terminal stage of illness, and the values that are important in managing this

Working with colleagues and in teams

This is about working effectively with other professionals to ensure good patient care. It includes sharing information with colleagues, effective service navigation, use of team skill mix, applying leadership, management and team-working skills in real-life practice, and demonstrating flexibility with regard to career development.

This means that as a GP you should:

  • Recognise the roles of health and social care colleagues and draw on this expertise appropriately
  • Use the ‘best possible evidence’ to inform patients of the ‘best possible’ way to navigate the healthcare system

Maintaining performance, learning and teaching

This area is about maintaining performance and effective CPD for oneself and others, self-directed adult learning, leading clinical care and service development, participating in commissioning, quality improvement and research activity.

This means that as a GP you should:

  • Understand the principles of evidence-based practice and how you can apply these principles, given the condition of the patient and the healthcare system
  • Demonstrate an awareness that a combination of evidence-based treatments is not always evidence-based in itself. Interactions between single interventions may increase or decrease efficacy
  • Explore patient values and place them in context with clinical evidence, so that you can develop an appropriate shared-management plan
  • Demonstrate an awareness of your own attitudes, values, professional capabilities and ethics so that, through the process of reflective and critical appraisal, you are not overwhelmed by personal issues and gaps in your knowledge
  • Undertake self-appraisal through such things as reflective logs and video recordings of consultations, and seek out opportunities for your educational development based on this
  • Understand the common models of the consultation that have been proposed and how you can use these models to reflect on previous consultations in order to shape your future consulting behaviour

Organisational management and leadership

This is about the understanding of organisations and systems, the appropriate use of administration systems, effective record keeping and utilisation of IT for the benefit of patient care. It also includes structured care planning, using new technologies to access and deliver care and developing relevant business and financial management skills.

This means that as a GP you should:

  • Keep accurate, legible and contemporaneous records
  • Effectively use patient records (electronic or paper) during the consultation to facilitate high-quality patient care

Practising holistically and promoting health

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

This means that as a GP you should:

  • Be able to explain the concepts of ethnicity and culture
  • Include the cultural values and circumstances of your patient in the consultation
  • Understand the process by which patients decide to consult, and how this can affect consulting outcomes
  • Understand that consultations have a clinical, a psychological and a social component, with the relevance of each component varying from consultation to consultation (the ‘triaxial’ model)
  • Recognise that episodes of illness usually affect more than merely the patient
  • Understand the relationship between the interests of patients and the interests of their carers
  • Negotiate whether and how relatives, friends and carers might become involved, while balancing your patient’s right to confidentiality
  • Understand that your patient’s views and perspectives may change during the course of a chronic disease
  • Accept that patients may wish to approach health (and illness) in a non-scientific way. The reality for patients is that they make their own choices on the basis of their own values and not necessarily on the basis of clinical efficiency or resource implications
  • Accept that patients may prefer to delegate their autonomy to you as their GP, rather than accept this responsibility themselves

Community orientation

This is about involvement in the health of the local population. It includes understanding the need to build community engagement and resilience, family and community-based interventions, as well as the global and multi-cultural aspects of delivering evidence-based, sustainable healthcare.

This means that as a GP you should:

  • Be aware of the obligation to use available healthcare resources in a prudent manner, balancing individual patient needs with fairness to other patients
  • Manage the potential conflicts between personal health needs, evidence-based practice and public health responsibilities
  • Recognise that socio-economic deprivation is a major cause of ill health
  • Understand how the values and beliefs prevalent in the local culture impact on patient care
  • Understand how the demography and ethnic and cultural diversity of your practice population impact on the range and presentation of illness in the individual consultation
  • Identify lessons from individual consultations, such as unmet health needs and gaps in service provision, and use these to develop appropriate services for the community as a whole.
  • Recognise how consultations conducted via remote media (telephone and email) differ from face-to-face consultations, and demonstrate skills that can compensate for these differences
  • Understand interprofessional boundaries with regard to clinical responsibility and confidentiality

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