Clinical Governance, Ethics and Practice Management
What this domain tests
Professional standards, consent and confidentiality, quality improvement activity, and the administrative machinery of an Irish general practice.
Core rules
- Ethics framework. Work from the Medical Council's Guide to Professional Conduct and Ethics: partnership with patients, consent, confidentiality, and professional competence. Capacity is presumed, decision-specific and time-specific, and is assessed by whether the person can understand, retain, weigh and communicate the decision.
- Consent. Valid consent is informed, voluntary and given by a person with capacity. For a child, seek parental consent and, where appropriate, the child's assent; a mature minor may consent to some care, and confidentiality can be maintained in defined circumstances.
- Confidentiality. Share only the minimum necessary, with consent where practicable; know the statutory exceptions - public interest, court order, infectious disease notification and child protection.
- Child protection. Under Children First, reasonable grounds for concern must be reported to Tusla, and the designated liaison person informed; do not investigate yourself.
- Quality improvement. The audit cycle is standards, data collection, comparison, change, re-audit. Significant event analysis examines what happened, why, and what will change, without blame.
- Practice administration. Understand the GMS contract, PCRS claiming, medical certification, repeat prescribing controls, and the requirement to inform the Medical Council of certain events.
Worked example
A 15-year-old asks for contraception and states she does not want her parents told. You assess capacity and understanding, provide confidential care, encourage family involvement, and document the discussion and your reasoning. The ethical weight is on the capacity assessment and documentation, not on a blanket rule.
Traps
- Breaching confidentiality "just to be safe".
- Treating an audit as a one-off data collection without re-audit.
- Failing to document the capacity assessment.
- Assuming a request for records must be refused because a third party is mentioned.