General Practice

Question 1

Describe the career pathways of graduates

Answer 1

1. Foundation years (FY1/2) - end with full GMC registration

2. Training pathways: uncoupled and run-through

Question 2

What is uncoupled training?

Answer 2

Core training for 2-3yrs then speciality training to completion
I.e. core medical, anaesthetics, psychiatry, surgical

Question 3

What is run-through training?

Answer 3

Progression automatic as long as meets required standards
3yrs for GP and 5-7yrs other specialties
Broad overview then specialise

Question 4

What is holistic care?

Answer 4

Care for whole person as well as illness - manage problem physical, mental, social in management and prevention of disease

Question 5

What is the role of a GP?

Answer 5

Care for whole person, as well as illness
Promotion of healthy lifestyles
First point of contact
Out of hospital care

Question 6

What are task carried out by GPs around 7.30-9am?

Answer 6

Admin:
Looking through correspondence, discharge summaries and test results
Hospital letter might require specific GP action (i.e. forwarding results or arranging further tests)

Question 7

What are task carried out by GPs around 9am-1pm?

Answer 7

Morning surgery:
See ~18 patients
After, do paperwork and make phone calls to patients hospitals doctors

Question 8

What are task carried out by GPs around 2-3pm?

Answer 8

Home visits: homes or care homes

After, write referrals, prescriptions to sign and check lab results

Question 9

What are task carried out by GPs around 3-5.30pm?

Answer 9

Afternoon surgery

Question 10

What other staff do GPs work with?

Answer 10

Practice nurses 
Advanced nurse practitioners 
Phlebotomists/healthcare assistants 
Practice managers
IT/Admin staff 
Reception staff 
Secretarial staff

Question 11

What are the challenges of the 10 minute consultation?

Answer 11

Risk of short consult after GP trying to make up time
Less psychosocial problems recognised 
Long term problems dealt with less
Less health promotion 
More GP stress

Question 12

What are the personal qualities required in general practice?

Answer 12

Care about patients and relatives
Provide high quality care 
Awareness of own limitations 
Know when to seek help
Keeping up to date and improving quality of own performance 
Team work 
Good interpersonal and communication skills 
Clinical competence 
Organisational ability
Relating to the public 
Ability to deal with uncertainty

Question 13

How can different G practices vary?

Answer 13

Responsive to local health needs
Rural practices less common
Practice owned by GPs or by local NHS

Question 14

What are GPs responsible for if they are independent contractors?

Answer 14

Buy adequate and safe premises
Business affairs i.e. equipment, stock
Make sure all equipment and furniture safe to use
Employ and train staff

Question 15

What is the role of the practice manager?

Answer 15

Business manager; provide financial and business advise

Amin manager: manage practice staff and daily operations

Question 16

What is the role of practice nurses?

Answer 16

Management of long-term conditions and running clinics: asthma, diabetes, HPT, family planning, smoking cessation, vaccinations etc

Question 17

What is the benefit of digital record-keeping as opposed to paper?

Answer 17

Allows patient data to be easily access (by approved member) at any time and sometimes any place when working remotely

Patient data, listed, graphed and searched easily - conveys more info more efficiently

Question 18

What are the two many systems for digital record-keeping?

Answer 18

Vision and EMIA

They store appointment, assist in consults, support prescribing and allow GP to manage letter and blood results electronically

Question 19

What do IT systems enable GPs to do?

Answer 19

Store and book appointments 
Assist in consults 
Support prescribing 
Manages test results 
Manages hospital letters 
Identify patients for screening programs

Question 20

What does being an independent contractor allow the GP to do?

Answer 20

Decide pattern of work:
Can take on other roles like teaching
Balances home and work life issues

Question 21

What was removed from GP Contracts in 2004?

Answer 21

Out of Hours care:

GP no longers has to cover night and weekend, they can opt in or out (better work-life balance)

Question 22

Describe the ongoing learning

Answer 22

Mandatory 5 year revalidation - each year GP prepares by reading literature, attending courses and performing audits

Appraisal assessed by professional colleague

Question 23

What is the role of the IT/admin staff?

Answer 23

Know computer system to manage and recall patients for clinics and immunisations

Question 24

Discuss longitudinal care in GP

Answer 24

Treat same patient as the grow older
GP gain trust of patient and families, making consult quicker and easier
See patient with long-term conditions improve or deteriorate (acutely or chronically)

Question 25

Why is effective communication essential?

Answer 25

``` Improves: Patient satisfaction Recall Understanding Concordance Outcomes of care ```

Question 26

What are 4 essential components of clinical competence?

Answer 26

Knowledge Communication skills Physical examination Problem solving

Question 27

What are 3 broad types of skills needed for effective communication?

Answer 27

Content skills Perceptual skills Process skills

Question 28

What are content skills?

Answer 28

What GPs say - the substance of their questions and responses

Question 29

What are perceptual skills?

Answer 29

GPs internal decision making and clinical reasoning - awareness of own biases, attitudes and distractions

Question 30

What are process skills?

Answer 30

Way of communication (how they go about discovering info) and the verbal and non-verbal skills used and the structure and organisation of communication

Question 31

What are 2 factors that will influence the consultation?

Answer 31

``` Physical factors Personal factors (of GP and patient) ```

Question 32

What are physical factors that will influence consultation?

Answer 32

``` Site and environment (RTA in dark, cold, rain different to doctor managing same problem in emergency) Adequacy of med records Time constraints Patient status (new patient or known and new/old problem) ```

Question 33

What are personal factors that will influence the consultation?

Answer 33

Age - patient might want older/younger GP Sex - gender barrier Backgrounds and origins - language or religion barrier Knowledge and skills Beliefs - patients influenced by medical training, media, past experiences Illness - consult harder for terminal illnesses than minor

Question 34

What are the 3 different doctor/patient relationship styles?

Answer 34

Authoritarian or paternalistic relationship Guidance/co-operation Mutual participation

Question 35

Describe the Authoritarian doctor/patient relationship

Answer 35

GP uses authority of status and patient feels no autonomy | Tries to please GP and no active participation in treatment

Question 36

Describe the guidance/co-op relationship

Answer 36

GP has authority and patient obedient, but has greater feeling of autonomy and participates more actively

Question 37

Describe the mutual participation relationship

Answer 37

Best - patient feels some responsibility for treatment which involves both active participation and feeling of greater autonomy

Question 38

What are 3 different interviewing techniques?

Answer 38

Open ended question Listening and silence Facilitation (encourage communication by using manner, gesture or words)

Question 39

What are the 5 different types of questions?

Answer 39

``` Open ended Direct Closed - yes or no answer Leading - presumes answer avoid) Reflected - GP can avoid answering a direct question ```

Question 40

What are 3 different forms on non-verbal communication?

Answer 40

Instinctive - crying, laughter, pain expression Learned: life experiences or from training Clinical observation - doctor can recognise clinical syndrome

Question 41

What 4 points are important to consider with body language?

Answer 41

Culture Context - posture due to discomfort Gesture clusters - reinforces message as single gesture can be misinterpreted Congruence - lack of it between nonverbal messages and words indicates omission, inaccuracy or info suppression

Question 42

What are other forms of body language?

Answer 42

Gaze behaviour Posture - i.e. depressed: sunken head, anxious: fidgety Specific gestures - indicated patient comfort (barrier positions: folded arms, legs or feet)