What do I need to do before I start?
Please do let us know if you have any planned holiday or training dates that will take place during your attachment. This helps to plan timetables and the availability of the supervising doctors. It is also very helpful if you confirm your actual start date and any hospital on call commitments in advance. The Deanery does not always alert us to these and it helps with the planning process. If you would like to visit the practice in advance of attachment they would be delighted to meet you, please contact your practice manager who will be happy to set this up for you.
What time do I start?
Find out what time your surgeries start. Be prompt. Remember it takes time to turn on your computer, deal with messages, get yourself a drink etc.
Who is supervising my surgery?
After your induction programme you will be given a basic timetable but this is likely to change weekly because of other commitments, annual leave etc. It is your responsibility to work out changes to this. The doctor supervising your surgery should be your first port of call if you need help but it is always okay to ask someone else if your supervising doctor is held up.
How do I ask for help when I am stuck?
All the doctors are used to being interrupted while seeing patients and expect to be so. It is really important that you can always ask for help. However, an equally important part of General Practice is to learn where to look things up for yourself, how to deal with uncertainty and to learn about General Practice as a different type of discipline compared to hospital medicine. Above all ‘KEEP CALM AND CARRY ON!’
There are many useful ‘search engines’ you can use. Here are a FEW examples but there are many more – just ask!
1) www.patient.co.uk – good quality PILS (patient information leaflets) and also extra for gps
2) www.gpnotebook.co.uk – more in depth analysis
3) Practice formulary – stick to it, ANY out of formulary prescribing is not advised without discussion
4) BNF
5) Department of Work & Pensions: www.dwp.gov.uk/healthandwork/guidance.asp
6) Clinical Knowledge Summaries: www.cks.library.nhs.uk/home
7) Map of medicine: www.mapofmedicine.com username and password DORSET
8) RCGP: www.rcgp.org.uk
9) Bestpractice www.bestpractice.bmj.com (30 day free trial)
10) ‘cheese & onion’ GP equivalent bolted to your desk!
Please familiarise yourself with as many of these as possible before you start your own clinics.
You should aim to come up with a management plan. If you are unsure then check it with your supervising doctor by phone or catching them between patients. No one will ever decline to see a patient but often things can be safely dealt with over the phone.
Is there an order I should do things in for each consultation?
A rough guide for every consultation:
1) Housekeeping: keep desk free of clutter, hide visible coffee mugs, sort untidy couch, mobile phone off – not even on vibrate etc
2) Warm welcome to patient
3) Consider opening gambit – try to avoid ‘what can I do for you today? ’Useful tip try ‘what are you hoping for today?’, ‘what are we talking about today?’, and ‘tell me more’ ‘and what else?’
4) Try not to interrupt the patient at the start, make an effort to actively listen to the presenting statement.
5) Include occupation in your history and examination and record it
6) Make sure you can navigate the computer system confidently, going to the consultation, section, path test requests, prescriptions etc
7) Check and attend to QOF prompts EVERY TIME
8) Update and check medication screen
9) Finish off with summary to patient (sometimes written) with safety netting and follow up arrangements – which must all be recorded
10) After patient leaves – use the time to check on the quality of your notes etc and look up/record learning points.
11) Heave a sigh of relief and get the next patient – you may wish to look at their notes before calling them.
You will start with 30 min appts, changing to 20 min appts when you are ready and some Foundation doctors achieve15 min appts by the end of your attachment.
What should I do at the end of my surgeries?
1) Make sure you have kept an accurate record of each consultation – don’t write too much!
2) Notify your supervising doctor as soon as possible that you have finished by ‘bubble’ (instant messaging from the clinical system) or phone and arrange a time to go over your patients. Each patient is checked and ‘signed off’. It is your responsibility to be very proactive about this eg please don’t wait until just before the afternoon surgery starts to start the morning surgery check with your supervisor. You may think it is over the top to check every patient – but reference the Johari window and unknown unknowns!
3) Finish off any referrals; ensure you have handed over any samples, Fast Track referrals and X ray forms (not CXR). Again, keep a record of your referrals so you can follow the patient (hospital consultants often do not write back to the referring doctor)
4) Check your pathology links and file electronically any result, check your letters in your in tray
5) Check you have completed all phone calls, results, letters, prompts, notes write ups before seeing your supervising doctor if possible or before leaving for visits
What about home visits?
When you are feeling confident you will be asked to do home visits – initially accompanied. Remember there is always someone at the end of the phone to help you. This is an important part of working in the community and the most different single thing you will do from hospital medicine. There is nothing to stop you looking at the visit screen on Front Desk and allocating yourself a visit or visits. As a general rule all visits at the same address are done in one ‘hit’ - eg nursing homes. We do not encourage patients to insist on a particular doctor. Usually we try to discuss the patient with you before you go, give directions etc, rather than allocate a ‘nightmare’ to you! Visits are an important part of your training experience and you will not be able to be involved in a lot of other very time consuming stuff the other doctors have to incorporate into their working day – e.g. repeat scripts, QOF issues, training, appraisals, staff issues, financial planning etc, etc, etc. We provide you with a black bag. Please ensure it is appropriately stocked and maintained.
You must write up each visit immediately on return to the surgery and mark it on the screen as visited.
Will I be asked to do ‘extra’ patients/visits?
Extra patients and visits are part of the General Practice workload. Their assessment and management are an important skill to master. Please DO tell us if you feel overwhelmed but please do not decline work without a good reason clearly communicated to your supervising doctor. If you do not see unexpected patients you will miss out on an important area of experience.
How will Doctors and Staff know where I am?
We won’t unless you tell us! If you leave the building you should inform the reception desk. It wastes a lot of time looking for people and you might miss out on something unexpected and exciting. There may well be times that you have ‘spare’ time in the afternoons before afternoon surgery starts.
What time may I leave the surgery?
It is regarded as good practice and common courtesy to check with your supervising doctor (& any other doctors around) before you leave. As a general rule you must not leave work undone to be carried over to the next day. Yes, it is a long day; it is for all of us. But no one goes home leaving a pile of work for someone else. There may be phone calls, visits that are obvious and there may be things that are not obvious to you so PLEASE ask. This really is an important part of working as a team.
Will I have tutorials?
Yes, you have protected time for tutorials. However, EVERY surgery is a tutorial in itself and you will learn much from having each patient reviewed using case based discussion and random case analysis. Specific topics will be gone into in greater detail on request and you may, on occasions be able to join other training tutorials in the practice. The emphasis, however, is on self-directed learning and following up suggested leads from having your patients reviewed. Try to attend any practice education meetings. Plan your assessments with your Educational Supervisor- CBDs, DOPs, miniCEX, IT, SEAs, planning .Your induction programme will last approximately 2 weeks and include lots of computer familiarisation time. There is a lot to learn but we are experienced in helping you to get started.
AND FINALLY:
Above all enjoy yourself – whether or not you wish to continue with general practice – this attachment is a good opportunity to fast forward your clinical skills and gain wide experience. The practice staff are there to help you make this happen. After all you never know who will come through that door next! Good Luck!
Joanna Robinson
Final version 25 March 09