Leadership in General Practice
Because good GPs don't just treat patients — they quietly rewire the whole system so patients get treated better tomorrow.
Last updated: 20 April 2026
Leadership is one of the 13 RCGP capabilities, a mandatory WPBA requirement in ST3, and a domain that quietly runs through every SCA case and around 10% of the AKT. This page covers what it means, the frameworks you need to know, and how to actually do leadership in a busy UK GP practice — without sounding like a management textbook.
Downloads
Handouts, slide decks and teaching extras — ready when you are. Useful for tutorials, half-day release sessions, or a quick refresher before an ARCP panel.
Web Resources
A hand-picked mix of official guidance and real-world GP training resources. Because sometimes the best pearls aren't hiding in the official documents.
🏛️ Official guidance & frameworks
- RCGP Curriculum — Leadership, Management and Administration
- RCGP Leadership Capabilities Framework
- RCGP — Leadership Activity & MSF Guidance
- NHS Healthcare Leadership Model — 9 Dimensions
- NHS Healthcare Leadership Model (full PDF)
- Clinical Leadership Competency Framework (CLCF)
- GMC — Generic Professional Capabilities Framework
📘 King's Fund & evidence base
🎓 GP training & exam resources
⚖️ Medico-legal & professional duties
⚡ Quick Summary — One-Minute Recall
If you only read one section, read this one.
Leadership is influencing people and systems towards better patient care. Every GP does it, whether they have a title or not.
Leadership is one of the 13 capabilities (Organisation, Management & Leadership) — assessed across AKT, SCA and WPBA.
One Leadership Activity + one Leadership MSF (second half of ST3, after the activity, minimum 10 respondents).
NHS Healthcare Leadership Model (9 dimensions), MLCF/CLCF (5 domains), RCGP Leadership Capabilities Framework (4 contexts).
Transformational, transactional, situational, compassionate, laissez-faire. Good GPs flex between them.
Shared decision-making, safety-netting, involving the team, raising concerns safely, knowing NHS structure, GMC duties.
NHS structure (ICBs, PCNs), GP contracts (GMS/PMS/APMS), QOF, CQC, clinical governance, complaints, whistleblowing.
Leadership shows up as team problems, errors by colleagues, unhappy staff, angry patients, safeguarding, and saying "no" well.
Why Leadership Matters in GP
GPs sit at the centre of almost every patient journey — and at the heart of their practice. When leadership is good, teams work well, patients get safer care, staff stay longer, and change actually happens. When it's absent, mistakes repeat, people burn out, and patient care suffers.
King's Fund research has shown for over a decade that leadership is the single biggest influence on organisational culture in the NHS, and that compassionate leadership is linked to better staff engagement, higher care quality, better financial performance and lower patient mortality. That's not a soft finding — that's the reason leadership has become a mandatory training requirement.
You don't need a title to be a leader in GP. The newest registrar who flags a near-miss, suggests a better recall system, or gently challenges an unfair rota decision is leading. Leadership is a behaviour, not a badge.
Where leadership shows up in a GP's day
🩺 In the consulting room
Shared decision-making, running a 10-minute appointment well, safety-netting, managing uncertainty, de-escalating an angry patient.
🏥 Within the practice
Chairing a meeting, mentoring a student, improving a protocol, raising a safety concern, supporting an upset colleague.
🌍 Beyond the practice
PCN clinical director, LMC representative, educator, commissioner, appraiser, training programme director.
Leadership vs Management — Not the Same Thing
Trainees often use the words interchangeably. Examiners notice when you don't. A classic one-liner from Peter Drucker captures the difference: "Management is doing things right; leadership is doing the right things."
You need both. A GP partner balances the two every day.
Leaders ask "why are we doing this?" Managers ask "how will it get done?" Good GPs learn to ask both.
NHS Structure — A GP's Quick Guide
The downloads on this page cover NHS structure and politics in detail. Here is a simplified map so the names stop sounding like alphabet soup — and so you can spot them in AKT questions.
A highly simplified view. Scotland, Wales and Northern Ireland have their own equivalents — know the broad shape.
🔑 Key terms the AKT loves
| Term | Meaning |
|---|---|
| GMS | General Medical Services — the standard national GP contract |
| PMS | Personal Medical Services — locally negotiated contract |
| APMS | Alternative Provider Medical Services — broader contract, can include private providers |
| QOF | Quality and Outcomes Framework — performance-based payment for key clinical indicators |
| CQC | Care Quality Commission — independent regulator of quality and safety in England |
| ICB / ICS | Integrated Care Board / System — replaced CCGs in 2022, plan and commission local services |
| PCN | Primary Care Network — neighbourhood groups of GP practices, usually 30,000–50,000 patients |
| LMC | Local Medical Committee — represents GPs locally |
| DES / LES | Directed / Locally Enhanced Services — additional commissioned work beyond the core contract |
| Clinical governance | The framework for continuous quality and safety improvement |
Core Leadership Frameworks You Must Know
Three frameworks sit behind all UK GP leadership teaching. You don't need to memorise every word — but you do need to recognise them and know when each applies.
Three frameworks, one underlying idea: leadership is everyone's job.
1️⃣ The NHS Healthcare Leadership Model — 9 Dimensions
Developed by the NHS Leadership Academy in 2013, this is the most widely referenced UK healthcare leadership framework. It focuses on observable behaviours (what leaders actually do) rather than abstract traits — which is why it maps nicely onto the SCA and WPBA.
The 9 dimensions orbit around the core: personal qualities fuel everything else.
📖 Expand each of the 9 dimensions
| Dimension | What a GP does well |
|---|---|
| Inspiring shared purpose | Values the NHS ethos; curious about improving services and patient care |
| Leading with care | Knows the team's strengths and needs; builds a safe, supportive workplace |
| Evaluating information | Seeks varied information, makes evidence-based plans for change |
| Connecting our service | Builds relationships across teams and with other organisations |
| Sharing the vision | Communicates a compelling sense of direction to others |
| Engaging the team | Involves team in decisions; creates a shared sense of ownership |
| Holding to account | Agrees clear goals, checks progress, deals constructively with under-performance |
| Developing capability | Grows talent in others; mentors and teaches |
| Influencing for results | Gains support for change by understanding what matters to others |
2️⃣ MLCF / CLCF — The Five Domains
The Medical Leadership Competency Framework (MLCF) and its successor the Clinical Leadership Competency Framework (CLCF) were built on a simple idea: leadership is everyone's job, not something reserved for senior managers. Five domains sit at the core.
The CLCF has two extra domains for senior leaders (Creating the Vision, Delivering the Strategy) — but these five apply to everyone, including ST1 on day one.
3️⃣ The RCGP Leadership Capabilities Framework — 4 GP Contexts
The RCGP frames leadership across four stages of a GP career. It uses the same five areas as the MLCF but scales expectations to the context you're actually working in.
1. Postgraduate trainee
Developing foundational leadership during GP training — assessed through WPBA.
2. Practice level
Leading your immediate team — partners, salaried GPs, nurses, receptionists.
3. Locality level
PCNs, federations, multiple practices, local commissioning groups.
4. System level
ICBs, regional or national healthcare systems, strategic influence.
Leadership Styles You Need to Know
You will be asked — directly or indirectly — about leadership styles in SCA cases that involve team conflict, change, or underperformance. You may also see a conceptual AKT question on this. Here are the five that matter most in UK general practice.
| Style | In one line | Good for | Risk |
|---|---|---|---|
| Transformational | Inspires a vision and motivates people to reach it | Change projects, long-term improvement, engaged teams | Can lose sight of operational detail |
| Transactional | Reward and correction based on performance | Task-focused work, clear protocols, safety-critical processes | Limits innovation; poor for morale alone |
| Situational | Flex your style to the person and task (Hersey & Blanchard) | Mixed teams with different experience levels — e.g. a GP practice | Needs self-awareness; easy to misjudge readiness |
| Compassionate | Attend, understand, empathise, help (Michael West / King's Fund) | Staff wellbeing, engagement, psychological safety | Misread as soft if not paired with accountability |
| Laissez-faire | Hands-off; intervene only when necessary | Highly competent autonomous teams | Linked to lower motivation and disengagement if misused |
Most effective GP leaders blend the right-hand styles — but know when to drop to transactional for urgent, safety-critical tasks.
Hersey & Blanchard describe four styles — Telling, Selling, Participating, Delegating — matched to four levels of follower readiness. A new ST1 needs more Telling; an experienced practice nurse needs Delegating. Good GPs flex between styles without thinking about it.
Compassionate Leadership — The King's Fund Model
Compassionate leadership, championed by Michael West and the King's Fund, is the model most aligned with modern UK general practice. It's consistently linked in the evidence to better staff engagement, lower burnout, safer care and better patient outcomes. It's built on four behaviours.
Bailey & West (2022) — the four behaviours of compassionate leadership.
Compassionate leadership isn't just a philosophy — it's NHS England policy. NHSE and the National Quality Board have both endorsed it. If you show attending, understanding, empathising and helping in an SCA team-based scenario (e.g. an upset colleague, a receptionist being bullied), you are leaning right into what examiners want to see.
ST3 Leadership Activity & Leadership MSF — The WPBA Essentials
Two things are mandatory before you can sign off your CCT: a Leadership Activity and a Leadership MSF. Both are done in ST3, on your FourteenFish ePortfolio. Non-negotiable.
The order matters — MSF comes after the activity so respondents have something real to feedback on.
Examples of good Leadership Activities
👁️ "Fresh pair of eyes" exercise
Spend time looking at how the practice works as an outsider would. Spot an opportunity and propose a solution to the team.
🪑 Chair a practice meeting
Complete a short leadership-style questionnaire first, reflect on it, then chair a real meeting. Reflect on what you learned afterwards.
📋 Lead a clinical protocol update
Pick something topical (e.g. revised COPD pathway), write the draft, get team input, get it signed off.
💚 Wellbeing project
Organise a simple initiative — coffee round, peer reflection group, whiteboard for thanks — to enhance team wellbeing.
🌐 Website / patient comms review
Audit the practice website against accessibility and inclusion criteria. Suggest improvements.
🤝 Lead a small audit or QI project
Note: formal QI projects are assessed separately (QIA), but a QI-flavoured activity can double up nicely.
Trainees who pick enormous, ambitious projects often never finish them. Trainees who pick something small, specific, and genuinely useful to the practice tend to produce the best reflections — and the best MSF feedback. Keep it simple.
The Leadership MSF — the numbers you must remember
- Done in the second half of ST3, after the activity
- Minimum 10 respondents — invite more, because not everyone replies
- Usually at least 5 clinicians and at least 5 non-clinicians
- Complete your own self-assessment first — it lets you compare
- Responses are anonymous to you, but your educational supervisor sees who was invited
- Discuss results with your ES and record actions in your learning log
Trainees often leave the MSF too late. Automatic reminders go out at 10 days, but real people are slow. Start the MSF with plenty of time before your final ARCP panel — weeks, not days.
🚀 Leadership Beyond CCT — What Comes Next
The Leadership Activity and MSF are where your leadership journey starts — not where it stops. Once you are a qualified GP, a remarkable range of leadership roles opens up. Knowing they exist, even if you don't take them up straight away, helps you see your training in context and answer one of the most common SCA questions: "Where do you see yourself in five years?"
Most qualified GPs pick up two or three of these over a career. You don't do them all — and you certainly don't do them all at once.
The headline roles — at a glance
| Role | What you do | Typical time commitment |
|---|---|---|
| PCN Clinical Director | Lead a Primary Care Network of ~30,000–50,000 patients. Set strategy, liaise with ICB, shape additional roles, drive quality improvement across practices. | Roughly 1 session per week for a 50k-patient PCN (0.25 WTE baseline), though the role typically expands beyond this. |
| GP Partner | Co-own the practice. Share clinical, financial, employment and premises responsibility. Leadership by definition. | Variable — often full-time clinical plus business meetings outside sessions. |
| Educational / Clinical Supervisor or Training Programme Director | Teach and support trainees, run tutorials, complete ESRs, sit on ARCP panels. Shapes the next generation. | From 1 session per trainee (as ES) to 2+ sessions (as TPD or Associate Dean). |
| GP Appraiser | Appraise colleagues annually to support their revalidation with the GMC. | Each appraisal takes a half-day or so including preparation and write-up. |
| LMC representative | Represent local GPs on the Local Medical Committee — the profession's voice on local workforce, contract, and policy issues. | Usually monthly meetings plus task-and-finish work. |
| ICB / system-level leader | Clinical lead for a condition or pathway at ICB level, or a named clinical advisor role. | Highly variable — typically advertised and time-defined. |
| GPwER (GP with Extended Role) | Formal extended-role accreditation in a specific clinical area, with leadership of local services in that area. | Usually 1–2 sessions per week of the specialty work. |
| Medico-political / national roles | BMA GP Committee, RCGP faculty roles, council, working groups, policy consultations. | Elected or applied-for; time commitment varies hugely. |
Portfolio careers are now the norm, not the exception. Many modern GPs work 4–6 clinical sessions a week and fill the rest with one or two of the roles above. This protects wellbeing, reduces burnout risk, and keeps the job interesting. Thinking early about which roles appeal to you helps shape your learning log, PDP and study choices.
You don't need a fixed five-year plan. Examiners like candidates who show a direction of travel — curiosity about one or two leadership roles, and an awareness that general practice is more than just clinical sessions. "I'm interested in getting involved in education / PCN work / my LMC once I've settled into post-CCT practice" is a strong, credible answer.
⚠️ Common Pitfalls — Easy to Make, Costly in Exams
If your answer starts with "I'm only a trainee, so…" you've already lost marks. Leadership is a behaviour you demonstrate, not a role you wait to inherit.
Describing protocol compliance or rota-writing as "leadership" in your WPBA log shows you haven't understood the difference. Save the "leading change" language for genuine influence.
Trying to solve every SCA problem alone. GPs in real practice talk to pharmacists, nurses, safeguarding leads, partners. Name them.
"Come back if you're worried" is not safety-netting. Specific symptoms + specific timeframes + specific routes back = safety-netting.
A full 10% of the paper. Leaving it until the last two weeks is a classic mistake — and an easy way to drop marks that were actually within reach.
ES panels and ARCP panels spot this instantly. A thin reflection on a small real activity beats a polished entry on a pretend project.
🌍 Real-World Wisdom from the Trainee Community
The advice below is distilled from UK GP trainee forums, trainer blogs, deanery support programmes, UK-focused GP training YouTube channels, podcasts (including Primary Care Knowledge Boost and eGPlearning), and medical defence organisation case studies. All of it has been filtered against RCGP, GMC and UK law — anything that conflicted has been dropped. What remains is the stuff that genuinely helps in practice and in the exam.
Community insight is gold — but only after it has been checked against official guidance.
🎯 What trainees say actually works in the SCA (leadership-flavoured cases)
These are recurring themes from GP trainees who have recently passed the SCA and from UK-focused GP YouTube educators who demonstrate real consultations. They are not shortcuts — but they are the small habits that keep showing up.
Swap "We should…" for "We could consider…". Swap "I think you need…" for "How do you feel about…?" Tiny word changes turn a doctor-led plan into a shared plan — which is exactly what the Relating to Others domain rewards.
A common target used by successful trainees: six minutes on the history, six on the management. Clinical Management & Medical Complexity carries additional weighting in the SCA — if you run out of time and skip the plan, you risk the whole case.
The trainees who describe the best exam-day experience say the same thing: they forgot the role-player was acting and just did what they do in clinic. Practising on real patients in your GP surgery is better preparation than any case bank.
"I'd speak to our safeguarding lead", "I'd ask our practice pharmacist", "I'd check with the duty doctor". Recent trainees consistently report that naming specific colleagues shows examiners you understand how a GP practice actually works.
Every case is marked by a different examiner — a case that went badly has no effect on the next one. Trainees say the biggest mistake is letting a wobbly case two steal marks from case three. Close the door on it mentally and walk into the next one fresh.
Deanery advice echoed widely by recent candidates: get your practice partners to play difficult patients — angry, tearful, refusing, rambling. Real SCA role-players often require negotiation, compromise and persuasion. You can't build those muscles on easy cases.
😠 The angry patient — a shared-community framework
Across trainer blogs, deanery guidance and UK GP YouTube channels, one structure for handling an angry patient comes up again and again. It maps closely onto what examiners describe wanting to see. None of it conflicts with GMC or RCGP advice — it simply makes the principles actionable.
Five steps widely used by UK GP educators and trainers — a pattern worth drilling until it becomes automatic.
The step nobody mentions is a three-second silence after Step 1. A brief silence signals that you are not rushing to fix or deflect — you are actually listening. Recent trainees describe this as the single most useful technique they learned from watching senior GPs manage upset patients.
Role-players in the SCA are not physically threatening — but real patients occasionally are. In real practice, if a consultation feels unsafe, end it, leave the room, and ask for help. You are not obliged to stay in a dangerous situation, and the GMC does not expect you to. Document and debrief afterwards.
🪜 Raising concerns safely — the trainee ladder
Drawn from MDU and MPS case studies, GMC guidance on raising and acting on concerns, and real trainee questions asked of medical defence helplines. The principle is simple: go up the ladder one rung at a time, and document every rung you stand on.
Your ES or trainer is almost always the right first step. Document every conversation. Keep a proportionate tone. Focus on patient safety, not personalities.
In a well-known MDU case, a trainee who suspected a colleague was drinking heavily before shifts was advised that she did not need proof — a reasonable belief that patients might be at risk was enough to raise a concern. The result was not a career-ending referral; it was an occupational health appointment and a referral to NHS Practitioner Health. Raising concerns is often the kindest thing you can do for a colleague in difficulty.
A free, confidential NHS service for doctors and dentists with mental health or addiction problems affecting their work. Worth knowing about — both for yourself and for any colleague you might need to support. The GMC is clear: health concerns about a doctor are almost always managed with support, not erasure from the register.
🪑 Chairing a practice meeting — crowd-sourced survival guide
Chairing a meeting is one of the most popular Leadership Activities on the WPBA. It's simple, real, and gives you something to reflect on. The tips below come from trainers and trainees who have done it well — and from those who learned the hard way.
📋 Before the meeting
Send out a clear agenda with timings. Ask people to flag items they want discussed. Meet briefly with the practice manager to check nothing sensitive is missed. Print the agenda.
🕰️ During the meeting
Start on time. State how long you have. Stick to timings — politely. Invite the quietest voice in the room before anyone else jumps in. Name the decision aloud before moving on.
🧯 If it gets tense
Step back. Name it calmly ("I can see we have different views on this"). Don't take sides. Refocus on the shared goal — usually patient safety or patient experience.
📝 After the meeting
Send concise minutes with named action owners and deadlines. Unassigned actions don't happen. This is the step most first-time chairs skip — and regret.
A commonly shared piece of advice from trainees who wrote up a great leadership log: do a short self-questionnaire on your leadership style before the meeting, then afterwards compare how you actually behaved with what you predicted. The gap between the two is gold for reflection — and examiners/ARCP panels love that kind of specific, honest insight.
🪞 Navigating the Leadership MSF — community tips
The MSF is the moment where what you think you do as a leader meets what your team sees you do. Trainees who found this valuable (rather than bruising) tend to share these habits.
Ask widely
Invite at least 15 people to get 10 responses. Include reception, nursing, the pharmacist, admin — not just GPs. Non-clinical feedback is often the most revealing.
Don't chase positives
If the feedback stings, don't immediately run another MSF to "balance" it. That misses the point. Engage with it, change something, move on.
Compare self vs team
The gap between your self-rating and the team's rating is the richest learning. Bring it to your ES. Overconfident and underconfident both carry their own risks.
Pick one thing
Don't try to fix everything. Pick one behaviour to work on and turn it into a PDP item. Concrete beats comprehensive.
Spot the repeat
If three or more respondents say the same thing (kindly or otherwise), that's a pattern worth taking seriously. One outlier comment probably isn't.
If comments identify the writer
MSFs are anonymous to you, but sometimes a comment reveals the writer by content. Discuss it with your ES rather than sitting with it alone.
🌍 Leadership through IMG eyes — community advice for international trainees
International Medical Graduates make up a significant part of UK GP training. Several recurring themes come up in trainee blogs, IMG-focused YouTube channels and deanery IMG forums — all consistent with RCGP guidance, none conflicting with it.
In many healthcare cultures, the most senior doctor decides and juniors follow. In the UK, the newest receptionist is expected to challenge a GP if they spot a safety issue. This is not rudeness — it's a safety culture. SCA examiners reward doctors who genuinely include and invite challenge from the whole team.
UK consultation language leans tentative: "I wonder whether…", "Would it be OK if…", "Shall we try…". This can feel indirect if your medical training was more directive. Both are professional — but the SCA is marked against UK norms, so practise the softer register until it feels natural.
Shared decision-making in the UK means actively inviting the patient's preferences before presenting a plan — not after. Many IMG trainees describe this as the biggest shift: not "here's what I recommend, what do you think?" but "what matters most to you about this? — let's work out a plan together."
The GMC is explicit: all doctors have a duty to raise concerns about patient safety. Staying silent to avoid conflict is not safer — it's a GMC issue. In the exam, candidates who explicitly flag something they would report score better than those who quietly move past it.
📚 Where to find good trainee-led content — the curated map
Based on what recent trainees consistently describe as useful. Official resources remain your first stop for anything clinical or exam-structural; trainee-led content is best used for the feel of the exam and real-world nuance.
| Where | What you'll find | Best for |
|---|---|---|
| RCGP website — the SCA and curriculum pages | Blueprint, marking domains, free webinars, RAG rating tool | Understanding exactly what the exam expects |
| North West Consultation Toolkit (endorsed by RCGP) | Consultation framework aligned with SCA marking | Self-assessing your own practice consultations |
| Primary Care Knowledge Boost podcast | Interviews with examiners and experienced GPs | Listening on the commute — examiner-eye perspective |
| eGPlearning (podcast and YouTube) | Primary care tech, policy updates, ePortfolio walkthroughs | Keeping up with the organisational domain of the AKT |
| UK-focused GP consultation skills YouTube | Worked examples of SCA-style consultations in action | Seeing what "good" looks like, not just reading about it |
| MDU / MPS / MDDUS case studies | Real medico-legal dilemmas and expert advice | Preparing for professional dilemma SCA cases |
| Trainee blogs and Substacks | Honest, recent accounts of what passing the SCA actually took | Study planning, study-group strategies, emotional reality |
| Deanery SCA resources (e.g. North West, Severn, Bristol) | Case banks, interview clips with recent successful trainees | Free, high-quality, locally-vetted practice material |
Forum content and paid revision courses can both be excellent — but always sense-check clinical claims against NICE, BNF and RCGP. Community wisdom is strongest on process (how to prepare, how to speak, how to chair) and weakest on content (specific clinical recommendations). Trust the RCGP website for what the exam is; trust the community for how to survive it.
💎 Insider Pearls — What Nobody Tells You At First
The trainees with the strongest portfolios don't pick grand projects. They pick small, specific things — a recall template, a safer triage question, a better handover format — and finish them properly.
Who cares about this? Who will this affect? Who needs to be on board? Most failed leadership projects skip step 3.
Most trainees over-talk in leadership moments. The strongest ones ask, "What's your take on this?" and then actually wait for the answer.
Unexpected feedback feels personal. It almost never is. The most powerful response is to engage with it honestly and change something — not to harvest more positive feedback to drown it out.
Giving someone 30 seconds to finish their sentence without interrupting is a leadership behaviour. So is saying, "Can we pause for a moment — I want to make sure I've got this right."
"I notice that wasn't how we normally do this — can we talk about it?" is one of the most useful sentences in clinical leadership. Kind, direct, and makes the invisible visible.
🧠 Memory Aids — Frameworks That Stick
LEADER — what good GP leadership looks like
| L | Listen — to the patient, the team, the quiet voice in the corner |
| E | Empathise — attend, understand, feel with people |
| A | Align — get clear on the shared purpose and name it |
| D | Decide — make the call, clearly, with the team |
| E | Enable — remove barriers; delegate appropriately; teach |
| R | Review — check the plan worked; feed learning back |
SAFE — the leadership moment in every SCA case
| S | Share the decision with the patient |
| A | Acknowledge uncertainty and emotion honestly |
| F | Flag to the team — name who else you'd involve |
| E | Escalate or safety-net with specific, clear advice |
AUDI — the four behaviours of compassionate leadership
(Yes, like the car — easier to remember.) Attending, Understanding, Doing empathy, Intervening helpfully. That's the Bailey & West model in four letters.
For Trainers & TPDs — Teaching Leadership
Common blind spots trainees have
- Believing leadership is only for partners, clinical directors, or senior GPs
- Writing leadership reflections that are actually management reflections in disguise
- Underselling their own leadership work (running a small teaching session is leadership!)
- Struggling to name a specific leadership style they have used or seen
- Finding the AKT organisational domain harder than they expected
Tutorial ideas that work well
📝 Style audit tutorial
Get each trainee to complete a short style questionnaire (many free versions online), then bring their results to a group discussion. Ask: "When has this style served you well? When has it tripped you up?"
🎭 Real case, three styles
Take a recent practice challenge (rota conflict, complaint, protocol change). Ask three trainees to role-play three different leadership styles for the same scenario. Discuss outcomes.
🪞 MSF pre-read
In the session before a trainee does their Leadership MSF, walk through a sanitised anonymised example from a previous trainee (with permission). Shows them what "useful feedback" looks like.
🏛️ NHS structure quiz
A 10-minute rapid-fire whiteboard quiz on ICBs, PCNs, CQC, QOF, contracts. Great for revealing gaps — and catching them before the AKT does.
💬 "Name the leader" exercise
Think of a leader you admire. Describe them without using the word "leader" itself. Group guesses the style. Brilliant discussion opener.
📚 Topic guide walk-through
Work through the RCGP Leadership Topic Guide together. Helps trainees see what the curriculum actually expects, not what they imagine it expects.
Reflective questions for tutorials
- Describe a moment in the last week when you demonstrated leadership — even a small one.
- What's the difference between leadership and management in your own words?
- Which of the nine Healthcare Leadership Model dimensions feels strongest for you? Weakest?
- Think of a colleague whose leadership style you'd like to emulate. What exactly do they do?
- What is the most useful piece of MSF feedback you've ever received?
FAQ — Quick Questions
Do I have to do a Leadership Activity AND a Leadership MSF?
Can I use my QI project as my Leadership Activity?
How many respondents do I need for the Leadership MSF?
What's the quickest way to improve in the AKT organisational domain?
How do I show leadership in SCA cases that aren't obviously about leadership?
I'm an IMG — is leadership viewed differently in the UK NHS?
What is the named Responsible Officer?
Where does "duty of candour" come in?
What typically comes up
- NHS structure — what an ICB does, what a PCN is, role of CQC, role of NHS England
- GP contracts — knowing the difference between GMS, PMS and APMS
- QOF indicators — recognising when a clinical action is QOF-linked
- Clinical governance — audit cycle, significant event analysis, complaints handling
- Complaints procedure — timelines (e.g. complaint acknowledged within 3 working days under the NHS complaints procedure), Parliamentary and Health Service Ombudsman as final stage
- GMC duties — especially "Leadership and Management for All Doctors" — raising concerns, probity, delegation
- Whistleblowing — Public Interest Disclosure Act 1998, Freedom to Speak Up Guardians
- Data & record-keeping — GDPR, Caldicott Principles, data retention
- Safeguarding governance — named GP for safeguarding, MASH, escalation routes
- Appraisal & revalidation — annual appraisal, 5-yearly revalidation, named Responsible Officer
- Questions that ask "who commissions…" — core primary care is now commissioned by ICBs (not CCGs, which were abolished in July 2022)
- QOF vs DES/LES distinctions — QOF is part of the core contract; DES/LES are additional
- Complaints routes — complaint first to the practice, then to the Parliamentary & Health Service Ombudsman (England). NHS England no longer handles primary care complaints as first port of call
- "Duty of candour" — this is a legal obligation (Regulation 20 of the CQC regulations 2014), not just an ethical one
- Raising concerns — always through internal routes first; external only after internal channels have failed or patient safety is at immediate risk
Cross-check all facts against the GMC Leadership & Management for All Doctors, the RCGP Curriculum Topic Guide on Leadership, and NICE CKS / BNF for anything clinical. The organisational facts update over time — always check the most current source.
What examiners reward in leadership-flavoured cases
- Involving the patient as a partner — shared decision-making, not doctor-led direction
- Involving the team — naming which colleague you'd speak to, and why (e.g. "I'd ask our practice pharmacist to review…")
- Safety-netting clearly — specific symptoms, specific timeframes, specific routes back
- Raising concerns appropriately — knowing when to act and how to escalate without being destructive
- Managing uncertainty honestly — owning what you don't know rather than bluffing
- Holding your ground kindly — saying "no" to inappropriate requests while preserving the relationship
- The angry patient demanding antibiotics for a viral URTI — tests negotiation and holding ground
- Colleague error — a patient tells you another GP missed something. Tests probity and handling of difficult truths
- Safeguarding — tests escalation, knowing who to involve, and documentation
- Unhappy staff member in a role-play — tests compassionate leadership behaviours
- Multi-issue consultation — tests prioritisation, a core leadership skill
- Sick colleague / fit note for a colleague — tests professionalism and boundaries
- Explicit safety-netting — never imply it, always say it out loud
- Explicit consent when sharing information or referring
- Signpost at the start and when you change direction — "If it's OK, I'd like to ask a few questions first, and then we'll talk about what to do…"
- Check understanding at the end — not a rhetorical "OK?" but a real check
- Document — mention your plan to write it up, escalate, or discuss with a colleague
- "What would matter most to you in how we manage this?"
- "I want to be honest with you — I'm not certain, so here's what I'd like to do…"
- "I'd like to discuss this with our safeguarding lead / pharmacist / the duty doctor — is that OK?"
- "Our practice works as a team on this, so I'd suggest…"
- "I hear that you're frustrated, and I want to help you get the right answer."
- Name a specific team member when relevant — it signals you understand how general practice actually works
- Offer written information — "I can send you a leaflet / link to patient.info" — shows good governance
- Acknowledge follow-up responsibility — "I'll make sure someone phones you with the result"
- Name the limits — "I can't make that decision on my own — I'd want to discuss it with the partners first"
💔 Breaking Difficult News — The Leadership Moment No One Forgets
Breaking bad news is the single most common "leadership-flavoured" moment in real GP practice. Examiners consistently flag it as a high-stakes SCA skill. And it's not just cancer — telling someone they have diabetes, that they can't drive, that their memory is going, or that your colleague made a mistake — all of it is breaking bad news. Done well, it defines a good GP. Done badly, it is the thing patients remember for life.
SPIKES — the classic framework
SPIKES is the most widely taught framework in UK GP training, endorsed by GP educators and consistent with RCGP teaching. It was developed for cancer consultations but adapts well to almost any difficult conversation. In the SCA's 12-minute format you won't do every step at length — but you should be able to show every letter.
SPIKES (Baile et al., 2000) — remains the single most-taught UK medical communication framework.
The three sentences that matter most
"I'm afraid the news isn't what we were hoping for…" — one short sentence that prepares the patient. The single most commonly missed step. Without it the diagnosis lands cold.
After the news, say nothing. Three, five, even ten seconds of silence is not a failure — it is the skill being tested. Let the patient respond before you fill the space.
"Cancer" not "a growth". "Dementia" not "memory changes". Vague euphemisms confuse and delay — they don't protect. Clear words spoken gently are kinder than soft words spoken vaguely.
If SPIKES feels too clinical for your style, AKEFS is a warmer alternative: Anxiety (explore worries), Knowledge (find out what they know), Explanation (share clearly, briefly), Feelings (explore their response), Sympathy & Support (genuine care, clear follow-up). Whichever framework you pick, use the same one every time so it becomes second nature.
- No warning shot — jumping from small talk to diagnosis with no softening sentence.
- Filling the silence — panic-talking about referrals and statistics before the patient has processed the headline.
- Being vague to soften the blow — "a little something on the scan" confuses more than it protects.
- Forgetting the strategy — ending the consultation with the news, not with a clear plan and follow-up.
When the difficult news is that your team got something wrong, the principles are the same but duty of candour (Regulation 20, CQC 2014) applies. Give a timely, genuine apology. Say what happened, in plain words. Explain what you'll do about it. An apology is not an admission of legal liability — it is a professional and legal obligation, and the GMC expects nothing less.
🧩 The multi-issue consultation — prioritisation as leadership
The patient sits down and says: "It's my knee, my sleep is terrible, I think my blood pressure tablets are giving me a cough, and while I'm here could you also look at this mole?" — four problems, twelve minutes, one doctor. Handling this well is pure leadership: you are leading the consultation, the patient and the clinical priorities all at once.
Agenda-setting research shows that the average GP consultation raises 2+ concerns — and that late-arriving ones are the most dangerous. Early elicitation is safer and scores higher in the SCA.
"Before we start, I just want to make sure I know everything that's on your mind today — is there anything else you were hoping to discuss?" — asked once at the start, and repeated if the patient seems to pause. This one sentence reduces late-arising concerns, builds trust, and is very visible to examiners.
Research in UK general practice shows that patients typically raise around two concerns per consultation — but GPs often only ask about further concerns at the very end, when there is no time left to address them. Eliciting the agenda early prevents the "doorknob comment" that derails your schedule and, more importantly, your safety.
🗣️ Useful Consultation Phrases — Leadership Edition
These phrases are designed for the kinds of moments where leadership behaviours show through in an SCA case. Practise them until they feel natural — because scripted phrases fail the exam; adapted phrases pass it.
Opening — inviting the agenda
- "How can I help today?"
- "Tell me what's been going on."
- "What's brought you in to see me?"
Agenda-setting — catching everything early
- "Before we get into it, is there anything else you were hoping to talk about today?"
- "Let me just check — is there anything else on your mind?"
- "We've got about ten minutes — which of these would you like to focus on today?"
- "That's a lot to cover well in one visit. Let's pick the most important one today and bring you back for the others — does that work?"
Exploring ICE — understanding their view
- "What's worrying you most about this?"
- "Were you thinking it might be something specific?"
- "What were you hoping I could do for you today?"
- "How has this been affecting your day-to-day life?"
Showing empathy — a human response
- "That sounds really difficult."
- "I can understand why that would worry you."
- "It makes complete sense that you're concerned."
- "That must have been frightening."
Managing uncertainty — honest leadership
- "I want to be honest with you — I'm not completely sure yet, and here's what I'd like to do to find out."
- "There are a few possibilities here. Let me walk you through my thinking."
- "Sometimes it's not possible to be completely certain at this stage — and that's OK, as long as we have a plan."
Breaking difficult news — warning shot, words, silence
- "I'm afraid the news isn't what we were hoping for."
- "Before I explain what we found, I want you to know we have a clear plan for what happens next."
- "I'm so sorry — the scan shows that this is cancer." [then pause]
- "Take all the time you need. I'm here."
- "Is there anything you'd like to ask me, or shall I keep going when you're ready?"
- "I want to be straightforward with you, because I think that's what you deserve."
Shared decision-making — involving the patient
- "We've got a couple of options — let's talk through what might suit you best."
- "What matters most to you in how we manage this?"
- "Is there anything that would make one option better than the other for you?"
- "What are your thoughts on that?"
Involving the team — a GP never works alone
- "I'd like to discuss this with our practice pharmacist — is that OK with you?"
- "Our safeguarding lead is the right person to take a view on this — I'll make that referral."
- "I want to check the plan with one of the partners before we go ahead."
- "Our nursing team can follow this up with you — let me arrange that."
Holding ground kindly — saying "no" well
- "I understand why you feel that would help, but I need to be honest with you about why I'm not able to do that."
- "I hear that you're frustrated, and I want to help you get to the right answer — even if it's not the one you were hoping for."
- "Let's take a step back and think about what we can do."
Raising a concern — the leadership moment
- "I'd like to write this up as a significant event so we can all learn from it — that's not about blame, it's about making sure it doesn't happen again."
- "I want to flag this with the practice manager so it's properly looked into."
- "Thank you for telling me. I think the right next step is…"
Safety-netting — specific and clear
- "If things don't improve in the next X days, I'd like you to come back."
- "If you notice X, Y, or Z, please come back sooner or call 111."
- "Come back if you're worried at any point — that's what we're here for."
Closing — check and confirm
- "Does the plan we've agreed make sense to you?"
- "Is there anything else you wanted to cover today?"
- "Do you feel happy with where we've got to?"
Most leadership-flavoured phrases follow the same shape: "I [feeling / hearing / acknowledgment] + I'd like to [action] + is that OK with you?" — feel, then act, then check. Memorise the structure, not the words.
✅ Final Take-Home Points
The bits to remember tomorrow
- Leadership is a behaviour, not a role — you're already doing it.
- Leadership ≠ management — the exam notices when you confuse them.
- Know the three frameworks — NHS Healthcare Leadership Model (9), MLCF/CLCF (5), RCGP (4 contexts).
- Know five styles — transformational, transactional, situational, compassionate, laissez-faire. Good GPs flex between them.
- Compassionate leadership (Attend · Understand · Empathise · Help) is the model NHS England endorses and the SCA rewards.
- ST3 Leadership Activity + MSF are mandatory — small, real, and early beats big, ambitious, and late.
- AKT organisational domain is 10% of marks — don't neglect it. Know contracts, QOF, CQC, complaints, duty of candour.
- SCA leadership shows in the small things — shared decisions, naming the team, honest uncertainty, specific safety-netting.
- Safety-net with specifics — symptoms, timeframe, route back. "Come back if worried" is not enough.
- Listening is leadership — 30 seconds of genuine silence can be the most effective leadership act in a consultation.
Why Leadership?
Dr Emma Phipps writes…
GPs have the privilege to shape the health and wellbeing of entire communities, and with this comes the duty to equip ourselves with the right skills to make a difference. Strong and competent leadership is needed to challenge culture and change things for the better – and we need to look to ourselves to meet this challenge. The leaders of the future are developing themselves as the leaders of today.