Proposed core competences for GPwSI genetics - NHS National ...

A Competence Framework for General Practitioners with a SpecialInterest in GeneticsThis framework describes areas of competence for GPs with a special interest (GPwSI) in genetics. It isdivided into:- A. Core competences that a GP should demonstrate at appointment to a GPwSI genetics post- B. Core competences that a GP will need to attain after appointment- C. Project specific competences from which a GPwSI may draw, depending on the specific nature oftheir post.The competences cover the following areas:A. Core competences atappointmentB. Core competences afterappointmentC. Project specificcompetences1. Generalist2. Genetics including publichealth genetics7. Genetics including publichealth genetics12. Genetics including publichealth genetics3. Education 8. Education 13. Education4. IT 9. IT 14. IT5. Leadership 10. Leadership 15. Leadership6. Management 11. ManagementIt is anticipated that the core competences and project specific competences that the GPwSI in genetics willbe working towards after appointment will be used in the appraisal process. They may also be useful in theaccreditation process.Development of the framework• Start-up funding for up to ten GPs with a special interest in genetics was announced in the 2003Genetics White Paper 1 . Ten GPwSI Genetics projects were announced in March 2005. The posts arepart time, funded for three years.• Following a request from the Department of Health (DH) Genetics Team, the GPwSIs discussed‘Competences and Accreditation for GPs With a Special Interest in Genetics’ at their meeting facilitatedby the NHS National Genetics Education and Development Centre 2 on 17 th May 2006. An outlineframework indicating the key content areas was produced and each GPwSI project mapped thecompetences required for their own pilot project against this framework.• The resulting GPwSI competences were mapped against the DH GPwSI genetics framework 3 , and thegenetics curriculum statement for GP Registrars 4 by the Centre and a small working group (GiniLeggatt, Anna Stone and Melissa Martyn) produced a draft competence framework.• Following discussion of the draft framework by the GPwSI genetics group on 15 th November 2006, thisfinal version was prepared and agreed by the GPwSI meeting on January 17 th 2007.1 Our Inheritance, Our Future – Realising the potential of genetics in the NHS. Government White Paper. Department ofHealth (2003).2 www.geneticseducation.nhs.uk3 The General Practitioner with special clinical interest in genetics: framework document (Department of Health, 2004).4 ‘Genetics in Primary Care’ - curriculum statement 6 of the Royal College of General Practitioner’s GP Registrar trainingcurriculum (NHS National Genetics Education and Development Centre and the RCGP, 2006).GPwSI Genetics Competence Framework, January 2007 1

Proposed competence framework for GPwSI in geneticsAt appointment to a GPwSI genetics post, a GP will need to demonstrate wide experience as a generalist, experience or understanding of essential areas relevant tothe post and a willingness to learn. The holistic nature of family medicine practice allows the development of generalist skills, such as an understanding of thepsychosocial and ethical dimensions of care, which have particular relevance to the role of a GPwSI genetics. Other essential areas relevant to the post includebasic clinical and public health genetics, adult education, IT, leadership and management.After appointment, a GPwSI genetics will work towards obtaining more advanced core competences and additional specific competences required for their ownproject.Some sources of evidence for core competences are suggested in this framework but these are not requirements; GPwSI are free to select other types of evidenceto demonstrate attainment of the competences. Evidence for project specific competences will need to be identified in relation to individual projects.A. Core competences for a GPwSI in genetics at appointmentAt appointment, a GPwSI genetics should…COMPETENCE – at appointmentSUGGESTED SOURCES OF EVIDENCE INCLUDE:1. Generalist - Clinical and management skills demonstrated in general practice, for example,through annual appraisals.- Success in RCGP membership examination preferred but demonstration ofequivalent experience, expertise and commitment would be acceptable.- Actively working in general practice.- Completion of critical appraisal skills training, or attendance at journal clubs.a. Be a competent and experienced family medicine practitioner able todemonstrate wide generalist clinical experience and an understanding of theholistic nature of primary care practices.b. Be able to demonstrate critical appraisal skills.2. Genetics, including public health genetics - Evidence of genetics experience at undergraduate or postgraduate level or ofattendance at specific genetics courses.a. Meet the genetics learning outcomes described in the ‘Genetics in PrimaryCare’ curriculum statement.- Especially important for all potential GPwSI genetics is the ability todemonstrate skills in family history taking, risk assessment and effectivecommunication of genetic information and an understanding of theethical, legal and social implications of genetic information.GPwSI Genetics Competence Framework, January 2007 2

COMPETENCE – at appointmentSUGGESTED SOURCES OF EVIDENCE INCLUDE:b. Have an understanding of the structure of the genetics service, whichincludes the roles of different genetics professionals, what happens in agenetics consultation and local referral procedures.3. Education - GP trainer, teaching medical students, having been involved in training a practicenurse or having gained a postgraduate qualification in education.a. Be able to demonstrate experience in the teaching and training of healthcare professionals.b. Have an awareness of the structure of primary care education.c. Have an awareness of educational theory as it relates to the delivery ofeducation to health service professionals. This may include learning styles,teaching methods, presentation skills and evaluation.4. IT - Active GP in a computerised practice.a. Be able to use common primary care computing systems confidently.b. Be able to use standard software, such as word processing, presentationand email packages (e.g. Microsoft Word, PowerPoint and Outlook).c. Be able to use literature-searching software, for example PubMed.d. Be aware of useful on-line genetics resources.5. Leadership - Having set up new systems in general practice or in education, such as a GPregistrar training programme. It might also include leadership in areas outsidegeneral practice.a. Understand the local organisation of primary care.b. Provide evidence of leadership and networking skills.6. Management - Experience in staff management, audit, setting up and running specific clinics orbeing a committee member.a. Provide evidence of NHS management skills.b. Have an awareness of project management skills.c. Have a personal development plan for the GPwSI genetics role.GPwSI Genetics Competence Framework, January 2007 3

B. Core competences for a GPwSI in genetics after appointmentAfter appointment, a GPwSI genetics should…COMPETENCE – after appointmentSUGGESTED SOURCES OF EVIDENCE INCLUDE:7. Genetics, including public health genetics - Attendance at outpatient genetic clinics with evidence of reflective learningfollowing observation. Attendance at clinical genetics meetings. Active mentoringby a geneticist. Membership of a genetics professional society (BSHG) or aprimary care genetics peer network or attendance at the meetings of suchorganisations.a. Be able to demonstrate expanded clinical genetics knowledge andexperience.b. Be able to provide advice and support to other primary care practitioners onhow best to meet the needs of their patients with, or at risk of, a geneticcondition or with concerns about an inherited condition.c. Act as a contact point between primary care and specialist geneticsservices, which includes being able to assist practices to access specialistgenetics services appropriately.d. Demonstrate an understanding of current developments in genetics relevantto primary care practice.8. Education Evidence for these skills may be demonstrated through appraisal or project updatereports.a. Be able to use research methods to assess learning needs for geneticseducation in primary care.b. Be able to identify and make use of different educational methods toaddress the learning needs identified in primary care.c. Be able to evaluate these educational initiatives in relation to the learningneeds identified in primary care.9. ITa. Make regular use of on-line genetics resources.10. Leadership Evidence for these skills may be demonstrated through appraisal or project updatereports.a. Act as a ‘champion’/advocate/leader/ambassador for genetics within primarycare. This would include helping primary care practitioners understand theimpact of genetics and developments in genetics on their practice.GPwSI Genetics Competence Framework, January 2007 4

COMPETENCE – after appointmentb. Understand how genetics services are commissioned in the local area andthe role that primary care can play in delivering some of these services.SUGGESTED SOURCES OF EVIDENCE INCLUDE:11. Management Evidence for these skills may be demonstrated through appraisal or project updatereports.a. Develop advanced project management skills.- This may include specifying the scope, aims and objectives of a project,setting priorities and time scales, defining probable outcomes andmethods to evaluate the impact of a project, identifying barriers to thesuccess of a project and identifying resources needed for the successfulcompletion of a project, being able to re-define priorities in response tochange.b. Develop advanced management skills. This may include, for example,organising or chairing meetings, or managing others’ agendas duringnegotiations.GPwSI Genetics Competence Framework, January 2007 5

C. Project specific competences for GPwSI in geneticsAfter appointment, a GPwSI in genetics will need to develop additional, project specific, competences. Below are some suggested competencesdrawn from the pilot GPwSI genetics posts, which may help a future GPwSI in genetics to define the competences needed for their role.COMPETENCE – project specific12. Genetics, including public health geneticsa. Clinical Genetics:Have an advanced understanding of specific areas as dictated by the jobrequirements such as:- i. Common chromosomal anomalies: when to suspect them from a familyhistory or a clinical presentation, advanced understanding of the origins ofdifferent types of chromosome anomalies and their clinical consequences.- ii. Single gene disorders: inheritance patterns, when to suspect them from afamily history or a clinical presentation, characteristics of disorders commonin the practice population, principles of risk estimation for family members.- iii. Familial cancer genetics: the genetic basis of susceptibility to specificcancers, together with other factors that may influence the progression tocancer. Guidelines for referral. Advanced ability to assess patients basedon their family history (with or without the use of risk assessment tools).Advanced ability to communicate risk. Ability to manage low/ medium/ highrisk patients.- iv. Multifactorial inheritance: awareness of familial forms of commondiseases (e.g. breast and bowel cancer, Parkinsons disease) andknowledge of disorders with a genetic component (e.g. cerebrovasculardisease, Alzheimers, asthma).- v. Other genetic mechanisms that cause disease e.g. triplet repeats.- vi. DNA testing: uses and limitations of both those offered by the RegionalGenetics Labs and over the counter.- vii. Family history: be able to take a family history, draw a pedigree andinterpret it.- viii. Screening: uses for specific genetic conditions, knowledge of currentrelevant screening programs, prenatal screening.- ix. Advances within genetics: e.g. pharmacogenetics, PIGD.SUGGESTED SOURCES OF EVIDENCE INCLUDE:GPwSI Genetics Competence Framework, January 2007 6

COMPETENCE – project specificSUGGESTED SOURCES OF EVIDENCE INCLUDE:b. Clinical Service Applications:Provide direct clinical care to patients- i. alongside the Regional Genetics Service, or PCT commissioned- ii. for patients with a family history- iii. for patients with a specific genetic condition: possibly coordinating longtermcare for patients and families- iv. genetic testing for specific conditions: be able to interpret andcommunicate the results- v. advanced skills in communicating genetic information (geneticcounselling)- vi. advanced skills in assessment, management and communication of risk- vii. reassurance in primary care of those at population risk of a geneticcondition- viii. Pre-conception counselling: ability to identify couples at risk of geneticdisordersc. Public Health Genetics: - Clinical experience in a specialist genetic unit, providing a geneticsservice to specific populations within a community or acute trustsetting.i. Understand the role of public health in translating developments in geneticsinto practice.ii. Understand basic epidemiology applied to genetic disorders, includingunderstanding predictive values, sensitivity, specificity, prevalence andincidence.iii. Be familiar with sources of referral data, their usefulness and limitations.iv. Understand the commissioning process, and be involved in thedevelopment, planning and commissioning of genetics services.v. Have an advanced understanding of population genetic screeningprogrammes.13. Education including evaluationa. Be aware of research methods that can be used to assess local educationalneeds among primary healthcare professionals.b. Be aware of the needs of adult learners and different learning styles.c. Understand and be able to make use of different educational interventions/methods.GPwSI Genetics Competence Framework, January 2007 7

COMPETENCE – project specificd. Be able to utilise different settings/opportunities to provide education.SUGGESTED SOURCES OF EVIDENCE INCLUDE:e. Be able to select suitable methods to evaluate the success of educationalinterventions .f. Understand important issues in questionnaire design and be able toconstruct and pilot a questionnaire.g. Be aware of different methods of analysis of questionnaire data and be ableto analyse and evaluate data collected by questionnaire.i. Be able to handle referral data and interpret them appropriately.j. Understand the research governance framework and local and nationalprocedures.h. Be able to apply for ethics approval for a project.14. ITa. Have an understanding of website design: the issues involved in designingwebsites to support decision making with respect to genetic information at alocal level.b. Be able to use pedigree drawing packages.c. Be able to set up and use disease registers for genetic conditions.d. Be able to set up relevant genetic screening templates within commonprimary care conditions.e. Be able to liaise with local IT teams and the Regional Genetics Service todevelop the Genetics Service website for primary care.15. Leadershipa. Support and be involved in the development and implementation of localguidelines and protocols and the implementation of national guidelines acrossprofessional and organisational boundaries.b. Liaise with the Regional Genetics Service to develop appropriate accessstrategies for patients (development of new patient pathways).c. Be involved in the commissioning of genetic services.GPwSI Genetics Competence Framework, January 2007 8