Download A4Medicine Mobile App
Empower Your RCGP AKT Journey: Master the MCQs with Us! 🚀
GPs have a duty to:
Treat all patients with dignity and respect
Support patients to make informed choices about their care
Protect vulnerable people from abuse or neglect
GP trainees must understand how to:
Apply equality and diversity legislation
Assess mental capacity and obtain valid consent
Recognise and act on safeguarding concerns in adults and children
Support advance care planning
Tailor care for individuals with learning disabilities (LD), who often face health inequalities and may lack capacity
The Equality Act 2010 protects patients from discrimination and promotes fair access to healthcare. GPs must understand and apply this law to ensure inclusive, non-discriminatory practice.
Unlawful to discriminate based on protected characteristics
Applies to all healthcare staff and settings
GPs must reflect on personal biases and challenge discrimination
Especially important when caring for patients with learning disabilities (LD)
| Characteristic | Definition / Example |
|---|---|
| Age | All ages – young or old |
| Disability | Physical or mental conditions, including LD |
| Gender reassignment | At any stage of transition |
| Marriage & Civil Status | Married, civil partnered, or single |
| Pregnancy & Maternity | Includes pregnancy and breastfeeding |
| Race | Colour, nationality, ethnic or national origin |
| Religion or Belief | Includes atheism or lack of belief |
Accessible Information Standard (AIS) – Mandatory for all NHS services:
| âś… Requirement | đź’¬ Examples |
|---|---|
| Ask & record communication needs | Ask about preferred formats (e.g., braille, Easy Read) |
| Flag & share needs | Add alerts in records; inform other providers |
| Provide support | Offer interpreters, large print, visual aids |
| Train staff | Use quiet rooms, clear lighting, calm settings |
GPs must adapt care to reduce barriers:
Use simple language, visuals, or carers
Offer longer / quieter appointments
Avoid busy waiting areas
Involve family or advocates if appropriate
🔍 Equality Act 2010 requires these adjustments for disabled patients.
| 🧑‍⚕️ Who? | All patients ≥14 yrs on LD register |
|---|---|
| 🔍 Why? | Detect health issues early; promote wellbeing |
| 🔎 Focus | Epilepsy, constipation, dysphagia, mental health |
| 🧾 Extra | Review meds, vaccines, and offer tailored advice |
Confidentiality is a core ethical and legal duty. However, GPs must also know when and how to share patient information, especially for safeguarding or public interest. Understanding the types of consent, when to override confidentiality, and how to assess capacity is essential in safe, lawful practice.
| Consent Type / Basis | When Used |
|---|---|
| Implied Consent | For direct patient care: referrals, team communication, prescribing |
| Explicit Consent | Teaching, research, insurance, employment reports, non-clinical sharing |
| Disclosure Without Consent | Legal obligations (e.g. court, DVLA), public interest (serious harm), safeguarding |
Consent, Confidentiality & Capacity (Core Principles)
| Principle | Description |
|---|---|
| Patient involvement | Patients have the right to be involved and supported to make informed decisions. |
| Ongoing dialogue | Consent is a continuing process, not a one-off event. |
| Information and support | Provide understandable information and listen actively. |
| Exploring what matters | Discuss risks, benefits, alternatives—including doing nothing. |
| Presumption of capacity | Adults are presumed to have capacity unless proven otherwise. |
| Best interests | For those lacking capacity, act in their overall benefit with input from those close to them. |
| Legal constraints | Even where the law limits consent, involve the patient as much as possible. |
Advance Care Planning & Legal Frameworks Table
| Tool / Document | Created By | Legal Status | When It Applies | What It Covers | Key Points |
|---|---|---|---|---|---|
| ADRT (Advance Decision to Refuse Treatment) | Patient (≥18, with capacity) | Legally binding | When patient lacks capacity | Refusal of named treatments in specific situations (incl. CPR) | Must be valid & applicable. Life-sustaining refusals: written, signed, witnessed |
| Advance Statement | Patient | Not legally binding | When patient lacks capacity | Preferences, values, general wishes about care | Guides best interests decisions; should be considered |
| DNACPR (Do Not Attempt CPR) | Doctor (with patient input) | Not legally binding | During cardiac or respiratory arrest | CPR only | Clinical decision; not blanket-applied; consult patient/family where possible |
| ReSPECT Form | Patient + clinician | Not legally binding | Emergencies when patient can't communicate | Broader emergency care; what to give or avoid | Supports rapid, personalised planning; must be reviewed regularly |
| LPA – Health & Welfare | Patient (≥18, with capacity) | Legally binding (if registered) | When patient lacks capacity | Medical care, daily living, end-of-life decisions | Must specify authority for life-sustaining decisions |
| LPA – Property & Finance | Patient (≥18, with capacity) | Legally binding (if registered) | Once registered; can be used earlier if allowed | Bills, accounts, property management | Registered with Office of Public Guardian; no health authority |
| Court of Protection | Court | Legal authority | Complex or disputed cases | Appoints deputies, resolves disputes | Oversees Mental Capacity Act; can overrule attorneys |
| Best Interests Decision | Clinician | Required under MCA 2005 | When person lacks capacity | Any medical or personal decision | Follow MCA principles; involve family; document clearly |
Safeguarding is the duty to protect individuals—particularly vulnerable adults and children—from abuse, neglect, and exploitation. In general practice, GPs and trainees are often among the first to notice subtle signs of harm due to their trusted relationships with patients. Recognising abuse, responding appropriately, and following referral pathways are essential skills in primary care. Abuse can take many forms, and being able to identify these early can prevent further harm and ensure timely intervention.
| Type of Abuse | Examples / Description |
|---|---|
| Sexual abuse | Indecent exposure, sexual harassment, unwanted touching, sexual acts, rape |
| Physical abuse | Hitting, slapping, restraining, forced feeding or toileting, misuse of medication |
| Psychological (emotional) | Threats, humiliation, isolation, verbal abuse, controlling behaviour, cyberbullying |
| Domestic abuse | Coercive, controlling, violent or threatening behaviour by partner or family member |
| Discriminatory abuse | Harassment or mistreatment due to race, gender, disability, religion, sexual orientation |
| Financial / material abuse | Theft, scams, misuse of funds by carers or attorneys, unauthorised financial transactions |
| Neglect | Failure to provide food, hygiene, medication, personal care or safe living conditions |
| Self-neglect | Refusal or inability to care for oneself, poor hygiene, hoarding, refusing support |
| Organisational abuse | Neglect or mistreatment within care settings (e.g. hospitals, care homes) |
Equality, capacity and safeguarding are fundamental to safe, person‑centred general practice. GPs must recognise and challenge discrimination, ensure patients with communication needs or learning disabilities receive accessible care, support patients to make informed choices and respect their preferences, and safeguard vulnerable adults and children from harm. Understanding the legal frameworks – including the Equality Act, Mental Capacity Act, Children Act, Care Act and Caldicott principles – helps GP trainees practise ethically and lawfully, improving outcomes for all patients.
For examination and clinical practice, GP trainees must be able to apply legal and ethical frameworks to realistic situations rather than simply reciting legislation. The following scenarios illustrate how the principles above translate into everyday decision‑making:
Assessing capacity in older adults – When a person with dementia refuses medication, the clinician must use the Mental Capacity Act’s functional test. Capacity is decision‑specific: the GP should explain the treatment, check whether the person can understand, retain, weigh up the information and communicate a choice
If they lack capacity for this decision, the clinician should consult any advance statements or previously expressed wishes, involve family or advocates and make a best interests decision, favouring the least restrictive option
Documenting both stages of the capacity assessment and the reasoning behind the best interests decision is essential for accountability.
Consent in young people – A 15‑year‑old seeking contraception should be assessed under the Fraser guidelines. The practitioner must be satisfied that the young person cannot be persuaded to inform a parent, understands the advice, would suffer physical or mental harm without it, is likely to continue sexual activity anyway and that providing contraceptive advice is in their best interests
If these conditions are met, and the young person demonstrates sufficient maturity and understanding (Gillick competence), the clinician can provide treatment while still encouraging family involvement. The consultation should explore safeguarding concerns such as exploitation or coercion and document the assessment.
Safeguarding concerns – Situations like suspected domestic abuse or a child with unexplained injuries require immediate risk assessment. GPs have a duty to act on safeguarding concerns and to share information with safeguarding teams when there is a risk of significant harm
Confidentiality may need to be breached to protect the patient or others; this should be justified using the Caldicott principles and recorded with details of the concern, referrals made and rationale. Repeated presentations for sexually transmitted infections or termination of pregnancy may indicate exploitation and warrant referral
Documentation – Thorough records are critical. Capacity assessments should note the specific decision, the patient’s abilities in each domain and any best‑interest considerations. Safeguarding referrals must include factual descriptions of injuries, behavioural signs and any immediate actions. Decisions to share information without consent should reference the legal basis, weighing confidentiality against safety.
Balancing autonomy, beneficence and safety is challenging; GP trainees should practise reasoning through such scenarios and reflect on outcomes. Mastery of these concepts – and the ability to apply them judiciously – is essential for safe practice and success in the RCGP Applied Knowledge Test.
[1](https://www.odt.nhs.uk/odt-structures-and-standards/regulation/mental-capacity-act-2005/)
[2](https://www.nhs.uk/social-care-and-support/making-decisions-for-someone-else/mental-capacity-act/)
[3](https://www.hra.nhs.uk/planning-and-improving-research/policies-standards-legislation/mental-capacity-act/)
[4](https://cpdonline.co.uk/knowledge-base/mental-health/principles-of-the-mental-capacity-act/)
[5](https://www.scie.org.uk/mca/practice/assessing-capacity/)
[6](https://braininjurygroup.co.uk/grouptalk/testing-capacity-brief-overview-two-stage-test/)
[7](https://mca-cs.trixonline.co.uk/chapter/assessing-mental-capacity-under-the-mental-capacity-act)
[8](https://www.bgs.org.uk/resources/15-cga-in-primary-care-settings-mental-capacity-issues)
[9](https://www.england.nhs.uk/long-read/consent-to-using-and-sharing-patient-information/)
[10](https://www.bma.org.uk/media/vu5fl1cn/confidentiality-updated-feb-2025.pdf)
[11](https://www.holtdoctors.co.uk/blog/updated-confidentiality-guidance-from-the-gmc)
[12](https://www.scribd.com/document/685155589/GMC-guidance-for-doctors-Confidentiality-good-practice-in-handling-patient-information-70080105)
[13](https://www.scribd.com/document/800722423/GMC-guidance-for-doctors-Confidentiality-Disclosing-information-for-employment-insuran-70064157)
[14](https://pmc.ncbi.nlm.nih.gov/articles/PMC3407401/)
[15](https://www.macmillan.org.uk/dfsmedia/1a6f23537f7f4519bb0cf14c45b2a629/10014-10061/primary-care-10-top-tips-for-dnacpr)
[16](https://www.legalandgeneral.com/insurance/over-50-life-insurance/wills/living-wills/)
[17](https://www.macmillan.org.uk/cancer-information-and-support/treatment/if-you-have-an-advanced-cancer/advance-care-planning/advance-directive)
[18](https://www.carehome.co.uk/advice/living-wills-advance-decisions-and-advance-directives)
[19](https://www.ageuk.org.uk/siteassets/documents/factsheets/fs72_advance_decisions_advance_statements_and_living_wills_fcs.pdf)
[20](https://www.leighday.co.uk/our-services/human-rights/health-social-care/do-not-resuscitate-decisions/)
[21](https://www.oswaldmedicalcentre.co.uk/pages/Palliative-and-End-of-Life-Care)
[22](https://www.timesmojo.com/what-is-the-difference-between-a-dnar-and-respect-form/)
[23](https://pmc.ncbi.nlm.nih.gov/articles/PMC9277023/)
[24](https://www.rdash.nhs.uk/policies/recommended-summary-plan-for-emergency-care-and-treatment-respect/)
[25](https://compassionindying.org.uk/how-we-can-help/lasting-power-attorney-health-welfare/)
[26](https://www.nhs.uk/social-care-and-support/making-decisions-for-someone-else/giving-someone-power-of-attorney/)
[27](https://lifetimelawyers.org.uk/Public/Public/Resources/Blog-Posts/What-is-a-Lasting-Power-of-Attorney-.aspx)
[28](https://www.mind.org.uk/information-support/legal-rights/mental-capacity-act-2005/lasting-power-of-attorney-lpa/)
[29](https://hackney.moderngov.co.uk/documents/s52054/item%208%20LPA_for_Health_and_Welfare_An_introduction_v6.2.pdf)
[30](https://www.gov.uk/use-lasting-power-attorney/health-welfare)
[31](https://northyorkshireccg.nhs.uk/wp-content/uploads/2022/01/SC-and-adult-training-Guidance-Primary-Care-v2-Nov-2021-FINAL.pdf)
[32](https://northeastlondon.icb.nhs.uk/wp-content/uploads/2024/02/NHS-NEL-Safeguarding-Adults-and-Children-Policy-2022-25-FINAL-VERSION.pdf)
[33](https://www.england.nhs.uk/long-read/safeguarding-children-young-people-and-adults-at-risk-in-the-nhs/)
[34](https://pmc.ncbi.nlm.nih.gov/articles/PMC6327289/)
[35](https://www.osab.co.uk/wp-content/uploads/2023/02/How-to-make-a-good-Safeguarding-referral.pdf)
[36](https://cpdonline.co.uk/safeguarding-guides/safeguarding-guide-for-gps/)
[37](https://www.wembleyparkgp.nhs.uk/about-us/practice-policies/at-the-practice/safeguarding-of-adults-procedure/)
[38](https://fflm.ac.uk/wp-content/uploads/2020/12/RCGP-NSPCC-Safeguarding-Children-Toolkit.pdf)
[39](https://www.londonsafeguardingchildrenprocedures.co.uk/referral_assess.html)
[40](https://elearning.rcgp.org.uk/mod/book/tool/print/index.php?id=15290)
[41](https://elearning.rcgp.org.uk/mod/book/view.php?chapterid=367&id=12531)
[42](https://www.themedicportal.com/blog/gillick-competence-and-fraser-guidelines/)
[43](https://www.cqc.org.uk/sites/default/files/Brief_guide_Capacity_and_consent_in_under_18s%20v3.pdf)
[44](https://mental-capacity.co.uk/gillick-competence-fraser-guidelines/)
[45](https://www.wirralsafeguarding.co.uk/gillick-competence-and-fraser-guidelines/)
[46](https://learning.nspcc.org.uk/child-protection-system/gillick-competence-fraser-guidelines)
[47](https://www.cheshirewestandchester.gov.uk/documents/social-care-and-health/children/team-around-the-family/young-people-and-consent-guidance-notes-130219.pdf)
[48](https://www.bma.org.uk/media/txrnpo3s/consent-and-refusal-by-adults-with-decision-making-capacity-guidance-updated-2025.pdf)
[49](https://www.theukcatpeople.co.uk/post/gillick-competence-fraser-guidelines-uk-medicine-ethics-interview-questions)
[50](https://drerwinkwun.com/sca-guide-how-to-handle-safeguarding-concern/)
[51](https://geekymedics.com/mental-capacity-assessment-osce-guide/)
[52](https://gp-training.hee.nhs.uk/bolton/teaching-programmes/st3-programme/past-st3-teaching/st3-structured/gpst3-stp-aug-2020-feb-2021/safeguarding-cases/)
[53](https://elearning.rcgp.org.uk/mod/book/view.php?id=15290)
[54](https://primarycare.northeastlondon.icb.nhs.uk/wp-content/uploads/2025/04/New-RCGP-safeguarding-standards.pdf)
[55](https://www.scribd.com/document/856066439/Confidentiality-guidance-from-the-General-Medical-Council-and-the-Royal-College-of-Psychiatrists)
[56](https://www.nwpgmd.nhs.uk/sites/default/files/rca-guidance-consent-180620-rcgp.pdf)
[57](https://www.health-ni.gov.uk/articles/mca-principles)
[58](https://www.racgp.org.au/running-a-practice/practice-standards/standards-5th-edition/standards-for-general-practices-5th-ed/core-standards/core-standard-6/criterion-c6-3-confidentiality-and-privacy-of-heal)
[59](https://hastingslegal.co.uk/dnr-do-not-resuscitate/)
[60](https://www.rcgp.org.uk/getmedia/8c4f05fe-c442-42a8-94e1-6325168efd69/Confidentiality-Toolkit.pdf)
[61](https://www.cqc.org.uk/sites/default/files/documents/rp_poc1b2b_100563_20111223_v4_00_guidance_for_providers_mca_for_external_publication.pdf)
[62](http://dnar.co.uk)
[63](https://www.scie.org.uk/mca/introduction/mental-capacity-act-2005-at-a-glance/)
[64](https://www.racgp.org.au/getattachment/9ba7da06-fd5c-4f1e-98e4-329e4b5ce858/attachment.aspx)
[65](https://www.apw-ifa.co.uk/how-to-create-a-living-will-or-advance-directive/)
[66](https://www.nicsfed.co.uk/wp-content/uploads/2019/12/Primary-Care-Safeguarding-Children-PolicyNov19-v17docx_.pdf)
[67](https://www.england.nhs.uk/long-read/safeguarding/)
[68](https://www.carehome.co.uk/advice/are-living-wills-legally-binding-in-the-uk)
[69](https://www.nice.org.uk/guidance/ng189)
[70](https://www.nhs.uk/tests-and-treatments/end-of-life-care/planning-ahead/lasting-power-of-attorney/)
[71](https://www.doctors.net.uk/news/rcgp-publishes-whole-life-safeguarding-toolkit)
[72](https://www.nelliesupports.com/post/what-is-the-test-for-assessing-mental-capacity-a-deep-dive-into-the-updated-two-stage-approach)
[73](https://www.hilldickinson.com/insights/articles/discussing-order-which-assess-capacity)
[74](https://gmpcb.org.uk/general-practice/gp-excellence/resources/rcgp-clinical-toolkits/)
[75](https://www.youtube.com/watch?v=QZiXLJx4Yec)
[76](https://mdujournal.themdu.com/issue-archive/autumn-2023/what-you-need-to-know-about-changes-to-good-medical-practice)
[77](https://fflm.ac.uk/resources/publications/rcgp-safeguarding-children-toolkit-for-general-practice/)
[78](https://www.braininjurygroup.co.uk/grouptalk/testing-capacity-brief-overview-two-stage-test/)
[79](https://primarycare24.org.uk/wp-content/uploads/private/PC24POL37-Capacity-to-Consent-Policy-V4.1-October-2021.pdf)
[80](https://proceduresonline.com/redcarcleveland/cs/p_cap_consent.html/1000)
[81](https://www.redbridgescp.org.uk/wp-content/uploads/2024/05/Redbridge-SCP-Multi-Agency-Safeguarding-Referrals-Threshold-Guidance-December-2023.pdf)
[82](https://www.nice.org.uk/guidance/ng108/chapter/recommendations)
[83](https://www.gov.uk/guidance/making-barring-referrals-to-the-dbs)
[84](https://www.nice.org.uk/guidance/ng108)
[85](https://www.buckschildrensmapp.co.uk/mental-capacity-and-consent/)
[86](https://www.england.nhs.uk/south/wp-content/uploads/sites/6/2016/04/mash-oct2016.pdf)
[87](https://www.nbasw-atsnb.ca/assets/Uploads/toolkit-for-primary-care-capacity-assessment.pdf)
[88](https://practicebusiness.co.uk/practical-steps-to-improving-surgery-safeguarding)
[89](https://www.bgs.org.uk/sites/default/files/content/resources/files/2019-03-12/CGA%20Toolkit%20for%20Primary%20Care%20Practitioners_0.pdf)
[90](https://www.hsj.co.uk/primary-care/gps-contacting-patients-about-do-not-resuscitate-forms/7027279.article)
[91](https://www.nhs.uk/tests-and-treatments/consent-to-treatment/capacity/)
[92](https://pmc.ncbi.nlm.nih.gov/articles/PMC5967875/)
[93](https://en.wikipedia.org/wiki/Do_not_resuscitate)
[94](https://elearning.rcgp.org.uk/pluginfile.php/175878/mod_book/chapter/613/CIRC-Mental-Capacity-Act-Toolkit-2011.pdf)
[95](https://pogp.hmppsintranet.org.uk/wp-content/uploads/2020/04/RESPECT-DNAR.pdf)
