Workplace Based Assessment (WPBA): Capability Framework

Workplace Based Assessment (WPBA) is a professional capability framework and constitutes one of the three components of the Membership of the Royal College of General Practitioners (MRCGP) examination.

It is designed to evaluate the GP trainee’s progress in areas of professional behaviour that are difficult to assess in the other MRCGP components, i.e. the Applied Knowledge Test (AKT) and the Clinical Skills Assessment (CSA). 

WPBA is intended to:

• look at your day-to-day practice performance for evidence of learning and reflection based on real experiences

• support and drive your learning by providing constructive feedback on strengths and developmental needs, thus ensuring you possess the NHS core competencies

• determine fitness to progress towards completion of training.

This knowledge and skills framework specifically tests the trainee’s capability in 13 GP competencies derived from the core RCGP curriculum statement ‘Being a GP’. The RCGP capabilities are as follows:

1. Fitness to practise – the doctor's awareness of when his/her own performance, conduct or health, or that of others, might put patients at risk, and taking action to protect patients

2. Maintaining an ethical approach – practising ethically, with integrity and a respect for diversity 

3. Communication and consultation skills – communication with patients, and the use of recognised consultation techniques

4. Data gathering and interpretation – for clinical judgement, choice of physical examination and investigations and their interpretation

5. Clinical examination and procedural skills – competent physical examination of the patient with accurate interpretation of physical signs and the safe practice of procedural skills

6. Making a diagnosis/decision – a conscious, structured approach to decision making

7. Clinical management – recognition and management of common medical conditions in primary care

8. Managing medical complexity – aspects of care beyond managing straightforward problems, including management of co-morbidity, uncertainty, risk and focusing on health rather than just illness

9. Working with colleagues and in teams – working effectively with other professionals to ensure good patient care, including sharing information with colleagues

10. Maintaining performance, learning and teaching – maintaining performance and effective CPD for oneself and others

11. Organisation, management and leadership - an understanding of the use of computer systems to augment the GP consultation and primary care at individual and systems levels, the management of change, and the development of organisational and clinical leadership skills 

12. Practising holistically, promoting health and safeguarding – seeing the bigger picture, i.e. operating in physical, psychological, socioeconomic and cultural dimensions, taking into account feelings as well as thoughts

13. Community orientation – management of the health and social care of the practice population and local community 

How WPBA capabilities are assessed

Capability assessment utilises the full range of WPBA tools available and should be carried out at different times using different tools, and ideally by different assessors.

Capability assessment through WPBA

The table below outlines WPBA tools and where you are most likely to find evidence for each capability.

Table 1 Capability Assessment through WPBA. MSF = Multisource Feedback; PSQ = Patient Satisfaction Questionnaire; COT = Consultation Observation Tools; CbD = Case-based Discussion; CEX = Clinical Examination Exercise; CSR = Clinical Supervision Report.

While completing hospital posts in ST1 and ST2, you are assessed against your peers; for primary care posts, your COT component is benchmarked against that of an independent GP. Once you reach ST3, you will be assessed at the level of a GP.

Capability assessment through naturally occurring evidence

Throughout your GP training, you should record ‘naturally occurring’ evidence related to this list of competencies in your Trainee ePortfolio and compare it against the NHS key skills framework for GPs.

For example, an audit you performed and presented at a practice meeting could provide evidence of several foundation competencies, including maintaining performance, learning and teaching, data gathering and interpretation, and communication skills. This evidence will then be used to inform six-monthly reviews, as well as at the end of your training to establish whether you are ready to practise independently. 

In addition to documenting naturally occurring evidence, GMC-approved evidence of WPBA also includes completion of specific assessments and reports, as well as certain mandatory requirements, such as Child Safeguarding and Basic Life Support. 

As time goes by and your Trainee ePortfolio begins to demonstrate areas of strengths and developmental needs, your trainers will adapt your training accordingly to collect new evidence to fulfil the NHS competency framework.

RCGP Competencies: Detailed Descriptors

As part of the Educational Supervisors Review (ESR), your progress in each of the 13 competencies will be marked by you and your supervisor. Detailed descriptors can be found on the RCGP page, but broadly speaking, each capability is rated as one of the following:

• Needs further development (NFD) – below expectations

• NFD – meets expectations

• NFD – above expectations

• Competent for licensing

• Excellent

Additionally, the capabilities framework (CF) has been augmented and now also includes descriptors for negative behaviour, called Indicators of potential underdevelopment (IPU); these have been implemented to explicitly state that a trainee is going in the opposite direction rather than simply not performing to a sufficiently satisfactory level. For instance, if the trainee is noted to ‘work in isolation’, the IPU ‘gives little support to team members’ may also apply.

Note an IPU is only an indicator of potential underperformance as any negative behaviour recognised for the first time may be a one-off on the part of the trainee or because the observer was incorrect. The purpose of these descriptors is to aid in early recognition of underperformance to provide constructive feedback to the trainee.