Fitness to practice capability - GP trainee portfolio examples - WellMedic (2023)

This GP trainee guide forms the first of our new series of blogs focusing on GP trainee portfolio capabilities and how you can easily demonstrate competence in a hospital and GP placement.

This blog will cover fitness to practice and how this can be demonstrated within a hospital GP trainee placement and a GP placement.

If you’d like to recap the importance of GP trainee portfolio capabilities, please click here to read our reflecting guide, “A guide to help you with the GP trainee portfolio. Reflecting as a GP trainee.”

What will we cover?

What is fitness to practice?

Preparing for your self-rating.

How should I use the detailed descriptors?

GP trainee portfolio fitness to practice examples for a hospital placement.

GP trainee portfolio fitness to practice examples for a GP placement.

What is fitness to practice?

Let’s start with the official definition from the RCGP.

“This is about professionalism and the actions expected to protect people from harm. This includes the awareness of when an individual’s performance, conduct or health, or that of others, might put patients, themselves or their colleagues at risk.”

I’m going to break this down into a few components.

Who does this domain apply to?

Firstly and most importantly, it applies to you.

Secondly, it can also include your colleagues as long you’re able to reflect on their situation.

What does it cover?

Performance

I’ve always considered this to be work-related performance, am I working effectively and safely?

Conduct

How do I behave within the workplace?

Health

Are there any personal health-related issues that could be reflected on?

The three areas can be applied to your colleagues, are they effective and safe, how do they conduct themselves within the workplace, and do they have any health-related issues that can be reflected on?

How is this relevant?

The relevance of the fitness to practice capability is the most critical area that you need to consider. How does your or your colleagues’ performance, conduct, or health place you, your colleagues or patients at risk?

To consider risk, it’s well worth considering the difference between a hazard and risk.

A hazard could potentially cause harm, so this links directly into performance, conduct and health.

Whereas the risk is the degree of likelihood that harm will be caused.

Key take-home: Identify potential hazards and reflect on them!

Preparing for your self-rating.

Self-rating your performance in the RCGP WBPA capabilities underpins the importance of the GP trainee portfolio. If you’re already familiar with self-rating, feel free to skip this section!

Before your mid-point and full educational supervisor review, you will be asked to demonstrate complete coverage of the RCGP capabilities. This effectively means that you have to present evidence of each capability a minimum of three times per review.

Under the “ESR preparation” banner on your FourteenFish portfolio page, you will see circles representing thirteen capabilities and other circles representing clinical experience groups.

Once a link has been added and finalised by your educational supervisor in a learning log, or if a link has been added to your assessments, a grey circle will appear.

Once you link to a clinical experience group, it will appear as green.

When self-rating your performance, you must complete a form for each capability. Within this form, you will be asked to complete the following;

1. Your rating

You must select from; Needs further development, Competent, Excellent.

2. Evidence to support your rating

Within this box, you have to link to a maximum of three of your linked entries and justify why you’re using those entries as evidence.

We cover the importance of self-rating and examples of preparing for your ESR in our FourteenFish GP trainee portfolio support package.

Here is a really quick example, but we will come to some others shortly.

“I have demonstrated this capability within this entry as I have demonstrated insight into my personal health issue. I was suffering from insomnia following a close bereavement, and I realised that my lack of sleep would impact patient care, and I spoke with my team and arranged appropriate counselling.”

As you will realise, having to justify thirteen capabilities every six months is pretty tedious!

Key take-home: Write your justifications at the time of reflecting, and you can simply transfer the statement as evidence without having to re-write or re-justify how you’ve met the capability.

How should I use the detailed descriptors?

You can find the detailed descriptors once you select a capability within an entry. Which can be found under the show word descriptors heading.

Click here to access the summary tables provided by the RCGP.

If you’d like to demonstrate evidence without any dispute from your educational supervisor, I would encourage you to include the statement taken from the detailed descriptors within your justification.

Here is the “competent” justification for fitness to practice that I used in my earlier example.

“Demonstrates insight into any personal health issues.”

As you can see from the descriptor table for fitness to practice, there are four columns. I would strongly discourage linking to the underperformance! There isn’t anything wrong with linking to the “Needs further development” column as long as you’re then willing to acknowledge this in your self-rating and address progression in future entries.

Now that we’ve set the scene, let’s move on to the GP trainee portfolio examples for fitness to practice.

GP trainee portfolio fitness to practice examples for a hospital placement.

Fitness to practice example one – Arriving late to work

Brief description

The current medical rota requires us to be at the morning handover at 08:00 am. I cannot make the morning handover due to childcare commitments, which means I arrive at 09:00 am. I am unfamiliar with the new patients, so I am constantly trying to catch up with my jobs list.

Justification of the fitness to practice capability

I have demonstrated this capability by taking effective steps to address my personal circumstances that are impacting my performance as a doctor.

Given that the morning handover cannot be changed, I have managed to agree on an earlier drop off time with my child’s school for two mornings, for the other two mornings, a friend has agreed to drop my child off at school, and for the last day, I will arrive at work for 09:00 am.

Following this change, I have been more effective on the ward as I can start the ward jobs immediately after the ward round. I have found that this has also helped the wider team as there is an extra doctor present from 08:00 am.

Capability demonstrated

Takes effective steps to address any personal health issue or habit that is impacting on their performance as a doctor.

Fitness to practice example two – Counselling patients for a missed miscarriage

Brief description

During this rotation, I have been asked to counsel patients following a missed miscarriage. The treatments options are; expectant management, medical management or surgical management. I have found this to be extremely challenging as the patients are very upset and I am not comfortable with counselling patients having just started my gynaecology placement.

Justification of the fitness to practice capability

I have demonstrated this capability by encouraging scrutiny of professional behaviour, and by demonstrating my openness to constructive feedback.

I have demonstrated this by asking the gynaecology registrar to observe me directly counsel a patient with a missed miscarriage. Following this, we were able to discuss areas of improvement.

The registrar felt that I was overloading the patient with too much information and that I should focus on breaking bad news sensitively in the early stages. Following this, we can either offer the options immediately or allow the patient time and then return with information regarding management options.

Capability demonstrated

Encourages scrutiny of professional behaviour, is open to feedback and demonstrates a willingness to change.

Fitness to practice example three – Prescribing error

Brief description

During the morning ward round, I was reviewing the drug kardex for a patient clerked in by the night team with pneumonia. The patient had been prescribed the incorrect dose of IV antibiotics.

Justification of the fitness to practice capability

I have demonstrated this capability by providing positive support to colleagues who have made mistakes or whose performance gives cause for concern.

Having experienced something similar, I offered ongoing support to my colleague. We were both in agreement that there is significant understaffing for the night team and that we would approach our respective clinical supervisors to ensure that we could practice safely.

Capability demonstrated

Provides positive support to colleagues who have made mistakes or whose performance gives cause for concern.

GP trainee portfolio fitness to practice examples for a GP placement.

Fitness to practice example four – Rota adjustments

Brief description

Having failed the AKT during my ST2 rotation, I now have to prepare for my AKT and RCA during my ST3 GP placement. I am finding this stressful, and given my commitments to parenting, I cannot manage my time effectively. I have subsequently agreed to reduce my working hours to 80% on a less-than-full-time basis.

Justification of the fitness to practice capability

I have demonstrated this capability by achieving a balance between my professional and personal demands that meets my work commitments and maintains my health.

I felt that by continuing on a full-time basis, I was unable to allocate my time amongst my career commitments and the commitments I have as a father. This was becoming overwhelming, and the stress was affecting my performance as a doctor. I feel that the additional day away from work will help me manage my time better by reducing my hours.

Capability demonstrated

Achieves a balance between their professional and personal demands that meets their work commitments and maintains their health.

Fitness to practice example five – Not knowing what to do

Brief description

I have recently managed a patient with poorly controlled diabetes who has presented with faecal incontinence. Her emergency MRI scan is normal, and I am unable to explain her faecal incontinence fully. I suspect there is an element of diabetic enteropathy.

Justification of the fitness to practice capability

I have demonstrated this capability by taking advice from appropriate people and, if necessary, engaging in a referral procedure.

During this case, I first discussed the presentation with my clinical supervisor who agreed that the presentation could be secondary to poorly controlled diabetes. The patient accepted that this was a possibility but felt that she should have further investigations in secondary care.

I subsequently referred the patient to gastroenterology for their input. In addition to this, I felt that the bladder and bowel service could also offer their expertise to the patient to best manage incontinence and improve the patient’s health outcome.

Capability demonstrated

Takes advice from appropriate people and, if necessary, engages in a referral procedure.

Fitness to practice example six – General practice negativity

Brief description

As a practice, we have collectively felt the recent strain from our patients. Patients have been dissatisfied with the limited number of face to face appointments. We have tried to remain positive by encouraging staff to engage with a gratitude journal.

Justification of the fitness to practice capability

I have demonstrated this capability by encouraging an organisational culture in which the health of its members is valued and supported.

I recognised that many team members were struggling with the constant negativity, and we felt that a weekly group reflection around gratitude would help maintain a positive atmosphere within the practice. A small change within our weekly practice has helped remind us all that although there is some negativity, we are still making a huge difference to many patients.

Capability demonstrated

Encourages an organisational culture in which the health of its members is valued and supported.

If you’ve found this guide to be helpful, please share it with your colleagues!

WellMedic will continue to release similar guides for the other GP trainee portfolio capabilities. Click here to visit our blog.