Essential Clinical Cases for F2 GP Trainees

Clinical Induction

10 common GP presentations

This clinical induction of e-learning resources has been designed to help you learn about 10 common GP consultations. You could easily have patients presenting with all of these in 1 day! The modules will also introduce you to the websites frequently used by GPs and we suggest that you save them as favourites on your desktop.

General Practice can vary significantly form one day to the next … you will continually be challenged and need to broaden and develop your knowledge. During your GP rotation, you will have the opportunity to learn in various ways including: discussing patients with your trainer, reflecting on cases, looking up information and participating in tutorials. However, these modules will provide a good starting point for you – and we suggest you read them as early as possible to get the best out of your rotation.

 

Consultation 1. Headache

GP Notebook is an invaluable resource and a good first place to look for clinical guidance. Register free via Univadis as you will use GP notebook almost every day. Follow the links on headache. You need to be able to distinguish between primary and secondary headaches and know how to identify red flags. What would be your first line treatment for tension headache, migraine and medication overuse headaches?

http://www.gpnotebook.co.uk/simplepage.cfm?ID=-288358397

 

Consultation 2. Contraception

Pill checks and prescribing contraceptives is common in GP but something you may never have done during your rotations so far. You need to know who can and can’t have certain pills, and the wider contraceptive choices available for patients. This is summarised on the UKMEC guidelines. We suggest that you print it out, pin it to your notice board and check it before prescribing any contraceptives.

http://www.fsrh.org/pdfs/ukmecsummarysheets2009.pdf

It is good practice to give patients an information leaflet. People often forget the missed pill rule so revise this with them each time. Your practice will probably have leaflets but if not this is a good resource:

http://www.fpa.org.uk/resources/downloads

Start by reading the leaflets on combined and progesterone only pills – they will answer many of the questions you are likely to have.

The Faculty of Sexual and Reproductive Healthcare has clinical guidance on all forms of contraception. We suggest that you save this website as a favourite so you can quickly find information when you need to.

http://www.fsrh.org/pages/clinical_guidance.asp

 

Consultation 3. 2 week wait (2ww)

If you suspect a patient has cancer you will normally refer him/her via a 2 week wait referral.

You need to be familiar with what symptoms warrant a 2ww referral and discuss this with your trainer. There are proformas for 2ww referrals on most computer systems and you need to learn how to use these. Look through the profomas because they are good summaries of red flags that should form part of your history taking.

In June 2015 Nice developed new guidelines for recognition and referral of suspected cancer. You should read though these and be aware of red flags for cancer referral.

http://www.nice.org.uk/guidance/NG12/chapter/1-recommendations

 

 

Consultation 4. Febrile child

You should read the NICE guidelines on managing febrile children – and we suggest that you ask your trainer to review children with you in clinic. A key point from the guidance is to ‘Measure and record temperature, heart rate, respiratory rate and capillary refill time as part of the routine assessment of a child with fever’. It can be difficult to remember expected heart and respiratory rates etc for children of different ages, so make yourself a table and keep it on your desk.

http://www.nice.org.uk/guidance/CG160/chapter/Introduction

 

We recommend that you print out this table, and use it:

http://www.nice.org.uk/guidance/cg160/resources/cg160-feverish-illness-in-children-support-for-education-and-learning-educational-resource-traffic-light-table2

 

Consultation 5. Eczema

Dermnet.nz is a fantastic website for dermatology with lots of pictures and advice.

http://www.dermnetnz.org/dermatitis/atopic.html

When prescribing creams you need to give patients clear instructions on how to use them. Revise the ‘finger tip unit’ for applying steroid cream:

http://www.patient.co.uk/health/fingertip-units-for-topical-steroids

 

Consultation 6: Diagnosing new hypertension and initiating medication.

It is important to diagnose hypertension carefully as patients may remain on medication for many years. Find out how this is done in your practice and if you have access to AMBP monitoring. Read Key Priorities for Implementation in the NICE guidance.

http://www.nice.org.uk/guidance/CG127/chapter/Introduction

Calculate your QRisk at http://www.qrisk.org/index.php

For more detailed information about medication regimes refer to: http://cks.nice.org.uk/hypertension-not-diabetic

 

Consultation 7. Tired all the time.

The modern epidemic! You need to develop skills in separating physical and psychological causes and managing this consultation well.

www.patient.co.uk/doctor/fatigue-and-tatt

When patients first present you will likely undertake a set of bloods to exclude conditions such as anaemia and hypothyroidism.

There is an excellent video for managing hypothyroidism on the GP update website.

There is also an excellent video for diagnosing and managing fibromyalgia which is often a comorbidity in chronic fatigue.

Click here to watch both videos.

 

Consultation 8. Depression

http://www.patient.co.uk/health/depression-leaflet

Find out how to refer/patients self refer for psychological therapy. It is also useful to be aware of the websites that patients might use – look at the advice on MIND:

http://www.mind.org.uk/information-support/a-z-mental-health

 

Consultation 9. Back pain

http://www.gpnotebook.co.uk/simplepage.cfm?ID=93978626

NHS Choices has good advice on common complaints and information on back exercises:

http://www.nhs.uk/Livewell/Backpain/Pages/low-back-pain-exercises.aspx

 

Consultation 10. When to give antibiotics

There is good guidance on this website: http://www.dorsetccg.nhs.uk/Downloads/aboutus/medicines-management/Other%20Guidelines/HIOW%20GP%20Antibiotic%20Guidelines%202012%20final.pdf