UK Medical Licensing Assessment (UKMLA) General Practice, Primary Care and Population Health Syllabus

General Practice, Primary Care and Population Health syllabus — full chapter and topic list

Expand any chapter to see its topics and sub-topics. This is the whole examinable outline for General Practice, Primary Care and Population Health in UK Medical Licensing Assessment (UKMLA), not a summary of it.

1. 1

   The Primary Care Consultation

   4 topics

   • Consultation models and communication skills
     • Patient-centred consultation
     • Shared decision-making
     • Managing uncertainty and the undifferentiated patient
   • Breaking bad news and difficult conversations
   • Working with interpreters and addressing health literacy
   • Continuity of care and the GP-patient relationship
2. 2

   Common Presentations in the Community

   4 topics

   • Common acute presentations
     • Sore throat, cough and respiratory tract infection
     • Urinary symptoms
     • Rashes and minor skin problems
   • Common chronic symptoms
     • Tiredness and fatigue
     • Persistent pain
     • Medically unexplained symptoms
   • Recognising red flags and safety-netting
   • Appropriate referral and use of investigations
3. 3

   Long-Term Condition Management in Primary Care

   4 topics

   • Chronic disease registers and structured review
   • Multimorbidity and polypharmacy
     • Medication review and deprescribing
     • Frailty assessment
   • Self-management support and social prescribing
   • Cardiovascular and diabetes management in primary care
4. 4

   Care of the Older Person and Frailty

   4 topics

   • Comprehensive geriatric assessment
   • Geriatric giants
     • Falls and immobility
     • Incontinence
     • Delirium and confusion
   • Frailty and functional decline
   • Pressure ulcers and tissue viability
5. 5

   Palliative and End-of-Life Care

   4 topics

   • Symptom control in palliative care
     • Pain management and the WHO analgesic ladder
     • Nausea, breathlessness and secretions
     • Use of syringe drivers
   • Recognising dying and care in the last days of life
   • Advance care planning and preferred place of care
   • Bereavement and support for families

General Practice, Primary Care and Population Health flashcards for UK Medical Licensing Assessment (UKMLA)

25 of 50 cards from the General Practice, Primary Care and Population Health deck — real questions with worked answers.

1. What are the seven tasks of the Calgary-Cambridge consultation model?

   Initiating the session, gathering information, physical examination, explanation and planning, closing the session, plus two continuous threads running throughout: providing structure and building the relationship.

2. In the patient-centred clinical method, what are the two agendas that should be explored in every consultation?

   The disease agenda (the doctor's biomedical framework: history, examination, investigations) and the illness agenda (the patient's experience: Ideas, Concerns and Expectations - ICE).

3. What does the 'ICE' framework prompt the clinician to elicit?

   Ideas (what the patient thinks is going on), Concerns (what they are worried about), and Expectations (what they hope to gain from the consultation).

4. What is the SPIKES protocol for breaking bad news, expanded?

   Setting up, assessing the patient's Perception, obtaining the patient's Invitation, giving Knowledge/information, addressing Emotions with empathic responses, and Strategy/Summary.

5. When breaking bad news, what is a 'warning shot' and why is it used?

   A brief preparatory statement (e.g. 'I'm afraid the results were not what we hoped') given before the bad news, to prepare the patient psychologically and reduce the shock of the information.

6. What is the recommended approach to acknowledging emotion when a patient becomes distressed after bad news?

   Use the NURSE technique: Name the emotion, Understand/express empathy, Respect/praise the patient, Support them, and Explore the emotion further. Allow silence and avoid rushing to reassure prematurely.

7. When working with an interpreter, why should family members generally not be used as interpreters?

   Risk of inaccurate or selective translation, breach of confidentiality, the family member's own emotions or agenda biasing the message, and safeguarding concerns (e.g. masking abuse). A trained professional interpreter should be used.

8. Give three practical tips for conducting a consultation through a professional interpreter.

   Speak directly to the patient (not 'tell her...'), use the first person, use short sentences with pauses, avoid jargon/idioms, and allow extra time. Maintain eye contact with the patient, not the interpreter.

9. What is 'health literacy' and roughly what proportion of UK adults struggle with health information?

   Health literacy is the ability to obtain, understand and use health information to make decisions. Around 4 in 10 (43%) UK adults struggle with health-related written information, rising to ~61% when numeracy is involved.

10. What is the 'teach-back' method and why is it useful for low health literacy?

    Asking the patient to explain back, in their own words, what they have understood about their condition or plan. It checks comprehension without being patronising and identifies gaps to re-explain.

11. Define 'continuity of care' and name its three commonly described types.

    Continuity of care is the ongoing therapeutic relationship and coherent management over time. The three types are: relational (personal continuity with the same clinician), informational (shared records), and management continuity (consistent, coordinated care plans).

12. What evidence-based benefit is associated with higher relational (personal) continuity of care in general practice?

    Lower mortality, fewer hospital admissions and emergency department attendances, better adherence, higher patient and doctor satisfaction, and lower costs.

13. List four 'red flag' features in a headache history that warrant urgent investigation.

    Thunderclap onset (peak within minutes), new headache with focal neurology or papilloedema, headache worse on waking/coughing/straining, new headache in age over 50, systemic features (fever, weight loss), and headache in immunocompromised or cancer patients.

14. What is 'safety-netting' in primary care, and what three elements should it contain?

    Safety-netting is advising patients what to look out for and what to do if things change. It should specify: (1) which symptoms/signs to watch for, (2) how and when to seek further help, and (3) the expected time course of the illness.

15. List four red flags in low back pain suggesting cauda equina syndrome.

    Bilateral sciatica, saddle (perineal) anaesthesia, bladder/bowel dysfunction (urinary retention or incontinence), and reduced anal tone or sexual dysfunction. This is a surgical emergency.

16. What are the NICE criteria thresholds for the 2-week-wait suspected cancer referral for unexplained weight loss with other features?

    Urgent (2-week-wait) referral is prompted by unexplained weight loss combined with other features (e.g. abdominal pain, anaemia, or specific organ symptoms); a key principle is investigating new unexplained weight loss in patients over 40, often with low-threshold direct-access investigations.

17. What does the QOF (Quality and Outcomes Framework) chronic disease register system require GPs to maintain?

    A register of all patients with each chronic condition (e.g. diabetes, CHD, COPD, hypertension) to enable systematic structured review, recall, and monitoring of evidence-based quality indicators with associated payments.

18. Define 'multimorbidity' as used by NICE.

    The presence of two or more long-term health conditions, which can include physical and mental health conditions, ongoing conditions such as learning disability, symptom complexes such as frailty or chronic pain, sensory impairment, or substance misuse.

19. Define 'polypharmacy' and distinguish appropriate from problematic polypharmacy.

    Polypharmacy is the concurrent use of multiple medicines (commonly defined as 5 or more). Appropriate polypharmacy optimises treatment for complex/multiple conditions; problematic polypharmacy is when medicines are not all clinically indicated, cause harm, or impose unmanageable burden.

20. Name a validated tool used to identify potentially inappropriate prescribing in older adults.

    STOPP/START criteria (Screening Tool of Older People's Prescriptions / Screening Tool to Alert to Right Treatment), and the Beers Criteria.

21. What is 'social prescribing' and give two examples of what a link worker might connect a patient to.

    Social prescribing connects patients to non-clinical community services to address social, emotional or practical needs. Examples: exercise/walking groups, befriending or peer-support groups, debt or housing advice, arts or volunteering activities.

22. According to NICE, what blood pressure target is used for treating hypertension in patients under 80 in primary care (clinic reading)?

    A clinic target below $140/90\ \text{mmHg}$ (and below $135/85\ \text{mmHg}$ on home/ambulatory monitoring). For patients aged 80 and over, the clinic target is below $150/90\ \text{mmHg}$.

23. What is the standard HbA1c target for most adults with type 2 diabetes managed on lifestyle or a single non-hypoglycaemic agent?

    $48\ \text{mmol/mol}$ ($6.5\%$). For those on a drug with hypoglycaemia risk (e.g. sulfonylurea) the target is $53\ \text{mmol/mol}$ ($7.0\%$).

24. Which cardiovascular risk tool does NICE recommend for primary prevention, and at what 10-year risk is a statin offered?

    QRISK3. Atorvastatin $20\ \text{mg}$ is offered for primary prevention when the 10-year cardiovascular risk is $\geq 10\%$.

25. How is eGFR conceptually used to stage chronic kidney disease, and what value indicates Stage 3a?

    eGFR estimates glomerular filtration rate from creatinine, age and sex. CKD is staged G1-G5; Stage G3a corresponds to an eGFR of $45$-$59\ \text{mL/min/1.73 m}^{2}$, combined with an albuminuria (ACR) category.

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