nmrcgp for consultants

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The Domains - what they really mean...

Before you look at your individual specialties, you need to get an overview of this first. Don't worry, you don't need to remember it, just get an understanding of it. It is this structure which we will use on this site to help define what is required from your specialty.

There are 6 competency domains for being a GP. The first three have their focal point on the primary care consultation. The remaining three (4-6) are more complex and take a wider perspective, going beyond the consulting room GP-patient interaction.

Some of these are subdivided into further compentencies to make them more specific and therefore understandable.

1. PRIMARY CARE MANAGEMENT	What this all boils down to:
1a) Clinical management: the recognition and management of common medical conditions in primary care. 1b) Working with colleagues and in teams: working effectively with other professionals to ensure patient care, including the sharing of information with colleagues. 1c) Primary care administration and IMT: the appropriate use of primary care administration systems, effective recordkeeping and information technology for the benefit of patient care.	- To manage primary contact with patients, dealing with unselected problems - To cover the full range of health conditions - To coordinate care with other professionals in primary care and with other specialists - To master effective and appropriate care provision and health service utilisation - To make available to the patient the appropriate services within the healthcare system - To act as an advocate for the patient.
2. PERSON CENTRED CARE	What this all boils down to:
Communication and consultation skills. This competence is about communication with patients, and the use of recognised consultation techniques.	- To adopt a person-centred approach in dealing with patients and their problems, both in the context of patient’s circumstances - To use the general practice consultation to bring about an effective doctor–patient relationship, always respecting the patient’s autonomy - To communicate, to set priorities and to act in partnership - To provide long-term continuity of care as determined by the needs of the patient, referring to continuing and coordinated care management.
3. PROBLEM SOLVING SKILLS	What this all boils down to:
3a) Data gathering and interpretation: the gathering and use of data for clinical judgement, the choice of physical examination and investigations, and their interpretation. 3b) Making a diagnosis / making decisions. This competence is about a conscious, structured approach to decision making.	- To relate specific decision-making processes to the prevalence and incidence of illness in the community - 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 - To adopt appropriate working principles (e.g. incremental investigation, using time as a tool), and to tolerate uncertainty - To intervene urgently when necessary - To manage conditions that may present early and in an undifferentiated way - To make effective and efficient use of diagnostic and therapeutic interventions.
4. COMPREHENSIVE APPROACH	What this all boils down to:
Managing medical complexity and promoting health: aspects of care beyond managing straightforward problems, including the management of co-morbidity, uncertainty, risk and the approach to health rather than just illness.	- To simultaneously manage multiple complaints and pathologies, both acute and chronic health problems - To promote health and wellbeing by applying health promotion and disease prevention strategies appropriately - To manage and coordinate health promotion, prevention, cure, care, rehabilitation and palliation.
5. COMMUNITY ORIENTATION	What this all boils down to:
Community orientation: the management of the health and social care of the practice population and local community.	- To reconcile the health needs of individual patients and the health needs of the community in which they live, balancing these with available resources.
6. HOLISTIC APPROACH	What this all boils down to:
Practising holistically: the ability of the doctor to operate in physical, psychological, socioeconomic and cultural dimensions, taking into account feelings as well as thoughts.	- To use bio-psycho-social models, taking into account cultural and existential dimensions.

All these 6 domains have a

7. Contextual Aspect

- Having an understanding of the impact of the local community, including socio-economic factors, geography
and culture, on the workplace and 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 home and work environment on the care that they
provide.

8. Attitudinal Aspect

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

8a) Maintaining an ethical approach to practice: practising ethically with integrity and a respect for diversity.

- Justifying and clarifying personal ethics

8b) Fitness to practise: the doctor's awareness of when his/her own performance, conduct or health, or that of others, might put patients at risk and the action taken to protect patients.

- 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
- Being aware of the interaction of work and private life, and striving for a good balance between them.

9. Scientific Aspect

Maintaining performance, learning and teaching: maintaining the performance and effective continuing professional development of oneself and others.

- 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 problemsolving;
preventative health care.
- Being able to access, read and assess medical literature critically.
- Being able to develop and maintain continuing learning and quality improvement.