MRCGP Syllabus competency based

Being able to recognise and manage medical conditions in the following broad categories:

	Common
	Preventable
	Treatable
	Potentially catastrophic, i.e. life-threatening or disabling
	Uncommon but serious
	Atypical or non-diagnosable
	Untreatable

Elucidating and evaluating a patient’s condition, based on information gathering (history and symptoms) and, when necessary, clinical examination (interpreting signs) and appropriate procedural skills and/or special tests

Knowing, evaluating, and being guided by, the appropriate evidence base

Demonstrating the ability to make competent clinical decisions (diagnosis) and selection of appropriate investigation and/or treatment and knowing when no investigation or treatment is indicated

Employing sound skill-based clinical judgement to assess the seriousness of an illness in order to prioritise care

Respecting the autonomy of patients as partners in medical decision-making

Recognising and working within the limits of one’s professional competence, showing a willingness to consult with colleagues, and where appropriate delegating or referring care to those who are recognised as competent

Performing consistently well and with a commitment to improving one’s competence

Practising ethically, honestly and with integrity, so that patients can safely entrust their lives and well-being to the doctor

Accepting the responsibility of being available and accessible to patients

Having a knowledge of, and assisting patients to access, additional sources of information e.g. alternative and complementary health care, local and national support groups, voluntary and self-help organisations

Treating the patient as a unique person

Being an advocate for the individual patient

Providing longitudinal or continuous care

Simultaneously managing both acute and ongoing problems

Integrating information on physical, psychological, social and cultural factors which impact on patients

Demonstrating an appropriately focussed assessment of a patients’ condition based on the history, clinical signs and examination

Demonstrating the appropriate use of equipment routinely used in general practice and a familiarity with the breadth of tests offered in secondary care

Emphasising where appropriate the self-limiting or relatively benign natural history of a problem and the importance of patients developing personal coping strategies

Managing uncertainty, unpredictability and paradox by displaying an ability to evaluate undifferentiated and complex problems

Managing conflict, e.g. those which may arise when making decisions about the use of resources, when the needs or expectations of the individual patient and the needs of a population of patients cannot both be fully met

Demonstrating awareness of individual and family psycho-dynamics and their interaction with health and illness

Balancing conflicting interests when having a dual responsibility, such as a contractual obligation to a third party and an obligation to patients

Showing a flexibility of approach according to the different needs of a wide variety of patients irrespective of their age, gender, cultural, religious or ethnic background, sexual orientation or any other special needs

Practising medicine which is wherever possible evidence based, with individuals and populations

Balancing clinical judgement against evidence-based practice as determined by individual patient needs

Co-ordinating and integrating care by flexibly adopting the various roles (clinician, family physician etc) of a GP in the course of ordinary practice

Recognising the GP’s frontline (‘gate-keeping’) role, both by facilitating patients’ access to specialised care and by protecting them from unnecessary interventions

Managing time and workload effectively, and setting realistic goals

Maintaining comprehensive written and computerised records

Being able to recognise and meet the doctor’s needs as a person including self and family care (‘housekeeping’)

Recognising and working within the limits of one’s professional competence

Being able to work effectively in a team, either as a member or leader, accepting the principles of collective responsibility, and to consult colleagues when appropriate

Respecting patients as competent and equal partners with different areas of expertise

Sharing decision-making with patients, enabling them to make informed choices

Respecting patients’ perception of the experience of their illness (health beliefs); their social circumstances, habits, behaviour, attitude to risk, values and preferences

Understanding the role of patients’ ideas, values, concerns and expectations in their understanding of their problems

Incorporating patients’ expectations, preferences and choices in formulating an appropriate management plan

Showing an interest in patients, being attentive to their problems, treating them politely, considerately, and demonstrating active listening skills

Demonstrating communication and consultation skills and showing familiarity with well-recognised consultation techniques

Establishing effective rapport with the patient

Responding to patients’ verbal and non-verbal cues to any underlying concerns

Being able to detect, elicit and respond to patients’ emotional issues

Being able to deal with patients’ difficult emotions, e.g. denial, anger, fear

Making links between emotional and physical symptoms, or between physical, psychological and social issues

Communicating and articulating with patients effectively, clearly, fluently and framing content at an appropriate level, wherever the consultation takes place, including by telephone or in writing

Involving patients’ significant others such as their next of kin or carer, when appropriate, in a consultation

Sensitively minimising any potentially embarrassing physical or psychological exposure by respecting patients’ dignity, privacy and modesty

Explaining to the patient the purpose and nature of an examination and offering a chaperone when appropriate

Where appropriate, facilitating changes in patients’ behaviour

Having an understanding of family or group dynamics sufficient to allow effective intervention in patients’ family contexts

Demonstrating an awareness of the doctor as a therapeutic agent, the impact of transference and counter-transference, the danger of dependency, and displaying an insight into the psychological processes affecting the patient, the doctor and the relationship between them

Understanding the factors, such as longer consultations, which are associated with a range of better patient outcomes

Demonstrating appropriate professional values and attitudes, including caritas; trustworthiness; accountability; respect for the dignity, privacy and rights of patients; concern for their relatives; and providing equity of care

Adhering to contemporary ethical principles

Observing and keeping up to date with the laws and statutory codes affecting general practice, e.g. the Mental Health Act, Disability Discrimination Act, Human Rights Act

Respecting the principle of confidentiality; and, if breaching it without the patient’s consent, being prepared to justify the decision 

Demonstrating a commitment to maintaining professional integrity, standards and responsibility

Ensuring that whenever possible the patient has understood what treatment or investigation is proposed and what may result, and has given informed consent before it is carried out

Applying guidelines for the treatment of patients under 16 years of age with or without the consent of those with parental responsibility

Demonstrating an awareness of issues relating to clinical responsibility, e.g. with regard to drug treatment or patients attending complementary practitioners

Acknowledging the ‘good Samaritan’ principle, i.e. offering to anyone at risk treatment that could reasonably be expected

Making appropriate use of available sources of advice on legal and ethical issues at individual, professional, local and national levels

Following guidance on doctors’ obligation to protect patients from a colleague’s poor performance, health or conduct

Respecting a patient’s right to a second opinion

Adopting safe practice and methods in the working environment relating to biological, chemical, physical or psychological hazards, which conform to health and safety legislation

Demonstrating an awareness of the doctor’s role in society as an advocate of good health

Understanding the concept of public interest

Displaying an ability to make decisions or interventions in the interests of a community or population of patients

Understanding current ideas concerning the relative rights and responsibilities of Government, the medical profession and the public

Understanding the concepts of health and normality, the characteristics of healthy people, the qualitative measurement of health, and models of health and disease

Knowing the conditions which constitute the main reasons for patients consulting in primary care, namely (in descending order of workload) respiratory, eye, ear, nose and throat, musculo-skeletal, psycho-social, dermatology, cardio-vascular and gastro-intestinal problems

Demonstrating an understanding of demographic and epidemiological issues and the health needs of special groups, and the way in which these factors modify people’s use of the health care services

Recognising the impact of adverse environmental factors on health, including poverty, unemployment, poor housing, malnutrition, occupational hazards and pollution

Possessing a working knowledge of population-based preventive strategies including immunisation, health screening and population screening.

Understanding the acceptable criteria for screening for disease, and applying the concepts of primary, secondary and tertiary prevention

Having a working knowledge of screening and recall systems

Recognising and using opportunities for individual disease prevention and promoting the positive aspects of a healthy lifestyle

Keeping clear, accurate, legible and contemporaneous patient records, which report the relevant clinical findings, the decisions made, the information given to patients (including by telephone), details of any drugs or other treatment prescribed (including repeat prescriptions), and advice about follow-up arrangements

Employing written communication skills to make referrals, write reports and issue certification

Ensuring that colleagues are well informed when sharing the care of patients especially to ensure adequate follow-up

Providing all relevant information about a patient’s history and current condition when referring a patient to a colleague

Ensuring that patients are informed about the information shared within teams and between those providing their care

Assisting patients who choose to exercise their right to review their clinical records

Having knowledge of, and the means to access, printed and electronic sources of medical data, information and advice

Applying population-based screening and recall systems

Making informed choices about the relative roles of paper-held and electronic data in practice

Making full and appropriate use of available information technology to facilitate clinical practice, audit, chronic disease surveillance

Using, where appropriate, computer links with outside agencies e.g. hospitals, Health Boards / Authorities, Primary Care Groups / Trusts

Maintaining an awareness of advances in health informatics, telemetric medicine and computing technology, and their application in improving the delivery of health care

Practising in such a way as to minimise the risk to patients of harm or error

Fully informing patients about their diagnosis, treatment and prognosis

Explaining why a treatment is being prescribed, or a management plan proposed, and the anticipated benefits and potential side effects

Discussing the advantages and disadvantages of alternative courses of action

Effectively communicating risk by exchanging information, preferences, beliefs and opinions with patients about those risks

Providing clear explanations of the nature of clinical evidence and its interpretation

Ensuring appropriate follow up arrangements and ‘safety-netting’

Improving patient safety by critical event reporting, clinical audit, analysis of patients’ complaints or information provided by colleagues

Responding to criticisms or complaints promptly and constructively, and demonstrating an ability to learn from them

Being aware of the obligations for notifying outside agencies, for example, regarding safety of medicines and devices to the Medicines Control Agency, and notifiable diseases

Demonstrating a commitment to professional audit and peer review

Using feedback and comments from patients to identify their needs and wishes, and using them to bring about improvements in service

Participating in, and responding constructively to, appraisals and assessments of professional competence including revalidation procedures

Demonstrating commitment to the principles of clinical governance, which is ‘designed to enshrine high standards of practice, quality assurance and service improvement’

Using information technology where appropriate as a tool for audit and quality control

Understanding and applying the principles and terms used in inferential statistics and evidence-based medicine
(See Research & Evaluation Appendix 3)

Applying critical appraisal skills, statistical interpretation and the audit cycle to evaluate and improve care
(See Research & Evaluation Appendix 3)

Demonstrating an awareness of local and national systems for monitoring standards of care

Having an awareness of the benchmarking tools (for example the Performance Analysis Toolkit) used to provide analysis of national inpatient data to review provider performance such as length of stay, readmission rates, waiting times and treatment costs

Demonstrating a commitment to lifelong learner-centred education and CPD through, for example, personal learning and development plans

Demonstrating a commitment to keeping up to date with evolving knowledge, news and thinking

Fostering skills of self-awareness and self-appraisal necessary to identify one’s own strengths, weaknesses and learning needs

Participating willingly and with candour in regular mentoring or appraisal

Offering non-judgmental feedback and advice to colleagues as part of their professional development

Using self-assessment and formal appraisal as a prelude to acquiring explicit competencies and skills

Possessing the skills and commitment to formulate practice development programmes

Undertaking teaching in its widest sense, including the education of patients, doctors in training and colleagues

Ensuring that patients have genuine choice over whether or not to participate in the education of students or doctors in training, and that their care is not thereby jeopardised

Understanding the interdependence of clinical practice, organisation, information management, research, education and professional development

Treating colleagues fairly, and not discriminating against them on grounds of gender, race, disability, beliefs or lifestyle

Ensuring that patients are not encouraged to doubt any colleague’s knowledge or skills by making unnecessary or unsustainable comments about them

Recognising and respecting the roles of other members of the extended primary care team and colleagues in the secondary, social and voluntary sectors and working with them to deliver a high quality of care

Maintaining professional relationships with colleagues in the private sector that best serve the interests of patients

Demonstrating an awareness of the contribution of complementary practitioners and the nature of therapies that patients may use or request

Demonstrating a commitment to team collaboration and working in a multi-professional environment

Having an understanding of team dynamics, leadership and where individual responsibility lies for clinical and managerial issues

Developing strategies for communicating effectively internally within the primary health care team and externally with other organisations

Demonstrating a commitment to staff development, education, appraisal and training including the ability to conduct needs assessments

Possessing an awareness of potential employer/employee issues

Working with colleagues in Primary Care Organisations, for example, to develop guidelines and protocols

Having a knowledge of the role of ancillary sources of primary health care, e.g. NHS Direct, ‘walk-in centres’, the private sector

Cooperating with any formal enquiry into the treatment of a patient, not withholding any relevant information, and assisting the coroner or procurator fiscal if an inquest or inquiry is held into a patient’s death

Understanding the duties and responsibilities of being registered as a doctor with the General Medical Council

Understanding the importance for both doctors and patients of ensuring adequate insurance or professional indemnity cover

Understanding the regulatory and contractual frameworks under which doctors practise within the NHS, e.g. the Medical Acts

Understanding and applying the main areas of legislation covering human rights, equal opportunities, disability, employment, data protection, access to medical reports, consumer protection, health and safety, children and child protection, abortion, births, deaths, controlled drugs, driving motor vehicles

Understanding the duties, rights and obligations of the doctor as employer

Applying and understanding social services regulations for certification, benefits and allowances

Demonstrating a critical awareness of socio-political dimensions of health, for example, health care systems, policy and funding

Possessing an awareness of the different bases on which a general practitioner may practise in the NHS, including the legislation regarding the criteria for inclusion on a Health Authority / Board principal or non-principal list

Demonstrating an awareness of standards and guidelines for health care and performance review, including those defined and promulgated by the relevant national bodies

Possessing an awareness of workload issues relating to general and personal medical services including activities such as surgeries, clinics, telephone consultations, home visiting, minor surgery, teaching, outside commitments and on-call, including data on consultation and referral rates

Contributing to the delivery of an integrated out-of-hours service in line with current regulations and recommendations regarding availability and accessibility

Understanding general practice as an organisation in its various forms (e.g. single-handed, group practice etc) and in a variety of settings (e.g. rural, inner-city, urban, academic)

Understanding the key features of partnership agreements and alternative models of employment in general practice including for non-principals

Knowing the range of career opportunities available to general practitioners, including research, education and assessment

Awareness of significant differences in statutory bodies and legislation between the four countries of the United Kingdom

Ensuring that the doctor’s and the practice’s fiscal and financial affairs are in good order, ethically sound, and fully compliant with the law and with good accounting practice

Ensuring that any financial arrangements with patients are on a sound footing, honest and open, and causing no conflict of interest

Avoiding inappropriate financial gain or conflict of financial interest in the pursuit of practice

Understanding the business and managerial aspects of practice, such as sources of income and expenditure, use of premises, marketing, and the interpretation of accounts

Demonstrating truthfulness and honesty when completing certificates and other documents

Ensuring that any research undertaken in practice is done to the highest standards, as approved by a research ethical committee, so that the care and safety of patients is paramount.

Providing accurate, objective, honest and unbiased comments in references and including relevant important information, which might have a bearing on a colleague’s competence, performance, reliability or conduct