Action Points for the
13 Professional Capabilities

🏥 Health, Wellbeing & Work-Life Balance

• Identify at least two sources of peer support you will use in your GP career — consider the RCGP First 5 programme or local peer support groups — and document your engagement with these in your ePortfolio for your first GP appraisal.
• Complete a reflective learning log entry looking back on how you have balanced work and the rest of your life during this post. Consider what has worked, what has been challenging, and what you would do differently.
• Write a learning log entry reflecting on stress management — including what strategies have worked for you and what you plan to do differently in your next post to protect your health.
• After completing your SCA preparation, make a conscious effort to become an integral part of the GP team, take on the same responsibilities as a salaried GP, and reflect on what this teaches you about sustainable workload and post-CCT planning.
• Consider how you spend informal time with reception staff, nurses, and colleagues. Reflect on the balance between professional obligations and the importance of not isolating yourself. Write this up as a log entry.

⚖️ Professional Conduct & Probity

• Document at least two cases where Good Medical Practice guidance directly informed your clinical or professional decision-making — write these up as learning log entries.
• Continue to write up SEAs and reflect on the outcome — include what you learned, what you would do differently, and how you would advise a colleague in the same situation.
• Add learning log entries that specifically address professional duties — consider a case involving a concern about a staff member, a potential breach of confidentiality, or a patient safety issue.
• Ensure you address tasks with the level of attention to detail expected of a professional, particularly around prescribing accuracy and completing administrative tasks in a timely way. Reflect on this in relation to three specific situations before the next ESR.

🤝 Supporting Colleagues

• Consider how you would demonstrate practical support for a colleague who is experiencing difficulties — whether personal, professional, or in relation to a complaint or error. Write a reflective entry on this.
• After your SCA exam, consider taking on a small leadership role in a specific clinical area within the practice — use this as an opportunity to demonstrate FtP from a professional standards perspective.
• Remember that this capability covers confidence, leadership humility, and peer support, not just patient safety. Write at least one entry demonstrating confidence in a non-clinical professional situation.

💡 Self-Awareness & Insight

• Reflect on the contrast between your self-reported confidence levels and the positive feedback in your WPBA assessments and MSF. Explore this gap in a learning log entry — why might your self-perception differ from others' perceptions?
• Reflect on your own learning log entries from this MSF — what specific comments have been made about stress management, and what concrete change will you make as a result?
• Complete the post-reflection document recommended by your ES as a structured way of looking back on how you have developed during this placement — link this to capabilities 9 (TW) and 12 (HPHS) where appropriate.

⚖️ Using Ethical Frameworks

• When writing up any learning log entry that involves an ethical dimension, explicitly identify the ethical framework or principle at play — beneficence, non-maleficence, autonomy, justice. Do not just describe what happened; explain the ethical reasoning behind your decision.
• Read Raanan Gillon's four principles of medical ethics and write a brief reflective entry applying them to a case from your current post. This has been discussed at your ESR and not yet evidenced in your ePortfolio.
• Choose two cases for tutorial discussion where you had to balance competing ethical principles — for example, patient autonomy versus risk of harm, or justice in resource use versus individual patient benefit. Discuss using the four principles framework and write these up as professional conversations.
• Consider practical ethical questions such as: What is the ethical framework around prescribing pen V — how much information about side effects and alternatives is required? Explore one such "everyday ethics" scenario in a CbD.

🔍 Specific Ethical Areas

• Identify which ethical dilemmas cause you the most difficulty in decision-making and explore why. Write a reflective entry on one such dilemma and what you have done or will do to build confidence in this area.
• In your next post, actively look for cases involving capacity, consent, and age-related ethical issues — these are particularly prominent in certain specialties. Document what you found and how you navigated them.
• Reflect on the ethics of immunisation refusal: What are the ethical principles involved? Is this a safeguarding issue? What can and should you do as a GP when a parent declines vaccination for their child? Write this up as a tutorial or learning log entry before the next ESR.
• Think about "actively promoting equality of opportunity" (from the excellent word picture for this capability) — reflect on two specific patients where this was relevant and consider what you did or what you could have done differently.

💬 Bringing Ethics Into Everyday Practice

• Rather than only looking for dramatic ethical dilemmas, consider requesting a tutorial in which your trainer presents a variety of ethical scenarios — similar to the old MRCGP viva format. This gives you a wider range of ethical reasoning experience in a safe environment.
• Routinely identify and name the ethical conflict or tension in your clinical encounters — even minor ones. This habit makes the EA capability far easier to evidence over time.
• Continue to maintain awareness of ethical conflicts in your practice and reflect on them. At your next ESR, be able to name three cases where you applied an ethical framework to a decision, not just felt uncomfortable and improvised.

🎬 Video & Consultation Review

• Review at least two consultations in detail — either alone or with a peer — and specifically identify: missed verbal and non-verbal cues (and what you could have done with them), missed opportunities to explore background and context, and moments where the consultation was circling without progress. Write up the learning from each as a learning log entry.
• Look at time management within the consultation and aim to complete consultations in ten minutes. Record the time taken for each section of five successive consultations. Review video consultations with your trainer and identify which parts of the consultation you most need to work on. Reflect on this in your ePortfolio.
• Use joint surgeries for SCA practice as well as COTs — COTs are relatively structured in their scoring and joint surgeries help you develop the "soft" consultation skills that are harder to assess formally. Document at least three joint surgeries through COT or learning log entries.
• Ask your trainer or joint surgery observer to give you specific feedback on your rate of speech. If trainees or examiners have mentioned it feels too fast, practise with your SCA preparation group and collect feedback. Write this up as a learning log entry with your reflection.
• Use role play during tutorials, joint surgeries, and debriefs to develop and genuinely own the phrases you use with patients. The goal is to build a personal repertoire of clear, comfortable language — not to memorise scripts. Try explanations out with non-medical friends who will challenge your wording and tone. Practise actively for the SCA, asking group members specifically to give feedback on clarity and pacing. Document what you learn from this in your learning log.
• Train yourself to be genuinely curious in every consultation. A useful mental image: imagine a close friend is telling you their symptoms. You would ask spontaneous, natural follow-up questions rather than moving mechanically to the next item on a clinical checklist. Picking up on something the patient mentioned earlier and returning to it later shows genuine attentiveness and uncovers the parts of the story that matter most. Practise this in real consultations and reflect on specific examples in your ePortfolio.

🗣 ICE, Empathy & Patient-Centred Skills

• Develop a consistent habit of exploring ICE (Ideas, Concerns, Expectations) and the impact of illness on patients and their carers in every consultation. Practice doing this within ten minutes. Reflect on when this has worked well and when you have struggled — document examples in your ePortfolio.
• Be curious — imagine a friend is telling you something and ask spontaneous follow-up questions. Don't just move to the next question on your clinical list. Show interest in what the patient is telling you. This builds rapport and demonstrates genuine empathy.
• Consider how you have adjusted your communication skills for particular patient groups — for example, teenagers, children, elderly patients, patients with learning disabilities, or patients discussing sensitive topics such as sexual health. Write at least one learning log entry on one of these consultations before the next ESR.
• Continue to develop the skill of identifying cues and sharing management plans in a way that feels collaborative rather than prescriptive — these are essential skills for working as a rounded GP and must be demonstrated in COTs as well as learning log entries.

✏️ Written Communication & Record-Keeping

• Demonstrate that you are consistently able to communicate in writing — in both patient computer records and your ePortfolio entries — so that colleagues can clearly understand your thinking and your plans. Take two patient records you have written recently and review them: Are they usable by others? Do they reflect your verbal communication skills?
• Improve the quality of your written English by drafting entries in Word first, running a spell check, and then pasting into your learning log. However, remember that patient records cannot be drafted offline — practise clear, concise written notes in real time.
• You must improve your written communication so that colleagues can clearly understand: what you think the problem is, what your management plan is, and what you intend to follow up. Clear written communication is a patient safety issue, not just a presentation one.

💬 Explanation & Shared Decision-Making

• Get RCGP case cards and practise explaining common conditions, investigations, and procedures to non-medical friends — ask for feedback on your clarity of explanation and write 2–3 learning log entries on what you learned from this process.
• Now focus on explanations: don't spend too long exclusively on the patient's agenda — while the patient's perspective is vital, you need to get to the explanation and negotiation part of the consultation too. Practise your explanations in front of a mirror or with non-medical friends.
• Move on to more advanced consultation techniques — managing different types of patients and adapting your consultation style appropriately. Reflect on this at least once in your ePortfolio before your next ESR. We can discuss different approaches and useful sources at your review.

📋 WPBA & Evidence

• Write entries having decided in advance which capability or capabilities you are intending to evidence — look at the relevant progression point descriptors — so that your ES or CS can easily validate the entries and confirm they provide evidence for this capability.
• Repeat the PSQ in your ST3 post 2 review period. Repeat the MSF in your ST2 post 3 review period.
• Before the next ESR, ensure there are at least three learning log entries where communication with patients or carers is the primary focus — plus one or two where communication with the team or other professionals is the focus. Reflect on what worked well and what you would do differently.
• Join an SCA preparation group to develop both communication and consultation skills further. Write 2–3 learning log entries reflecting on the learning from these sessions in relation to consultation skills.
• Continue to add learning log entries describing specific consultation skills used in real clinical encounters — not just in SCA practice cases.

🌍 Language & Hospital Posts

• Continue to practise English in as many settings as possible — consider watching English television, listening to the radio, and speaking with colleagues and family in English throughout the day. The evidence for this will be visible in the quality of your written entries in your ePortfolio.
• Consider how to continue developing communication skills during hospital posts by applying them to the specific patient populations in each specialty. Even in hospital, try to explore ICE where appropriate and document this in learning log entries.
• In your Paediatrics post, develop a strategy for communicating effectively with children and their parents — including three-way consultations. Write an early entry about how this feels initially, then plan to document your development.

🔬 Focused History & Examination

• Demonstrate through COTs and learning log entries that you can take a focused history and perform a focused clinical examination — not an exhaustive clerking.
• The challenge now is to ensure that history and examination are focused and succinct so there is enough time for sharing the diagnosis and management plan within a GP consultation. Record the time you spend on history and examination in ten successive new-diagnosis consultations and reflect on these in your ePortfolio.
• Continue to integrate data gathering with a fluid, patient-centred consultation style — data gathering should feel like a conversation, not an interrogation.
• Need to be able to identify when shortcuts are appropriate and when they are not. Be alert to subtle cues and red flags. Avoid asking routine questions on every topic — you will run out of time. Reflect on specific occasions when this went well and when it didn't.

📊 Investigations & Results

• Always ask yourself: what benefit does this investigation provide, and what are the risks (including radiation, false positives, patient anxiety)? Review this question in a CbD. Also consider the sensitivity and specificity of at least three common tests (for example, haematinics, HbA1c, D-dimer) as a learning log entry.
• Consider and document cases where your clinical examination led to an important referral (for example, an abnormal PR or PV examination) and you subsequently received a letter confirming the findings. Use this as evidence for this capability. Aim to include at least one such example over the next six months.
• Continue to provide evidence from learning log entries and WPBA that you have a structured and focused approach to gathering information and interpreting clinical signs and investigations appropriately.
• Write up cases that show your skills in data collection — including managing abnormal results or deciding which investigations are appropriate for a specific clinical problem.

🧠 Differential Diagnosis & Clinical Thinking

• Work on widening your differentials when taking a history. Consider writing down possible differential diagnoses for all new-diagnosis consultations and share these in debrief. Reflect on the discussions in your ePortfolio.
• After each new presentation, practise generating a differential diagnosis: start with a textbook-style list, then adjust for this particular patient — consider their age, sex, social class, and prior history. For example, a 30-year-old with chest pain has a very different differential from an 80-year-old with the same presenting complaint.
• Don't lose sight of the GP focus in data gathering. Some learning log entries are around unusual or exotic presentations. Focus on applying prevalence and prior probability in your thinking — what is most common in this patient population? Reflect specifically on this in your ePortfolio.

🏥 Hospital Posts & Special Populations

• In Paediatrics, data gathering often involves a third party (a parent or carer). Reflect on how these skills differ from adult consultations and the additional challenges this brings — especially in three-way consultations. Write up at least two such cases.
• Use your skills developed in hospital posts to consider appropriate levels of investigation in GP. Recognise that the GP approach is fundamentally different from secondary care — the threshold for investigation in primary care is not simply "lower" but qualitatively different.

🩺 Priority Examinations to Complete

• Gain more experience and ensure you are observed competently performing the GMC-required intimate examinations: PR (per rectum), prostate, male genital, female genital, and breast examinations. Don't leave these until the final months of training — opportunities can be unpredictable. Plan actively.
• Ensure you complete at least two CEPS assessments highlighting competence in examining babies, toddlers, and children over the next six months — particularly if your next post is Paediatrics.
• Concentrate on demonstrating that you can competently and efficiently perform musculoskeletal examinations — in your A&E post, there will be good opportunities for this.
• Continue to perform intimate examinations regularly in GP to maintain your skills. Consider completing CEPS assessments that specifically demonstrate competence in MSK and neurological examinations.

📋 Evidence & Linking to ePortfolio

• Remember that CEPS is like any other capability — it needs to be linked to your learning log, COTs, Mini-CEX, Clinical Supervisor's Report, and formal CEPS assessments. When you write reflective learning log entries, include reference to examination findings or procedural skills where they are relevant.
• When you refer a patient based on your clinical examination (for example, an abnormal PR or abnormal PV finding) and receive a letter confirming the findings, include this as part of your evidence for this capability — this is excellent supporting evidence. Aim to include at least one such case over the next six months.
• You must ensure you gain the skills and complete the CEPS requirements using every available opportunity — don't wait for the perfect case; plan with your trainer which examinations are still outstanding.

🔄 Adaptation & Reflection

• Look at the full progression point descriptors for CEPS and include at least one reflection on how you have adapted your examination technique to fit different circumstances — for example, patient preferences, limited mobility, patient anxiety, or the physical constraints of the examination room.
• Include at least one reflection on adapting your examination process for patients with limited capacity to participate — for example, patients with dementia, learning disabilities, or severe pain. This demonstrates the excellent level descriptor.

🧠 Clinical Reasoning & Differential Diagnosis

• After each new presentation, practise generating a differential diagnosis: start with a textbook-style list and then adjust for this particular patient — considering age, sex, social context, and prior history. You can do this with colleagues or alone. Ask: "What is most likely?" and "What is the one not to miss?" Reflect on using these two questions in your ePortfolio.
• You should be demonstrating that you can make decisions appropriate to the individual patient — showing you can think laterally and broadly and appropriately in relation to risk when considering differential diagnoses. Evidence needs to show this, not just describe it.
• Pick a patient you have seen acutely and followed over time as the diagnosis became apparent — write up the case showing how your differentials changed, how you used time, and how you managed the uncertainty between consultations.

❓ Managing Uncertainty

• Provide evidence in your learning log and WPBA of coping with undifferentiated conditions and managing diagnostic uncertainty. Choose CbD cases specifically to demonstrate this — cases where the diagnosis was not clear at the first consultation are ideal.
• Try and gain confidence in diagnosing and managing conditions with uncertainty — coping with uncertainty and making appropriate decisions with limited information are the foundation of good independent GP practice. Reflect on occasions when you have done this well — as well as when it has been difficult.
• It would be very helpful to see clinical encounter entries where you have seen a patient presenting early in an illness and how the picture developed over time — demonstrating how you managed not knowing and made safe decisions at each stage.

📊 Pattern Recognition & Prevalence Thinking

• Reflect in one or two learning log entries on how the prevalence and incidence of conditions helped you to recognise their pattern in a specific clinical encounter. Prevalence-based thinking is the core of GP diagnostic reasoning.
• You need to provide evidence of choosing CbD cases effectively for this capability — your current choices do not demonstrate your clinical reasoning clearly. Choose cases with more diagnostic complexity and write your write-up to make your thinking process visible, not just the outcome.
• When reflecting in your learning log, show your "working" — how and why did you make decisions the way you did? What other diagnoses did you consider? How did you weigh them up? What would you do differently next time?

📋 Retrospective Review

• Consider conducting a retrospective review of a series of your clinical encounters — looking at whether your initial working diagnosis was correct (based on any subsequent contact for the same problem) and what the outcome of any investigations you ordered turned out to be. This is a valuable quality improvement activity and would also contribute to your PLT evidence.
• More of the CbDs you choose should include positive proof of sound clinical reasoning — your trainer observing you in joint surgeries and videos is confident in your clinical thinking, but this is not always being captured in the WPBA you are choosing. Deliberately select cases that showcase your reasoning.

📋 GP-Specific Management Skills

• Consider how you can demonstrate using time as a diagnostic tool. Write up at least two cases where you deliberately used a "watch and wait" approach and reflect on what you were thinking, how you communicated this to the patient, and what happened at follow-up.
• Write a learning log entry reflecting on how you manage the uncertainty inherent in general practice and the challenges this presents when sharing management options with a patient — particularly when you cannot yet give a definitive diagnosis.
• You will need to consider how GP management differs from the hospital posts you have been used to — including the appropriate use of time, managing chronic conditions across multiple consultations, and when it is right to do less rather than more.
• Take opportunities to extend GP-relevant management learning in your next post. Use NICE pathways as a quick reference tool for common conditions. Document the learning in your ePortfolio.

🔄 Continuity of Care & Follow-Up

• Choose learning log entries focused on providing continuity of care for the patient as a person — rather than a single problem — especially in palliative care or complex chronic disease contexts. Include consideration of drug interactions, medication review, and side-effect management.
• It would be good to see more evidence of follow-up and the provision of continuity of care now that you are in a more permanent GP role. Consider preparing evidence of follow-up for your first GP principal appraisal.
• When you see a complex patient, it often takes several consultations to address all of their issues. Write up a clinical encounter entry after you have seen such a patient multiple times — show how you addressed all the issues, prioritised what to do first, and documented the ongoing plan. These patients also make excellent CbD cases.
• In Paediatrics, management is often distinctly different from adult medicine. Reflect on these differences and how your management approach adapts. Write an entry on, for example, managing paediatric asthma or DKA — including how you would adjust your management plan as circumstances change.

🎓 Independence & Seeking Advice

• Demonstrate that you can independently manage all types of patients and conditions you are likely to encounter in GP — evidence this through well-chosen clinical encounters and CbDs/COTs that show independent decision-making.
• Provide learning log entries that demonstrate logical thought processes when determining appropriate management plans. Entries need to demonstrate you can manage patients independently without seeking senior advice — while of course continuing to ask when patient safety genuinely requires it.
• When you do seek advice from a senior colleague, always write down your own thoughts and plan first — before you make the call. Then write up a learning log entry comparing the plan you had and the plan the senior person suggested. This is valuable reflective learning and demonstrates this capability well.

📚 Knowledge & Guidelines

• Improve your knowledge of the management of minor illnesses in GP — this is the bread and butter of the role. Demonstrate this in learning log entries exploring the natural history of common conditions and how you used this knowledge to reassure or guide a patient.
• Continue to expand your clinical knowledge base — this will directly help your management decisions. Use NICE pathways as a quick, visual reference. Provide learning log entries (clinical encounters and SEAs) that demonstrate logical clinical management.
• Review your range of management options for a condition before you see the patient — not just a single guideline-driven option. Develop the habit of considering two or three clinically appropriate approaches and then choosing the most suitable one for this patient. Document this flexibility in your ePortfolio.