Executive summary
Welcome to UK primary care. As a Physician Associate, Paramedic, or Advanced Nurse Practitioner, you are a vital part of the modern general practice team. Your first 90 days are about establishing safe, effective, and efficient workflows. This means knowing your scope of practice, understanding your supervision requirements, and, crucially, knowing where to find trusted UK clinical guidance quickly.
This guide provides an evidence-led starter kit to help you thrive. It maps out the essential point-of-care references you will use every day, from NICE CKS and the BNF to the RCGP Safeguarding Toolkit. We'll also explore how to blend these trusted classics with smart AI assistants like iatroX to support your clinical reasoning and help you practice safely and confidently from day one, in line with NHS England's guidance on integrating these roles into general practice.
1. Your first 90 days: scope, supervision, and safe practice
Your first priority is to understand your role within the practice.
- Clarify scope & supervision: Understand what you can and cannot do. Your practice should have a clear framework for your scope and supervision, aligned with the latest national guidance from bodies like the Royal College of Physicians (RCP), the RCGP, and the BMA.
- Induction checklist: During your induction, make sure you know where to find: your safeguarding contacts, the emergency kit, local prescribing pathways and formularies, and the routes for e-Referrals and Advice & Guidance.
2. Point-of-care clinical references you’ll use daily
- NICE Clinical Knowledge Summaries (CKS): This should be your first stop for pragmatic, UK primary-care-focused "how-to" overviews on common conditions.
- NICE NG12 (Suspected Cancer): A critical guideline to master. Familiarise yourself with its red flags, investigation thresholds, and the specific language to use for safety-netting.
- The Green Book (UKHSA): The definitive source for all UK immunisation schedules, contraindications, and procedures.
- BNF/BNFC: The UK's medicines bible. Use it to check doses, interactions, and contraindications. Ensure you know how to access the Dental Practitioners' Formulary if relevant to your practice.
- Specialist Pharmacy Service (SPS): The NHS's expert hub for complex medicines queries, from monitoring and interactions to advice on PGDs and supply issues.
- BMJ Best Practice: A fantastic structured decision support tool, with free access for NHS staff via OpenAthens. Its offline app is invaluable.
- GPnotebook: A quick-reference encyclopaedia for rapid, in-consultation look-ups.
3. Prescribing & antimicrobial stewardship (AMS)
- Safe prescribing: Your ground truth is the BNF and SPS guidance. Understand when to use a Patient Group Direction (PGD) versus prescribing as an independent prescriber.
- TARGET Antibiotics Toolkit (RCGP/UKHSA): An essential resource for antimicrobial stewardship. It provides patient leaflets, audit tools, and evidence-based guidance for managing common infections like UTIs and RTIs.
- Vaccinations: Always operationalise the guidance from the Green Book. Sign up for the official "Vaccine Update" newsletter to stay current.
4. Risk scores & calculators
- Cardiovascular risk: Use QRISK3 for assessing 10-year CVD risk.
- AF stroke risk: Use CHA₂DS₂-VASc to assess stroke risk in patients with atrial fibrillation.
- Implementation tip: The QRISK3 site advises using the calculators integrated directly within your clinical system (EMIS or SystmOne) to avoid transcription errors.
5. Safeguarding essentials
The RCGP Safeguarding Toolkit is your core resource. It provides guidance on documentation, information-sharing, and what is required for Level 3 safeguarding training. Crucially, ensure you know your local safeguarding pathways and the contact details for your Designated Safeguarding Lead.
6. Red flags, safety-netting & when to refer
Master the art of safety-netting. Use the language and thresholds outlined in guidelines like NICE NG12 as a model for your own practice. Build safety-netting prompts and "was not brought" reminders into your consultation templates to ensure a closed loop of care.
7. Clinical decision support & AI helpers (use responsibly)
- BMJ Best Practice: Provides step-by-step diagnostic and management support, fully funded by NHS England.
- iatroX (UK-centric clinical AI): A powerful tool to complement your use of formal references. Use Ask iatroX to get rapid, guideline-cited answers to your clinical questions. Use Brainstorm to help structure your thinking around differential diagnoses and "don't-miss" flags in an educational setting. The integrated CPD feature allows you to log your learning automatically.
- Governance reminder: AI is a decision-support tool, not a decision-maker. You are always responsible for your clinical decisions. Always document the primary sources (e.g., the NICE CKS page) in your notes.
8. Learning & up-skilling (free/low-cost)
- RCGP eLearning: Offers a huge range of free and member-only modules mapped to the primary care curriculum.
- e-Learning for Healthcare (NHSE e-LfH): As an NHS professional, you have free access to national programmes covering everything from administrative triage and AMS to digital safety.
9. Role-specific roadmaps & professional standards
- HEE/NHSE Roadmap to Practice: For First Contact Practitioners, this roadmap outlines the capabilities, supervision requirements, and sign-off processes you need to follow.
- PA supervision & scope: Ensure your local practice supervision model is aligned with the latest guidance from the BMA, RCP, and RCGP as national standards continue to evolve.
10. Your everyday toolkit: quick-links bar
Create a browser folder with these essential links for one-click access:
- NICE CKS
- NICE NG12
- The Green Book
- BNF/BNFC
- SPS
- BMJ Best Practice
- GPnotebook
- QRISK3
- iatroX (Ask/Brainstorm/CPD)
11. 30-60-90 day plan
- First 30 days: Complete your mandatory safeguarding Level 3. Watch a TARGET antimicrobial stewardship webinar. Set up your quick-links bar. Build safety-netting macros into your clinical system.
- First 60 days: Audit 10 of your recent antibiotic prescriptions against the TARGET guidelines. Pilot using AI and CDS citations in your clinical notes to evidence your reasoning.
- First 90 days: Review your supervision objectives against the relevant professional roadmap or role guidance. Present your audit findings at a practice meeting.
12. FAQs for new starters
- “When do I refer on a 2WW?”
- Follow the specific guidance and symptom thresholds in NICE NG12.
- “Which vaccine chapter has changed recently?”
- The Green Book is updated chapter by chapter. Check the "latest updates" page on the GOV.UK site.
- “Which risk calculator should I use for CVD?”
- QRISK3 is the NICE-recommended tool for primary prevention in the UK.
- “Where can I find UK-specific advice on medicines in pregnancy/breastfeeding?”
- The Specialist Pharmacy Service (SPS) is the definitive expert resource for this.