Leadership and Management

Leadership and management questions test your knowledge of NHS structures, regulatory bodies, practice management, and professional responsibilities. These are often seen as dry topics, but they account for a meaningful portion of the AKT.

The Care Quality Commission (CQC) inspects and rates GP practices against five key questions: Is the service safe, effective, caring, responsive, and well-led? You should know the possible ratings (outstanding, good, requires improvement, inadequate) and what triggers a CQC inspection. Practices rated as inadequate may be placed in special measures.

Appraisal and revalidation are linked but distinct processes. Annual appraisal involves reflecting on your practice, reviewing CPD, reviewing significant events, and setting objectives. Revalidation happens every five years and is the GMC's process for confirming that a doctor remains fit to practise. The responsible officer makes a recommendation to the GMC based on appraisal evidence.

NHS structures are tested regularly. You need to understand the roles of NHS England, integrated care boards (ICBs), primary care networks (PCNs), and local medical committees (LMCs). ICBs replaced clinical commissioning groups in 2022 and are responsible for planning and commissioning healthcare for their population.

Employment law relevant to general practice includes understanding of salaried GP contracts, partnership agreements, locum arrangements, and the distinction between employed and self-employed status. The GMS, PMS, and APMS contracts govern how practices are funded.

Fitness to practise concerns involve understanding the GMC's processes, mandatory reporting obligations, and the duty to raise concerns about colleagues. The GMC can impose conditions, suspend, or erase a doctor from the register. You should know the threshold for referral and the difference between health concerns and conduct concerns.

Teamworking and delegation are tested through scenarios about skill mix, role boundaries, and appropriate delegation within the practice team including nurses, healthcare assistants, pharmacists, and social prescribers.