Recognising deterioration
Revise abnormal observations, altered mental state, poor perfusion, respiratory compromise, rapid progression and when a patient needs emergency transfer.
MRCGP AKT urgent and unscheduled care revision
Urgent-care questions test whether you recognise the unsafe patient early: sepsis, acute deterioration, anaphylaxis, chest pain, acute abdomen, OOH triage and clear safety-netting.
Quick answer
For AKT urgent and unscheduled care revision, prioritise sepsis, acute deterioration, NEWS2 as an adjunct, anaphylaxis, acute asthma, chest pain, acute abdomen, OOH triage and safety-netting.
What to revise first
Sepsis decisions
Know adult, child, pregnancy and recently pregnant sepsis risk features, why normal early observations can mislead, and when same-day escalation is unsafe to delay.
NEWS2 and judgement
Use NEWS2 as an adjunct to clinical assessment. AKT stems often test the unsafe patient where a score should not override deterioration, context or gut concern.
Anaphylaxis
Focus on early IM adrenaline, positioning, oxygen, fluids, repeated adrenaline if needed, observation, two auto-injectors and allergy referral after recovery.
Acute abdomen and chest pain
Cover peritonism, bowel obstruction, ruptured AAA, ectopic pregnancy, ACS, pulmonary embolism and when primary-care reassurance is unsafe.
OOH triage and safety-netting
Revise telephone triage limits, home-visit decisions, explicit safety-net advice, documentation and when diagnostic uncertainty requires face-to-face assessment.
Red flags to recognise quickly
- Suspected sepsis, mottled or ashen skin, non-blanching rash, new confusion, poor perfusion or rapidly worsening illness
- Severe breathlessness, hypoxia, exhaustion, inability to speak in sentences or silent chest
- Chest pain with sweating, collapse, severe breathlessness, haemodynamic instability or high-risk ECG features
- Acute abdomen with guarding, rebound tenderness, persistent vomiting, obstruction signs, pregnancy risk or collapse
- Anaphylaxis features: airway swelling, wheeze, hypotension, collapse or rapidly progressive systemic allergic reaction
- Safeguarding concern, unsafe home situation, carer inability to cope or patient unable to follow safety-net advice
Why this topic catches candidates out
The trap is over-managing uncertainty in primary care when the scenario needs escalation. AKT stems often test whether you can stop, recognise risk, call for help and document a clear plan.
AKT urgent care FAQ
Is urgent and unscheduled care tested in the MRCGP AKT?
Yes. Urgent and unscheduled care is a named RCGP curriculum topic. AKT questions test sepsis, acute deterioration, anaphylaxis, acute abdomen, chest pain, OOH triage, safety-netting and escalation decisions.
What should I revise first for AKT urgent care?
Prioritise sepsis recognition, NEWS2 as an adjunct, emergency red flags, acute asthma, anaphylaxis, chest pain, acute abdomen, same-day triage, telephone assessment limits and safety-netting.
Should NEWS2 replace clinical judgement in AKT questions?
No. NEWS2 supports recognition of acute deterioration, but AKT questions often test whether you escalate because the whole clinical picture is unsafe, even when a single score or observation is not definitive.
How does urgent care differ from minor illness revision?
Minor illness revision focuses on common self-limiting presentations and prescribing thresholds. Urgent and unscheduled care focuses on deterioration, red flags, out-of-hours triage and emergency escalation.
Official sources
This is revision guidance, not official RCGP advice. Check current RCGP, NICE, Resuscitation Council UK, local urgent-care pathways and BNF guidance for clinical decisions. Last reviewed June 2026.
October sitting
Oct 26
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