Beyond ICE: Deepening the Patient Perspective

The ICE framework — exploring a patient’s Ideas, Concerns and Expectations — remains a cornerstone of effective consultation in UK general practice. It works because it’s simple, human, and helps clinicians understand what has brought the patient today.

Yet many trainees find it harder to go further: to uncover the psychosocial context of illness or the true priorities that shape how a patient lives and decides about care. This is where Find the IMP builds on ICE, helping you explore the Impact, Meaning and Priorities of illness.

By integrating ICE + IMP, you can move beyond gathering information to developing stronger rapport, a fuller understanding of the person, and management plans that are genuinely tailored and patient-centred.

The result is more efficient consultations, greater empathy, and higher-quality shared decision-making — key features of excellent SCA performance and real-world general practice alike.

Resources

We are currently developing a variety of resources to help you Find the IMP in your consultations.

• Beyond ICE - Find the IMP tool adds three powerful steps to your consultations

These steps matter as they

• Build stronger rapport/trust

• Reveal the real agenda

• Help you tailor management plans the patient will actually follow

• Demonstrate patient centred care in the SCA

• Find the IMP Framework - from concept to implementation, great to explore on your own, or with your supervisor

GP Fluency - Statistics' Bitesize

Delivering difficult news is one of the most challenging tasks in general practice. Many models exist to help develop skills and approaches to do this in a way that allows doctors to deliver the bad news in way that it can be understood and digested by their patient.

Our quick guide starts with those that are well used “SPIKES”, “Ask -tell -ask”, and “Cambridge-Calgary” approaches. The second part of our guide goes into a bit more detail as it summarises a Psychological-Integrated Model for Breaking Bad News. It provides a structured, holistic & framework to guide GPs through these conversations, placing the patient’s experience, priorities, and wider life context at the centre of care.

This model helps clinicians:

• Prepare and connect with the patient in a supportive way

• Deliver information clearly and empathetically, using a “warning shot” to ease emotional processing

• Explore the personal meaning of the news and acknowledge emotional responses

• Understand the impact on home, work, family, and daily life

• Identify what matters most to the patient right now

• Co-create a personalised plan that integrates clinical management with psychosocial and practical considerations

Designed for UK general practice, this approach builds on traditional frameworks by explicitly incorporating patient priorities and the real-world impact of diagnosis, enabling clinicians to provide compassionate, tailored care.

Using this skills, working out which structures, work for you and your patients when breaking bad news and explaining next steps is key

Cases for you to use with peers/educators to practice and improve those skills:

1. Abnormal CXR - possible malignancy

2. Abnormal semen analysis in male infertility - severe infertility

3. Type 1 diabetes mellitus in a teenager - initial diagnosis with patient and parent