Procedures to day-one standard

Why this matters on day one

The GMC specifies which procedures a newly qualified doctor must be able to perform. The professional skill is not only doing them but knowing the boundary, and declining beyond it.

The sequence

1. 1Before. Indication, consent (explained, voluntary, capacitous), correct patient, correct side, allergies, anticoagulation, platelets. Equipment ready, assistant if needed, and a plan for what you do if it fails.
2. 2During. Aseptic non-touch technique. Local anaesthetic — know the maximum dose by weight. Never re-sheath a needle; sharps bin at the point of use. Stop if you are getting nowhere: two attempts then ask.
3. 3After. Document: indication, consent, operator, technique, anaesthetic used, findings, complications, samples sent, and post-procedure instructions. Sign the sharps and specimens yourself.
4. 4The 23 GMC procedures. Finalist tracks these individually with sign-off counts — venepuncture, cannulation, ABG, catheterisation, ECG, blood cultures, injections, IV infusions, oxygen, inhalers, nasogastric tube, and the rest. Competence is a count of supervised performances, not a feeling.
5. 5Know your limits. You should not be performing lumbar puncture, ascitic drain, chest drain or central line unsupervised as an FY1. Being asked to does not make it appropriate.

What goes wrong

• Consent taken as an afterthought, or by someone who cannot perform the procedure.
• Persisting past two failed attempts.
• Local anaesthetic dose not calculated by weight.
• Not documenting the procedure at all — the commonest omission.
• Doing something unsupervised because the ward is busy and the alternative is awkward.