Ethics, Law, Primary Care and Prescribing: The Biggest PLAB 1 Domain

Why this domain matters most

Twenty-seven questions is about a seventh of the paper. It is also the domain where UK knowledge differs most from other countries, where the answer depends on a source (the GMC, a statute, a national programme) not on clinical reasoning alone, and where several options look reasonable. The GMC places professional values and behaviours in the MLA content map alongside clinical knowledge, and PLAB 1 questions are based on that map. Candidates who treat this domain as common sense lose marks, because common sense in another health system is not the same as the UK position.

What is tested

• Professional standards. Good medical practice (2024): duties of a doctor, professional boundaries, social media, conflicts of interest and communication skills.
• Consent and capacity. Consent, the Montgomery standard and Gillick competence (Fraser guidelines), the Mental Capacity Act 2005 with principles, the capacity test, best interests and DoLS.
• Confidentiality and candour. Lawful disclosure without consent, duty of candour, complaints and raising concerns.
• Safeguarding and law. Safeguarding adults and children, domestic abuse, the FGM duty to report and modern slavery, death certification, coroner referral and organ donation, fitness to drive.
• Safety and evidence. Patient safety, human factors, incident reporting, clinical audit and quality improvement, evidence-based medicine including statistics, study design and screening principles.
• Population health. NHS screening, the UK immunisation schedule and travel health, notifiable disease, outbreak management and health inequalities.
• Primary care and older adults. Common presentations, safety-netting and urgent referral, falls, frailty, polypharmacy and continence.
• Therapeutics. Prescribing safety with the BNF, interactions, renal and hepatic dose adjustment, adverse reactions, pharmacokinetics, enzyme inducers and inhibitors, therapeutic drug monitoring, choosing investigations and radiation safety, genetics, allergy and drug allergy labelling.
• Teamwork. Leadership, handover and SBAR communication.

UK points to anchor your answers

These facts were verified on official pages on 21 October 2026.

• Good medical practice 2024 took effect on 30 January 2024. Its four domains are knowledge, skills and development; patients, partnership and communication; colleagues, culture and safety; and trust and professionalism. The duty of candour, being open if things go wrong, sits in the second.
• GMC 0-18 years guidance covers capacity and consent of children and young people, confidentiality, access to records, child protection, and the care of under-16s who seek contraception, abortion or STI care without parental knowledge or consent.
• Screening: cervical 25 to 64 every 5 years; breast 50 to 70; bowel 50 to 74 with a home kit every 2 years; AAA men at 65; diabetic eye from age 12; lung screening for ages 55 to 74 who have ever smoked in some parts of England.
• Immunisation: the NHS routine schedule includes MMRV from 1 January 2026, and adults are offered pneumococcal, flu, shingles, RSV and COVID-19 by age. See the full list on our UK guidelines page.
• Mental Health Act 1983: sections 2 (up to 28 days), 3 (up to 6 months, renewable), 5(2) (up to 72 hours), 5(4) (up to 6 hours), 135 and 136 (place of safety up to 24 hours, extendable to 36).
• DVLA: rules differ between Group 1 and Group 2 and by condition. Insulin-treated diabetes must be notified.

How the questions are framed

Professional stems describe a dilemma. A patient refuses treatment, a relative asks for information, a colleague seems impaired, a child wants contraception without telling parents, a patient with a condition keeps driving, a prescription contains a dangerous combination. The question asks what you should do first, or what you should do next, and the options include several things that might be reasonable at some point. The correct one usually follows a sequence: assess capacity, explore the patient's wishes, share information, involve the right people, document, and escalate if risk remains.

Therapeutics stems are different. They give a patient with several conditions and drugs and ask what to prescribe, stop or monitor. Read the medication list, renal function, liver function, age, pregnancy status and allergy history before the options. Most wrong answers fail on one of these.

What examiners ask about each group

• Consent. Decide whether consent is valid, what information the patient needs, and what to do if the patient refuses or lacks capacity.
• Capacity. Apply the statutory test, not the doctor's view of whether the decision is wise.
• Confidentiality. Identify when disclosure is lawful without consent, and limit it to what is necessary.
• Candour and complaints. Be open about errors, apologise, report and learn.
• Safeguarding. Recognise concerns, record and escalate through the right channel.
• Certification and the coroner. Know which deaths must be referred.
• Prescribing. Adjust for kidney or liver function, avoid interactions and monitor.
• Evidence. Interpret sensitivity, specificity, relative risk and study design.

Three typical traps

1. Judging capacity by the outcome. A decision that seems unwise does not by itself show a lack of capacity. The exam asks about the process of the decision, not whether you agree.
2. Breaching or over-protecting confidentiality. Disclosure without consent is allowed in defined circumstances, such as serious risk to others or a legal duty. The best answer discloses only what is needed, to the right person, and tells the patient where possible.
3. Missing the hidden drug problem. A patient with reduced kidney function who is prescribed a renally cleared drug, or a patient on an enzyme inducer given a drug it affects, is a common stem design. Check each drug against each condition.

How to revise it

1. Read Good medical practice 2024 and the 0-18 years guidance once, then apply each section to short scenarios you write yourself.
2. Make decision trees for consent, capacity, confidentiality and safeguarding.
3. Memorise the UK facts in the section above as flashcards.
4. Build a prescribing safety routine: allergy, renal function, liver function, pregnancy, interactions, monitoring.
5. Revise statistics with worked examples. Calculators are banned, so practise by hand.
6. Do 30-question professional blocks weekly and review the reasoning, not just the answer.

Start this domain early in your study plan and revisit it weekly. It connects to every other domain, particularly mental health (capacity and the Mental Health Act), child health (consent and safeguarding) and endocrine and renal (dose adjustment).