What do I need to do before I start?
Please let the Practice know if you have any planned holiday or training dates that will take place during your attachment. This helps the Practice to plan timetables and the availability of the supervising doctors.
Please confirm your actual start date and any hospital on call commitments in advance. The Deanery does not always alert the Practice to these and it helps with the planning process.
If you would like to visit the Practice in advance of the attachment, please contact the Practice Manager who will be happy to set this up for you.
What time do I start?
Your surgeries will usually start at 8.30 but you need to arrive well in advance. It takes time to turn on your computer, deal with messages, get yourself a drink etc.
You will need to check your blood test results before surgery starts, and before you leave at the end of your day, so please take this into account.
Who is supervising my surgery?
The practice should clearly inform you who is supervising each surgery, either by recording this on the computer system or by giving you a paper copy of supervising doctor. This will usually be your trainer but not always.
How do I ask for help when I am stuck?
As a training Practice, all the doctors are used to being interrupted while seeing patients. It is really important that you feel 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. You should also familiarise yourself with the practice formulary if available.
You should aim to come up with a management plan at the end of each consultation. If you are unsure then check it with your supervising doctor. Some trainers will want you to knock and come in, others will ask you to knock and wait, others prefer you to telephone for advice first or send a message – ask the supervising doctor before your start how they would like to be contacted.
Is there an order I should follow for each consultation?
A rough guide for every consultation:
- Housekeeping: keep your desk free of clutter, hide visible coffee mugs, sort untidy couch, mobile phone off etc.
- Look through the patient’s notes before calling them in. Look at the summary of significant problems, current medications, last few consultations and last few letters form hospital if appropriate.
- Warm welcome to patient. Think about your opening question – an example would be ‘How can I help?’
- Try not to interrupt the patient within the first minute, let them tell their story and actively listen.
- It is particularly useful to know ‘why the patient came today’. Is the issue starting to impact on their home life? Their occupation?
- Ask about the patient’s ideas, their concerns and their expectations. Practice this with your trainer so that you do it in a way that is natural for you.
- Follow history with examination.
- Request any investigations – think about why you are requesting them and how they will help.
- Prescribe medication if needed and check current medications.
- Check and attend to QOF prompts. This is an important part of General Practice.
- Finish off by summarising with the patient (sometimes written), ensure they have understood the plan and that you have addressed their concerns. It is very important to provide clear safety netting advice and follow up arrangements if needed – and equally important to record the advice you have given.
- After the patient leaves, use your time to check the quality of your notes and look up/record learning points.
- Time to move on to the next patient!
You will start with 30 min appointments, change to 20 min appointments as soon as you are ready and may wish to aim for 15 min appointments by the end of your attachment.
What should I do at the end of my surgeries?
- Make sure you have kept an accurate record of each consultation e.g. key points from history, positive and negative findings on examination and your plan.
- Notify your supervising doctor that you have finished and arrange a time to go over your patients.
At the beginning, your supervisor will look through all your patients and your notes. It is your responsibility to be proactive about this and make sure it is done promptly after each surgery. You must discuss all the patients you have seen in the afternoon before you go home – that can not wait until the next morning.
- Dictate your referrals. Keep a record of ALL your referrals so you can follow up the patient. Consultants often do not write back to the referring doctor.
- Keep a record of all your investigations and proactively follow them up.
- Check your blood results again at the end of surgery and file them electronically- you will be taught how to do this.
- Check you have completed all phone calls, tasks and notes before seeing your supervising doctor at the end of the day.
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 thing you will do from hospital medicine. They are an important part of your training experience.
You must write up each visit immediately on return to the surgery and mark it on the screen or in the visit book as visited.
Will I be asked to see ‘extra’ patients?
Extra patients are part of the General Practice workload. Their assessment and management are an important skill to master. Please do tell your trainer 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.
Do I have to take part in ‘extended hours’?
The surgery as a whole has to provide a number of appointments outside usual surgery hours. These are provided by doctors and nurses. As part of the team, you may be encouraged to take part in this.
What about repeat prescriptions?
You will be trained on how to sign these and you will usually do them alongside another doctor so that you can ask for assistance easily. Keeping up to date with repeat prescriptions safely is an important part of the working day. You will not be expected to do an excessive number but all doctors in the Practice take a share at some point to ensure a good patient service.
What time may I leave the surgery?
You should check with your supervising doctor before you leave. As a general rule, you must not leave work undone to be carried over to the next day.
We are all aware of the European Working Time Directive. If you feel that you are near/over the limit or likely to be, please take responsibility to communicate this with your supervisor.
Will I have tutorials?
Yes. It is a Deanery requirement to have at least 1 hour of protected tutorial time each week. However, EVERY surgery is a tutorial & you will learn much more from discussing patients at the end of each clinic. There will not be many rotations within your training to have 1-to-1 mentoring with a senior doctor every day, so take advantage of this fantastic learning opportunity.
The emphasis at this point in your career is on self-directed learning.
What do I do in Practice meetings?
Attend! This is a good opportunity to learn how General Practice works. There may also be multidisciplinary team meetings, Child Protection meetings and Educational meetings. There may be some business meetings for partners only.
Is there a dress code?
Dress as a professional, use common sense and ask the practice manager if you are unsure.
Who does my work when I am away?
Ask your trainer who will deal with your results and letters while you are away.
Above all enjoy yourself! This is a good opportunity to fast forward your clinical skills and gain wide experience. The Practice staff are all there to help you make this happen and Foundation Doctors consistently rate General Practice as one of the best learning environments of their career. Good luck and always ask for help if you need it!