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Clinical skills - Ensure you stay competent as a GP

Using CPD knowledge to deliver excellent patient care is what really counts.

Ambulatory BP monitoring: GPs need to keep up to date with new technology to stay competent (Photograph: SPL)
Ambulatory BP monitoring: GPs need to keep up to date with new technology to stay competent (Photograph: SPL)

Determination to keep your knowledge and skills up to date and to provide high-quality care to your patients is the crucial driving force needed to stay competent as a GP.

Keeping up to date with new and changing knowledge about clinical management is the easy part. GPs need to be on top of:

  • New guidance as it comes out.
  • Changes to local service pathways enabling new diagnostic tests to be used.
  • Revising their practices' clinical protocols to improve clinical management.

Merely meeting the requirements for a successful annual appraisal is not a true test of competence - you must also put your CPD learning to good use in the consulting room.

Personal development plan
The personal development plan (PDP) you agree at your appraisal is useful for capturing the main topics you need to focus on, and for checking that you have covered those subjects. But your PDP is not enough as it goes only part of the way to directing your learning.

We all know that keeping up to date nowadays involves constant effort to learn about small items that may escape our attention, such as a new tool to confirm AF or early dementia, technology that is new to you, such as ambulatory BP monitoring (ABPM), or revisions to your clinical computer system.

You may have included chronic kidney disease (CKD) as a priority topic in your PDP, read up on it and attended a local CPD workshop. But are you applying that learning by improving BP control in patients with CKD and ensuring their eGFR is being checked twice or more a year?

Are you up to speed?

Consider these four examples:

1. Hypertension monitoring

The latest NICE guidelines for hypertension require ABPM or home BP monitoring (HBPM) to confirm that previously unidentified patients have hypertension. You need to know more about the types/applications of the various equipment.

Your practice will need to buy sufficient equipment and train the nurses appropriately to ensure capacity and capability to care for patients with suspected hypertension or to improve BP control and avoid the 'white coat' effect on patients.

A practice protocol should be agreed for selecting patients for review, fitting a patient with ABPM for 24 hours, retrieving the equipment and refitting it on the next patient, interpreting the tracings and acting on the findings.

For HBPM you would expect the patient to record at least two readings a day for a minimum four days per week.

Your competence should span patient selection, quality of delivery of the test/choice of test over HBPM or traditional care, interpretation of the findings and comparisons with readings taken at the surgery.

2. B-type natriuretic peptide (BNP) testing

BNP testing is another good example of the competency challenge. It has been available for a considerable time in secondary care, but not to all primary clinicians, although it is really useful for GPs to exclude heart failure.

You could take a patient's pulse rate opportunistically to detect AF and organise an ECG if you suspect an irregular pulse.

But you could also use a risk-scoring tool to predict an individual's risk of developing AF over the next 10 years.

3. High stroke risk

Why not learn about the CHADS2 and CHADSVASc tools to identify patients at high risk of stroke? And what about the associated online GRASP-AF tool to identify patients diagnosed with AF but not receiving warfarin?

Then you can integrate the tools into your practice when considering if prescribing oral anticoagulation is justified.

4. Adverse drug warnings

Adverse reaction warnings are published all the time. A competent GP not only needs to know about the possible adverse reaction, they must also judge whether the risk is sufficient to review all patients on the drug concerned and stop it or switch to an alternative. They must also be able to explain the absolute or relative risks to patients so that they can make their own decision about the drug.

Apply your knowledge
Being competent is about applying your knowledge and skills every day to every patient you see or manage.

To do that you need to up-rate your competence on a continual, rolling basis, both in relation to all the little changes in nationally accepted knowledge of best practice and to any evidence that your personal clinical practice is less than excellent.

Such evidence may be revealed by clinical audits or by benchmarking your clinical activity compared with reliable information about other GPs' activity (referrals to specific specialties, say) or feedback from patients or colleagues.


These further action points may allow you to earn more credits by increasing the time spent and the impact achieved.

  • Focus on a drug newly licensed for primary care use. Read the NICE guidance. Contact your local prescribing adviser, amend the relevant clinical protocol, inform the practice team and organise the clinical audit.
  • Ask a local consultant to peer review your interpretations of ABPM readings and your subsequent clinical decisions for 10 patients.
  • Roll out the GRASP-AF tool to your practice, reviewing all patients with an AF diagnosis who are not on warfarin to check if they should be.

Save this article and add notes with your free online CPD organiser at gponline.com/cpd

Take clinical tests and claim certificates for CPD at myCME.com/gp

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