There are 13 core capabilities to meet whilst training, all relevant to working with mental health in general practice settings.
The RCGP’s Topic Guide explores part of the RCGP Curriculum: ‘Being a General Practitioner’. The guide uses question prompts to trigger reflection for each core competency, specifically thinking about mental health.
Trainees are encouraged to make such reflections after visiting a service and engaging in work-based learning.
The Topic Guide states that ‘As a Speciality Trainee, primary care is the ideal place to learn about the GP consultation in practice. There will also be excellent opportunities in secondary care settings’.
1: Fitness to practice
- What are the boundaries of my involvement and responsibilities relating to a case I have seen today?
- How do I maintain my own health as a GP?
- What is meant by ‘resilience’?
2: Maintaining an ethical approach
- How do I feel about patients consulting me with complex psychosocial and mental health problems?
- How do I deal with my feelings about working with patients who are distressed?
- What are the relevant sections from Good Medical Practice?
3: Communication and consultation
- How might mental health problems affect communication between doctor and patient?
- How do I achieve empathy and understanding of mental health issues?
- How do my own feelings affect my interactions?
4: Data gathering and interpretation
- What is the differential diagnosis in this case?
- What elements of the patient’s narrative and biographical data point to risk factors for depression?
- How do I sensitively assess alcohol and drug misuse?
5: Clinical examination and procedural skills
- What clinical assessment tools for depression and anxiety are appropriate for use in Primary Care?
- What are the essential ‘red flag’ symptoms and signs for depression and anxiety?
- How would you assess suicide risk in this patient?
6: Making diagnoses and decisions
- How do I differentiate between organic and psychological symptoms?
- Am I familiar with variations and patterns of presentations of common mental health conditions?
- How might time and continuity influence my decisions?
7: Clinical management
- What are the important evidence-based guidelines for management of mental health issues in Primary Care?
- When and how should I refer to specialist services?
- How do I manage continuity of care, response to treatment, and regular monitoring?
8: Managing medical complexity
- How does pre-existing or comorbidity affect the presentation of mental health conditions?
- What conditions have most significant implications for medical management and drug treatment?
- What are the priorities for ensuring patient safety?
9: Working with colleagues and in teams
- What alternative interventions and therapies are available in Primary Care?
- How do we create seamless multi-disciplinary services in this field?
- How do we define areas of responsibility and leadership in mental health services?
10: Improving performance, learning and teaching
- What are the best sources of updated information in Mental Health?
- What is the role of peer group support e.g. Balint groups?
- How can I audit the standard of care I provide?
11: Organisational management and leadership
- What additional risk factors should I screen for in patients with mental health conditions?
- What systems do I need to be in place to ensure safe and consistent monitoring?
- How do we develop services to provide ready access to marginalised/stigmatised members of society?
- What are the advantages and disadvantages of ‘self-referral’ systems?
12: Practising holistically, safeguarding and promoting health
- What are the important determinants and influences on mental health?
- How does my role extend beyond the medical model?
- How well equipped am I to explore cultural and spiritual factors in patients’ lives?
- Why might patients be reluctant to access psychological services?
13: Community orientation
- How can I ensure equity of access to mental health services?
- What community resources are available for my patients with mental health conditions (including the third sector)?
- How do I ensure that I understand and recognise the cultural issues in my practice population?
- Are there any support groups specifically for patients from certain cultural groups?
- What might the role of advocacy services be in these sorts of situation?