THE DOMAINS OF COMPETENCE: Primary Care management

To manage primary contact with patients, dealing with unselected problems.

Knowledge of the epidemiology of problems presenting in primary care

Mastering an approach that allows easy access for patients with unselected problems

An organisational approach to the management of chronic conditions

Knowledge of conditions encountered in primary care and their treatment.

To cover the full range of health conditions

Knowledge of preventative activities required in the practice of primary care

Skills in acute, chronic, preventative, palliative and emergency care

Clinical skills in history-taking, physical examination and use of ancillary tests

to diagnose conditions presented by patients in primary care

Skills in therapeutics, including drug and non-drug approaches to treatment of these conditions

The ability to prioritise problems.

To coordinate care with other professionals in primary care and with other specialist

Knowing how NHS primary care is organised

Understanding the importance of excellent communication with patients and staff skills in effective teamwork.

To master effective and appropriate care provision and health service utilisation

Knowledge of the structure of the healthcare system and the function of primary care within the wider NHS

Understanding the processes of referral into secondary care and other care pathways

Skills in managing the interface between primary and secondary care including communication with other professionals.

To make available to the patient the appropriate services within the healthcare system

Communications skills for counselling, teaching and treating patients and their families/carers

Organisational skills for record-keeping, information management, teamwork, running a practice and auditing the quality of care.

To act as advocate for the patient.

Developing and maintaining a relationship and a style of communication that treats the patient as an equal and does not patronise the patient

Skills in effective leadership, negotiation and compromise

THE DOMAINS OF COMPETENCE: Person centred care

To adopt a person-centred approach in dealing with patients and their problems, in the context of patient’s circumstances

The basic scientific knowledge and an understanding of the individual, together with his or her aims and expectations in life

The development of a frame of reference to understand and deal with the family, community, social and cultural dimensions in a person’s attitudes, values and beliefs

Mastering patient illness and disease concepts

The skills and attitudes to apply these in practice.

To use the general practice consultation to bring about an effective doctor–patient relationship, with respect for the patient’s autonomy

Adopting a patient-centred consultation model that explores the patient’s ideas, concerns and expectations, integrates the doctor’s agenda, finds common ground and negotiates a mutual plan for the future

Communicating findings in a comprehensible way, helping patients to reflect on their own concepts and finding common ground for further decision-making

Making decisions that respect the patient’s autonomy

Being aware of subjectivity in the medical relationship, from both the patient’s side (feelings, values and preferences) and from the doctor’s side (self-awareness of values, attitudes and feelings).

To communicate, to set priorities and to act in partnership

The skills and attitude to establish a partnership

The skills and attitude to achieve a balance between emotional distance and proximity to the patient.

To provide long-term continuity of care as determined by the needs of the patient, referring to continuing and coordinated care management

Understanding and mastering the three aspects of continuity: personal continuity; episodic continuity (making the appropriate medical information available for each patient contact); and continuity of care (24 hours a day and 365 days a year)

The ability to help the patient understand and achieve an appropriate work–life balance

Utilising disease registers and data-recording templates effectively for opportunistic and planned monitoring of long-term conditions to ensure continuity of care between different healthcare providers.

THE DOMAINS OF COMPETENCE: Specific problem solving skills

To relate specific decision-making processes to the prevalence and incidence of illness in the community

Knowledge of the prevalence and incidence of disease

Knowledge of the practice community (age–sex distribution, prevalence of chronic diseases)

The skills to apply specific decision-making (using tools such as clinical reasoning and decision rules).

To selectively gather and interpret information from history-taking, physical examination and investigations, and apply it to an appropriate management plan in collaboration with the patient.

Knowledge of relevant questions in the history and items in the physical examination relevant to the problem presented

Knowledge of the patient’s relevant context, including family, social and occupational factors

Knowledge of available investigations and treatment resources

History-taking and physical examination skills, and skills in interpreting data

A willingness to involve the patient in the management plan.

To adopt appropriate working principles (e.g. incremental investigation, using time as a tool) and to tolerate uncertainty

Adapting skills and attitudes to demonstrate curiosity, diligence and caring

Adapting stepwise procedures in medical decision-making, using time as a diagnostic and therapeutic tool

Understanding and acceptance of the inevitability of uncertainty in primary care problem-solving and the development of strategies that demonstrate this.

To intervene urgently when necessary

Specific decision-making skills for emergency situations

Specific skills in emergency procedures that may occur in primary care situations.

To manage conditions that may present early and in an undifferentiated way.

Knowledge of when to wait and reassure, and when to initiate additional diagnostic and therapeutic action.

To make effective and efficient use of diagnostic and therapeutic interventions.

Knowledge that symptoms and signs vary in their predictive value, as do findings from ancillary tests

An understanding of the cost-efficiency and cost–benefit of tests and treatments.

THE DOMAINS OF COMPETENCE: A comprehensive approach

To manage simultaneously multiple complaints and pathologies, both acute and chronic health problems.

An understanding of the concept of co-morbidity in a patient

The skill to manage the concurrent health problems experienced by a patient through identification, exploration, negotiation, acceptance and prioritisation

Skill in using the medical record and other information

The skill to seek, and the attitude to use, the best evidence in practice.

To promote health and wellbeing by applying health promotion and disease prevention strategies appropriately.

The ability to understand the concept of health

The ability to promote health on an individual basis as part of the consultation

The ability to promote health through a health promotion or disease prevention programme within the primary care setting

Understanding the role of the GP in health promotion activities in the community

Understanding and recognising the importance of ethical tensions between the needs of the individual and the community, and acting appropriately.

To manage and coordinate health promotion, prevention, cure, care, rehabilitation and palliation.

An understanding of the complex nature of health problems in general practice An understanding of the variety of possible approaches

 The ability to use different approaches for an individual patient and to modify these according to an individual’s needs

The ability to coordinate teamwork in primary care.

THE DOMAINS OF COMPETENCE: Community Orientation

To reconcile the health needs of individual patients and the health needs of the community in which they live, balancing these with available resources.

An understanding of the health needs of communities through the epidemiological characteristics of their population

An understanding of the interrelationships between health and social care

An understanding of the impact of poverty, ethnicity and local epidemiology on a local community’s health

An awareness of inequalities in healthcare provision

An understanding of the structure of the healthcare system and its economic Limitations

An understanding of the roles of the other professionals involved in community policy relating to health

An understanding of the importance of practice- and community-based information in the quality assurance of each doctor’s practice

An understanding of how the healthcare system can be used by the patient and the doctor (referral procedure, sick leave, legal issues, etc.) in their own context

The ability to reconcile the needs of the individual with the needs of the community in which they live

An understanding of GPs’ role in the commissioning of health care.

THE DOMAINS OF COMPETENCE: Holistic approach

To use bio-psycho-social models, taking into account cultural and existential dimensions.

Knowledge of the holistic concept and its implications for the patient’s care

The ability to understand a patient as a bio-psycho-social ‘whole’

The skills to transform holistic understanding into practical measures

Knowledge of the cultural background and beliefs of the patient, in so far as they are relevant to health care

Tolerance and understanding of patients’ experiences, beliefs, values and expectations, as they affect healthcare delivery.

ESSENTIAL FEATURES OF THE DISCIPLINE OF GENERAL PRACTICE – Contextual aspects 

Understanding the context of doctors themselves and the environment in which they work, including their working conditions, community, culture, financial and regulatory frameworks

Having an understanding of the impact of the local community (including socio-economic and workplace factors, geography and culture) on patient care.

Being aware of the impact of overall workload on the care given to the individual patient and the facilities (e.g. staff, equipment) available to deliver that care.

Having an understanding of the financial and legal frameworks in which health care is given at practice level.

Having an understanding of the impact of the doctor’s personal housing and working environment on the care that he or she provides.

ESSENTIAL FEATURES OF THE DISCIPLINE OF GENERAL PRACTICE – Attitudinal aspects 

Based on the doctor’s professional capabilities, values, feelings and ethics

Being aware of their own capabilities and values

Identifying ethical aspects of clinical practice (prevention, diagnostics, therapy, factors that influence lifestyles)

Having an awareness of self: an understanding that their own attitudes and feelings are important determinants of how they practice

Justifying and clarifying personal ethics

Being aware of the interaction of work and doctor’s own private life, and striving for a good balance between them.

ESSENTIAL FEATURES OF THE DISCIPLINE OF GENERAL PRACTICE – Scientific aspects 

Adopting a critical and research-based approach to practice and maintaining this through continuing learning and quality improvement.

Being familiar with the general principles, methods and concepts of scientific research and the fundamentals of statistics (incidence, prevalence, predicted value, etc.)

Having a thorough knowledge of: the scientific backgrounds of pathology; symptoms and diagnosis; therapy and prognosis; epidemiology; decision theory; theories about the forming of hypotheses and problem-solving; preventative health care

Assessing medical literature, reading and assessing it critically and putting the lessons from the literature into practice

Developing and maintaining continuing learning and quality improvement.