1. Clinical care

Good clinical care must include:
• an adequate assessment of the patient’s condition, based on the
history and clinical signs and, if necessary, an appropriate
examination;
• providing or arranging investigations or treatment where necessary;
taking suitable and prompt action when necessary;
In providing care you must:
• recognise and work within the limits of your professional
competence;
• be willing to consult colleagues;
• be competent when making diagnoses and when giving or
arranging treatment;
GMC Good Medical Practice, paragraphs 2.1–2.3, 3.1–3.3

Providing competent assessment and treatment is at the heart of good
medicine. As a GP, you need to be skilful in acquiring information that relates
to your patient and his or her presenting problem. Where possible, you should
allow enough time so that you can assess problems that may underlie the
presenting problem.
You should have consulting skills which elicit sufficient clinical information for
diagnosis and management, achieving coverage of important areas including
difficult and sensitive ones. Your consulting style should be responsive to
individual patients’ needs, involving them in decisions about management.
You should carry out appropriate physical examinations. This does not mean
that every patient needs to be examined, or that patients need to be
examined on every occasion. However, you do need to put yourself in a
position in which you would be able to identify an important problem if one
was there. You should be particularly careful when assessing problems and
giving advice on the telephone, when serious problems are potentially more
easily missed or misdiagnosed.

 The excellent GP

- maintains his or her knowledge and skills, and is aware of his or her limits of competence
- takes time to listen to patients, and allows them to express their own concerns
- considers relevant psychological and social factors as well as physical ones
- uses clear language appropriate for the patient
- is selective but systematic when examining patients
- performs appropriate skilled examinations with consideration for the patient
- has access to necessary equipment and is skilled in its use
- uses investigations when they will help management of the condition
- knows about the nature and reliability of investigations requested and understands the results
- makes sound management decisions which are based on good practice and evidence
- has a structured approach for managing long-term health problems and preventive care.

The unacceptable GP

- has limited competence, and is unaware of where his or her limits of competence lie
- consistently ignores, interrupts, or contradicts his or her patients
- fails to elicit important parts of the history
- is unable to discuss sensitive and personal matters with patients
- fails to use the medical records as a source of information about past events
- fails to examine patients when needed
- undertakes inappropriate, cursory, or inadequate examinations
- does not explain clearly what he or she is going to do or why
- does not possess or fails to use appropriate diagnostic and treatment equipment
- consistently undertakes inappropriate investigations
- shows little evidence of a coherent or rational approach to diagnosis
- draws illogical conclusions from the information available
- gives treatments that are inconsistent with best practice or evidence
- has no way of organising care for long-term problems or for prevention