Becoming a GP with Extended Role

A GP should be able to demonstrate:

• evidence of a CCT or equivalent in general practice
• evidence of being currently registered and licensed and in good standing with the GMC
• evidence of continued practice in a primary care role on a performers list (or equivalent) and active engagement in an annual medical (whole scope of practice) appraisal.

The GPwER should keep a record to demonstrate that the requirements of the extended role have been met, including the following:

• evidence of the acquisition of the core knowledge relevant to the extended role, including any relevant and appropriate academic qualifications 
• documented experience, and supervised training, within the specialty area of the extended role. It is important to include the name, scope of practice and qualifications of the clinical supervisor within the extended role
• evidence of the acquisition of the core skills relevant to the extended role, including appropriate supervised demonstration of competence (often indicated by sign-off within a logbook, or an equivalent direct observation of skills)
• evidence of positive feedback that affirms the individual’s communication and teamworking skills, and ability to provide an appropriate standard of practice in the extended role
• a structured reference from the clinical supervisor that covers all intended clinical areas of competence within the extended role.

For a new GPwER, a training record and logbook for reflection can be countersigned as appropriate by a clinical supervisor as new skills are gained. In some extended roles, particularly where there is a training requirement for supervised practice and Workplace-Based Assessments, a joint clinic with a clinical supervisor would be recommended for the GPwER in training.

A note on clinical guides and clinical supervisors

A clinical supervisor will support you through your training and demonstration of initial competence to begin practising as a GP with an extended role. 

A clinical guide should support you to review your extended role practice and help you demonstrate continued competence in the area.

In both cases, they will be either an experienced and practising GPwER in the specialty or a Specialist in this field.

Evidence required for some roles are detailed in an RCGP extended role framework. These include information on:

• The roles and services to be provided by the GPwER
• The support and facilities the GPwER will require
• The core competences for the extended role
• Evidence required to demonstrate initial competence
• A summary of how skills are acquired and under whose supervision, and how competence is assessed
• Details of how the role is accredited, where this is applicable  
• Supporting information to be provided at the (whole scope of practice) annual medical appraisal to demonstrate continued competence in line with GMC requirements for every scope of work
• Sustainability and environmental considerations in relation to the extended role
• Equality, diversity and inclusivity considerations in relation to the extended role

The GMC’s Good medical practice (GMP) explains (in paragraphs 1,2,3, and 101) that doctors must be competent in all aspects of their work and recognise and work within the limits of that competence. Additionally, GMP explains that doctors must be supervised appropriately for the work they're carrying out, and that their training, knowledge and skills must be up to date with guidelines and developments relevant to their work.

Doctors also need to make sure they have appropriate insurance or indemnity covering the full scope of their practice and review this regularly.

The RCGP’s general position is that, providing they are appropriately trained and supervised, GPs should have flexibility in how they demonstrate competence in an extended role. However, there may be some roles that require a particular postgraduate certificate, diploma or dual specialist registration, either because of legal or contractual requirements, or the law in the country in which a GP undertakes an extended role. 

In limited circumstances, the College may take a view that a certificate of participation in training, postgraduate letter of competence, review of a portfolio of supporting information, or diploma, or having dual accreditation should be a requirement for an extended role because of a particular need for consistency in that specialism. 

Ultimately, employers or service commissioners determine the requirements for a GP to undertake an extended role, so we would encourage members to discuss expectations in relation to demonstrating competence with them. 

The College’s position is that ongoing membership of, and recertification with, external bodies must be optional and not mandated for continued practice in an extended role. 

With appropriate inputs, the annual, whole scope of practice medical appraisal process, rather than periodic re-accreditation, is the established route for GPs to demonstrate continued competence in their extended role.

The evidence that a GPwER is keeping their requisite knowledge and skills up to date and maintaining their competencies should be reviewed through the GPwER’s annual whole scope of practice appraisal. Through reflection on appropriate supporting information in the appraisal portfolio, supplemented by additional evidence of reflection in the appraisal discussion, four key questions should be answered by the GPwER:

1. What do you do in this part of your scope of practice?
   • What does your GPwER role entail?
2. How do you keep up to date for this part of your scope of practice?
   • What continuing professional development (CPD) have you done that is relevant to your GPwER role and what have you learned as a result? 
   • How have you implemented this new learning in your role?
3. What review have you done of this part of your scope of practice and what difference has it made?
   • How do you know that your performance in your GPwER role is effective and safe? What have you done to improve the quality of your work and how successful have those changes been? 
   • Have there been any significant events and, if so, what has been learned and changed as a result?
4. What feedback have you received on this part of your scope of practice and what difference has it made?
   • What feedback have you personally solicited about your performance in your GPwER role including colleague and patient feedback as required by the GMC? What unsolicited feedback, in the form of complaints and compliments, have you received in your GPwER role? 
   • What other feedback about your work in your GPwER role have you received and reflected on? 
   • For all forms of feedback, what have you learned and changed as a result?

The GMC’s requirements for supporting information for appraisal and revalidation must be met for the GPwER scope of practice. This means that the annual appraisal portfolio should include the supporting information included below:

• CPD
• quality improvement activity (QIA)
• significant events
• patient feedback
• colleague feedback
• complaints and compliments.

Any clinical governance information collected by the organisation or employer should be provided to the doctor to reflect on. Where possible, an annual performance development review should be facilitated by a clinical guide working in the relevant extended role area. This information and review should be reflected on in the annual medical appraisal.

GPwERs should also include supporting information providing quality assurance - generally, this will be an audit or a consecutive and representative sample of outcomes audit. Depending on the specific role, and any contract for performing it, this may be an annual requirement.

GPwERs should collect patient feedback on the extended role at least once per revalidation cycle and provide evidence that they have reflected on that feedback. We recommend that GPwERs seek advice from their appraiser or RO team on whether these patients can be included in the survey for revalidation or whether they would like to see a separate survey of those patients.

If an extended role forms a very limited part of a GP's scope of practice, they have the option of using the Academy of Medical Royal Colleges 'factors for consideration' template (external PDF) to help demonstrate to themselves, their appraiser and their responsible officer that they remain safe, competent and up-to-date in this field of work.