🗣️ Communication Skills

📥 Some Good Introductory Resources

Handouts, summaries, and teaching extras — ready when you are.

🌐 Great Websites

A hand-picked mix of consultation skills resources — some well-known, some hidden gems. Because sometimes the best teaching material is not hiding behind a paywall.

Why Communication Skills Really Matter

You will hear, time and again, that communication skills are the bread and butter of General Practice. In the 1700s, "bread and butter" meant the basic necessities of life — the foundational, non-negotiable things you simply cannot do without. In GP, the consultation is exactly that. It is the fundamental thread that holds everything else together.

As a GP, virtually everything you do is delivered through a consultation. Your clinical diagnosis, your prescribing decisions, your health promotion, your ability to spot the frightened patient behind the smile — all of it flows through the medium of communication. A GP who has mastered consultation skills will find every other aspect of the job easier, more satisfying, and — critically — safer for patients.

General Practice is a specialty in its own right. You cannot simply take a qualified ophthalmologist and ask them to become a GP expert — any more than you could ask an accomplished GP to perform cataract surgery. (In the 1970s and 80s, hospital consultants could move into GP without specific training. Those days are long gone — and for good reason.) The GP consultation demands a unique set of skills: a blend of clinical reasoning, emotional intelligence, shared decision-making, and time management, all conducted simultaneously, in ten minutes, with a stranger. It requires intensive, specific training over several years. These pages exist to help you develop that expertise.

Consultation Skills vs Communication Skills

Many trainees use "consultation skills" and "communication skills" interchangeably. They are related, but not the same thing. Communication skills — active listening, empathy, explanation, use of language — form a large and crucial subset of consultation skills. But consultation skills also encompass clinical reasoning, time management, structuring the consultation, and decision-making.

Consultation skills include:

• Communication Skills — most of the topics on this page and in the downloads section
• Data-Gathering Skills — history, examination, investigations
• Decision-Making Skills — clinical reasoning, managing uncertainty
• Using the Computer in the Consultation — without letting it kill the rapport

Think of communication skills as the vehicle, and the consultation as the whole journey.

These pages focus predominantly on communication skills, while the broader consultation is addressed in our Consultation Models & Frameworks section.

Five Things to Hold in Your Mind Every Consultation

Regardless of which consultation framework you use, these five principles should run quietly in the background of every single consultation you conduct. They are your compass. Stray too far from any one of them and the consultation will feel wrong — even if you cannot immediately name why.

Developed from an e-discussion with Dr Vishal Naidoo, GP Educator, Cambridge, UK.

1. I — Intention. Remind yourself of your intention: to help the patient, and guide them through their medical journey, in order to reach a shared understanding. Not to diagnose quickly and move on. Not to fill in the electronic record. To genuinely help the human being sitting in front of you.
2. L — Listen to your patient. Use active listening, open questions, and appropriate silences to truly understand your patient. Try to withhold judgement on anything that is shared with you. Resist the urge to interrupt, redirect, or mentally compose your response while they are still talking. Listening is a clinical skill as much as auscultation.
3. R — Read your patient. Look at them and read their non-verbal cues. Does their body language marry with what they are saying? Pick up the slight flinch when a body part is mentioned, the eyes that well up when discussing a family member, the nervous laugh that does not match the words. Much of what patients communicate is never said aloud.
4. E — Engagement. The consultation should be bilateral — a two-way, sincere engagement between two adults. Not the parent–child relationship of days gone by. An open, relaxed posture, appropriate eye contact, genuine empathy, and confidence all signal to the patient that this is a safe space. The patient is seeking your expertise and your humanity.
5. D — Delivery. Reflect on the tone of your speech and the respect embedded in your manner. Pleasantness and respect go a very long way — particularly when delivering difficult information. Pleasantness is not weakness. It is a clinical tool.

Communication Skills — The Learning Pyramid

Communication skills build on each other. Start with the foundations, expand your toolkit, then develop the advanced skills that handle the truly challenging consultations. This is not a race — it is a progression over the course of your training.

Your Core Foundation Begin Here

First, get a consultation book — any of the recommended ones will do (see the Books section below). They will touch on most of what is on this page. But you will need to practise these skills, not just read about them. Do tutorials with your trainer. Practise on real patients. Video your consultations (with patient consent) and get your trainer or other educators to help you improve. And of course, work through the resources on this page.

Consultation Models, Frameworks & Time Management

A consultation framework is like a map. You do not have to follow it rigidly — experienced doctors can improvise — but without one, you are likely to find yourself lost. Think of a consultation without a framework as a train with no tracks: it can go in all directions at once, and it usually ends up somewhere unhelpful.

There are several well-established models. You need to find one that fits your personality, practise it until it becomes second nature, and then it will become so internalised that you will not even notice you are using it.

Expanding Your Toolkit — More Communication Skills

Once your foundations are solid, explore these areas to broaden and deepen your communication repertoire. Each represents a distinct skill that will make you a more effective, confident, and empathetic clinician.

Advanced Skills Level Up

Once your foundational and intermediate skills are embedded, these advanced areas will take your consulting to a higher level — particularly valuable for complex, challenging, or emotionally charged consultations.

A Note for Trainees from Abroad — A Gentle Paradigm Shift

This section is written especially for trainees who trained in countries where the consultation is predominantly doctor-centred — where the doctor speaks, the patient listens, and the idea of a patient challenging or questioning the plan feels, frankly, somewhere between rude and insubordinate. If this sounds familiar, please read on. This is one of the most important things you will read during your entire GP training.

In many medical training cultures around the world, the doctor's word is simply the final word. Patients come in, receive instructions, and are expected to comply. This model has a certain efficiency to it — you are, after all, the expert. You studied medicine for years. You passed the exams. You know what needs to happen.

And here is where Balint's concept of the "Flash" — a sudden moment of insight and understanding — becomes important. What if we told you that your medical expertise is actually only half of the picture?

The Mum Test

Imagine your mother comes to you feeling worried. She has been having chest pain and the doctor wants to send her for an angiogram. She is terrified. She has heard stories. She watched a neighbour go in for a similar procedure and, in her mind, never came out the same. She refuses. She is adamant.

Would you bark at her? Of course not. You would sit down. You would ask what she had heard, what she was afraid of, what would make her feel safer. You would listen — really listen — to her fears. And you would find a middle ground that respected both her fear and your clinical concern. You would involve her in the decision, because it is her body and her life.

Here is the thing: your patients are someone's mother, father, daughter, son. They carry the same human fears, the same need for dignity, the same right to understand what is happening to their own body.

Why Does This Matter for You Practically?

Consider this scenario. You prescribe a statin to a patient with high cholesterol. They come back three months later. Their cholesterol is unchanged. You never asked them why they might not want to take tablets. Had you asked, you would have discovered they had a terrifying experience watching their father deteriorate on multiple medications. In their mind, starting tablets means starting the slow descent towards death. They were not non-compliant. They were frightened and had no language to tell you.

Had you explored their ideas, their concerns, and their expectations, you would have unlocked this in the first consultation. You would have addressed the fear, negotiated a plan together, and they would have left feeling heard, understood, and far more likely to take the tablet.

Ironically, the doctor-centred approach — the one that feels quicker — is actually the one that wastes more time, because the problem never gets properly resolved.

But What About Respecting Cultural Differences?

A fair question. Some patients genuinely do prefer a more directive approach. But you cannot assume. The respectful thing is to check, not to assume. And even when a patient does defer to you, you still have a duty to ensure they understand what is happening and why.

A Last Thought — You Did Not Train to Be a Medical Vending Machine

You did not work this hard simply to dispense prescriptions and referrals. You trained to truly help people. That deeper, more satisfying version of medicine only becomes possible when you are genuinely curious about the person sitting in front of you. When you ask not just "What is the matter?" but "What matters to you?" The consultation becomes not a chore to get through, but the most interesting ten minutes of your day.

Welcome to patient-centred medicine. It is a bigger, richer, more human version of being a doctor. And once you have tasted it, you will not want to go back.

Resources for International Medical Graduates IMGs

If you trained outside the UK, some of the consultation approaches taught here may feel unfamiliar. This is entirely normal. The communication styles valued in UK General Practice have a strong evidence base and are well worth embracing fully.

For GP Trainers — Teaching Communication Skills

If you are a trainer, or an educator working with trainees, this section is for you. Knowing how to consult well yourself is only the first step. Teaching it to someone else is an entirely different skill.

🔥 AKT Exam Tips — Consultation Models AKT

The AKT regularly tests knowledge of consultation models and their theoretical underpinnings. The key is to know the core features of each model well enough to distinguish between them — the AKT loves questions that give you a clinical scenario and ask you to identify which model the doctor is demonstrating.

🎯 SCA Tips — Key Phrases for Every Stage SCA

The SCA is a high-stakes examination — but it is also an opportunity to demonstrate what good GP consulting looks like. Below are key phrases for every stage. These are not scripts to memorise verbatim; they are anchors — language patterns that, once made your own, will help you demonstrate each domain naturally and fluently.

A word of caution: the examiner is not looking for mechanical tick-box performance. If you robotically recite "I see — and what are your concerns about that?", it will feel artificial. The goal is to internalise these phrases so they come out naturally, in your own voice, at the right moment.

From the Trainee Community — Real Voices, Real Tips Peer Wisdom

💬 Advice from an SCA Trainee Who Passed with a High Score

The following is adapted from a detailed blog post by a GP trainee who passed the SCA with a high score in 2025. It is one of the most practical, honest pieces of peer advice currently available — written specifically for other trainees and IMGs.

Give yourself enough time

Start at least three months before your exam. But ideally, use the month before that three-month period to orient yourself: understand the exam format, speak to people who have already sat it, and get a feel for what is expected. That way, when the three-month clock starts, you can jump straight into practising rather than spending the first few weeks just getting your bearings. This pre-period is not revision — it is orientation.

Build a study group — or build a schedule

Having a consistent study group is key. Even if you start with just two or three people, make sure you have at least one or two partners you can practise with regularly. If you cannot find one single group, create your own schedule from a mix of different people:

Key study tips — what actually makes the difference

Aim to complete data gathering within 6 minutes. Start clinical management no later than 6 minutes. Round off by 10 minutes 30 seconds. This gives you ninety seconds for safety netting, follow-up, and any outstanding patient concerns — enough time for a proper, unhurried close rather than the rushed ending examiners notice immediately.

📝 Other Trainee Accounts — gptraining.info Community Blog

The site gptraining.info publishes first-person accounts from trainees who passed the SCA. The following tips are drawn from several accounts and are consistent with RCGP guidance.

Start with the RCGP website, not a course

Multiple trainees who passed first time report the same starting point: read everything on the RCGP SCA pages before doing anything else. One trainee who passed the first diet of the SCA in November 2023 (after failing the RCA by fifteen marks) reversed her approach — read everything first, then formed a study group, and passed first time. (Source: Dr Ranmini Weerasinghe, gptraining.info)

The phrase notebook — collect and internalise, don't script

Multiple trainees recommend keeping a physical notebook of phrases — not as a script, but to collect and internalise useful language. Try one new phrase in every other consultation rather than overhauling everything at once. Too many new phrases at once makes you sound mechanical — the opposite of what Relating to Others rewards. (Source: Dr Deepthi Lavu, RCGP Co-Chair/trainee blog)

The A4 whiteboard and silent timer

One trainee described: a silent timer at eye level beside the monitor; an A4 whiteboard with her eight-point consultation structure; a larger A3 board for jotting key patient info during data gathering — maintaining eye contact with the camera rather than looking down. She allocated two reading minutes to case notes, one to structuring her approach. She finished most cases with two minutes to spare. (Source: Dr Zebun Nahar, gptraining.info)

Ask about smoking, alcohol and PMH only when relevant

Examiners have specifically told candidates that not every case requires asking about smoking, alcohol, or past medical history. Asking these routinely wastes time and makes the consultation feel like a tick-box exercise. Ask when clinically relevant. Omit when not. This requires clinical judgement — which is precisely what the SCA tests. (Source: Dr Zebun Nahar, gptraining.info)

Use results consultations as specific preparation

A significant number of SCA cases involve results consultations — explaining blood tests, ECG changes, spirometry. In practice, trainees deal with results quickly. Treating each results conversation as a teaching moment directly prepares for a category of SCA case many candidates underweight. (Source: Dr Ranmini Weerasinghe, gptraining.info)

🎓 What UK GP Educators See Trainees Getting Wrong

From the WellMedic SCA preparation course (UK GP educators, updated 2024–25). Every item is consistent with RCGP examiner feedback. These are the standard reasons trainees underperform.

The delegation insight — a rarely-mentioned time-saver

Instead of personally covering lifestyle advice, medication counselling, and follow-up in exhaustive detail, briefly acknowledge each area and delegate: "The practice nurse can go through the medication in more detail — I'll book that in. What I want to make sure we've covered today is…" This is how real GP practice works and saves two to three minutes. (Source: Dr Irbaz, drerwinkwun.com, Oct 2024)

🎓 From the Examiners — What They Are Actually Looking For

Dr Anne Hawkridge (MRCGP examiner since 2007, co-author of the NW England Consultation Toolkit) organises SCA preparation into four themes:

From Bristol VTS examiner advice (SCA examiner training sessions — Bristol GP VTS / NHS England):

• The SCA is not primarily a knowledge test — that is the AKT's job. Reciting NICE guidelines at the patient scores poorly.
• Listen and respond to what the patient says — not what you expected them to say. Miss the cues, miss the marks.
• Make decisions based on probability — GP is the specialty of uncertainty. A candidate who needs seventeen investigations before deciding is demonstrating a hospital mindset.
• The SCA includes co-morbidity and complexity — expect to hold multiple threads simultaneously.

📺 UK GP Training YouTube Channels & Podcasts — A Curated Guide