Irish Guidelines and Law That PRES Level 2 Candidates Should Know

Why local rules matter on a knowledge exam

The Council says the exams are based on the Eight Domains of Good Professional Practice and that the Blueprint covers knowledge, skills and behaviours. A doctor trained elsewhere can know the medicine and still miss the answer, because the best action depends on who you tell, which service you use and which law applies. The hardest items are rarely about a rare disease. They are about what a doctor in Ireland does next.

We do not know how many items test local rules, because the Council does not say. The official sample paper has about ten ethics and professionalism items out of 90, and it includes a cervical screening and HPV item, which is a local programme. That is enough to make this strand worth a dedicated week.

The sources, in order

The Medical Council's Guide

This is the single most useful document for the ethics strand. The Council published its 9th edition, and news and legal commentary describe it as taking effect in 2024. Read it as an exam text, with a pen. For each section, ask what the Guide expects a doctor to do and what it forbids. Pay particular attention to these areas, which also match the sample paper's ethics items:

• Consent and capacity. Who can consent, what to do when a patient refuses, and how decisions are made for someone who lacks capacity.
• Confidentiality and disclosure. When you may share information without consent, and with whom.
• Records, photographs and data. What you may photograph, how it is stored and who may see it.
• Social media and boundaries. Contact with patients online, and what you post.
• Colleagues, whistleblowing and fitness to practise. What to do when a colleague's conduct puts patients at risk.
• Open disclosure. What to tell a patient or family after an error, and how soon.

The laws that recur

1. Assisted Decision-Making (Capacity) Act 2015. Commenced in 2023, as we understand it. Learn the presumption of capacity, the functional test and the principle that a decision is not unwise merely because others disagree. Learn the role of will and preferences when someone lacks capacity.
2. Mental Health Act 2001. Voluntary and involuntary admission, who recommends and who makes the admission order, the role of the tribunal, and the rights of the patient. Learn the order of steps and who is allowed to do each one.
3. Health (Regulation of Termination of Pregnancy) Act 2018. The circumstances in which termination is lawful, the role of the doctor and the statutory waiting period. Confirm the gestational limits from the Act.
4. Children First Act 2015 and child protection. Concerns about a child are reported to Tusla. Know the threshold and what you document.
5. Criminal Law (Sexual Offences) Act 2017. Age-related questions on sexual activity and what a doctor does when a young patient discloses it.
6. Data protection. The Data Protection Act 2018 and GDPR for records, requests for access and sharing with others.

We list these from the Council's own guidance and from standard Irish practice, and have not checked each section of each Act for this page. Use the Acts themselves, on the Irish Statute Book, for any figure or time limit, and do not rely on our summary for numbers.

Screening programmes

Screening items are favoured because they are local and factual. Facts we have checked on the HSE site:

• Cervical screening (CervicalCheck, HPV primary screening). It is offered from ages 25 to 65. At 25 to 29 the interval is every three years. At 30 to 65 it is every five years. After a total hysterectomy the GP decides whether screening is still needed. After a subtotal hysterectomy, screening may need to continue.

The other programmes are BreastCheck, BowelScreen and Diabetic RetinaScreen. Learn each programme's age band, test and interval from the HSE National Screening Service pages, because bands have been changing and we have not checked them for this page. A reliable habit is to write them in one table and re-check the table a week before the exam.

Immunisation

The HSE changed the primary childhood schedule for babies born on or after 1 October 2024. Reports of the change describe GP visits at 2, 4, 6, 12 and 13 months, the removal of the MenC dose at 6 months, the addition of varicella (chickenpox) vaccine at 12 months, and replacement of the combined Hib/MenC dose at 13 months by the 6-in-1 vaccine and a separate MenC dose. We took this from reports and not directly from the schedule document, so check it against the HSE National Immunisation Office schedule and its GP circular before you rely on it. Older children may have been vaccinated under the earlier schedule, and the exam may test either, so learn the logic of catch-up as well as the current table.

A group of babies born between 1 September 2024 and 28 February 2025 were offered nirsevimab for RSV in maternity hospitals as a pathfinder programme. Know what it is, but do not spend long on it.

How to record what you learn

Keep one notebook or file for local rules only, with a page for each source in the table above. On each page write the rule, the page or section where you found it, and the date you checked it. When you meet a practice question that depends on a local rule, add it. By the exam you will have a short, personal reference that you built from the sources themselves, and you will know which parts you checked and which you took from memory.

Clinical guidelines and prescribing

For acute care, the National Clinical Programmes and NCEC guidelines cover sepsis, maternity early warning, hypertensive disease in pregnancy, venous thromboembolism in pregnancy and perioperative care. Standard thresholds in the exam, for example in acute coronary syndrome, sepsis or anticoagulation, follow international guidelines that Irish documents also use. We avoid giving numbers here because the exam rewards understanding the decision, and we have not rechecked each threshold for this page.

For prescribing, use the Irish Medicines Formulary and HPRA guidance, and generic (INN) names. Spell in British and Irish style: paediatric, anaemia, oesophagus. Use SI units, such as mmol/L and kPa. The exam setting is the HSE, so questions refer to the GP, the emergency department and public hospital services, not to NHS structures.

Common local traps

• Using NHS terms. "Foundation year", "A&E" and "NHS 111" are not the answer here. The setting is the HSE.
• Applying UK law. The Mental Capacity Act 2005 and the Mental Health Act 1983 are UK statutes. Irish questions turn on Irish ones.
• Using old schedules. A baby born before 1 October 2024 and one born after follow different schedules.
• Assuming a UK screening interval. Cervical screening intervals differ by age band in Ireland.
• Answering the kind option. In ethics items, choose the option that follows the Council's Guide.

A week-long local layer plan

1. Day 1. Read the Guide's sections on consent and capacity. Make a one-page decision chart.
2. Day 2. Read the sections on confidentiality, records and photographs. Do 20 ethics questions.
3. Day 3. Learn the Mental Health Act steps and the capacity Act principles.
4. Day 4. Build the screening and immunisation tables from HSE pages.
5. Day 5. Learn the NCEC topics for sepsis, hypertensive disease in pregnancy and VTE.
6. Day 6. Mixed questions with a deliberate "what is the Irish answer?" check on each.
7. Day 7. Rest, then review your errors.

Link this work to your domain revision. The professionalism domain, psychiatry, paediatrics and obstetrics and gynaecology pages each carry the local points for their area.