Starting in practice
Starting out in General Practice (whether in your ST1, ST2 or ST3 year) can be a challenging time. You have to deal with a completely different way of working compared to hospital medicine, new computer systems and electronic patient records and usually a lot more responsibility for your own patients. This article from www.gpst.info offers some advice on starting out.
Settling in
Apart from the obvious differences in setting and the range of patients seen, there are changes in the level of responsibility and autonomy you have. Although you will initially be seeing patients with your trainer, you will very quickly find you have your own booked surgeries, and you will largely be working independently (although with help close at hand whenever you need it). This can be both daunting and very satisfying – you’ll be amazed at both how much you do and don’t know! One of the most pleasant changes from hospital medicine is the continuity of seeing patients over a long period of time, and getting to know them. Most registrars also love the freedom of not having a pager after so long.
Practice Routine
You will soon find out that the work day is slightly different in practice compared to in hospital. No more starting the day with a long ward round and then working through the morning and perhaps a clinic in the afternoon – interspersed with trips to the ward to resite cannulas and complete TTOs. Instead, you are likely to have a morning and afternoon surgery, with plenty of paperwork in between, some home visits, the odd tutorial and regular practice meetings. You will soon find out which days you are on call (home visits etc.), and which clinics happen on which days (baby clinic, smear clinic, diabetic clinic, COPD clinic etc. etc.).
Working with the team.
Although you will be in your room seeing your own patients a lot of the time, you will find that in primary care there is a large team of staff with various skills and roles that you have to fit into. You need to find out how to make the best use of the resources available. Some of the members of the team include:
| Practice Manager | Very important. Will sort out your pay, training on practice systems, may be involved in sorting out study leave and rota. Normally involved in keeping an eye on progress with QOF points under new contract. |
| Receptionists | Practices could not run without good receptionists. They will locate your notes, find results, and be responsible for letting patients know when you are going to be videoing for your assessments. Be nice to them! |
| Practice Nurse | Most practices now have nurse led clinics for various things – CHD, COPD, Asthma etc. May also see patients with minor ailments, as well as dealing with removal of sutures, immunizations, and assisting in minor surgery. |
| Healthcare Support Worker | Many practice employ a HCSW to take bloods, blood pressures and help the practice nurses with clinics etc. |
| District Nurses | May be attached or directly employed by the practice, usually involved in care of terminally ill patients, community management of DVT, care of housebound patients. |
| Health Visitors | Involved in child health surveillance, including developmental assessments, hearing assessments and home visits to children and new mothers. |
| Practice Secretary | Where would you be without someone to type and send all your dictated referral letters? Probably still at surgery until late. |
| Other doctors | Remember that your trainer is not the only one that you can learn from. The other doctors may be involved formally or informally, and should be able to offer help and advice when you are unsure of a diagnosis or when to refer. |
Electronic Patient Records
One of the biggest changes in General Practice comes when dealing with patient records. Many practices are paperless (or paperlight), with almost everything done on the computer system. Whichever system your practice uses (EMIS, Torex, Vision, SystemOne), you need to spend some time learning how to navigate it. Keeping accurate and detailed records is essential – not only for your patients, but to help colleagues when they follow up your patient, and also for your own protection in case there is ever a complaint. Make sure that you are comfortable with how to enter consultations, examinations, how to check blood results and access letters from secondary care.
Finally, I recommend that you LEARN TO TYPE! The better you can type, the more detail you can provide in your notes without running late. Emedica have developed a simple, fun way for you to improve your typing skills. You can use this free typing package, called Meditype to practice typing (it has a practice module and a typing game to make it more enjoyable). You can have a go at www.meditype.org.
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