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Flashcards in General Practice Deck (42):

Describe the career pathways of graduates

1. Foundation years (FY1/2) - end with full GMC registration
2. Training pathways: uncoupled and run-through


What is uncoupled training?

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


What is run-through training?

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


What is holistic care?

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


What is the role of a GP?

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


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

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


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

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


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

Home visits: homes or care homes
After, write referrals, prescriptions to sign and check lab results


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

Afternoon surgery


What other staff do GPs work with?

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


What are the challenges of the 10 minute consultation?

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


What are the personal qualities required in general practice?

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


How can different G practices vary?

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


What are GPs responsible for if they are independent contractors?

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


What is the role of the practice manager?

Business manager; provide financial and business advise
Amin manager: manage practice staff and daily operations


What is the role of practice nurses?

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


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

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


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

Vision and EMIA

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


What do IT systems enable GPs to do?

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


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

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


What was removed from GP Contracts in 2004?

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


Describe the ongoing learning

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

Appraisal assessed by professional colleague


What is the role of the IT/admin staff?

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


Discuss longitudinal care in GP

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)


Why is effective communication essential?

Patient satisfaction
Outcomes of care


What are 4 essential components of clinical competence?

Communication skills
Physical examination
Problem solving


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

Content skills
Perceptual skills
Process skills


What are content skills?

What GPs say - the substance of their questions and responses


What are perceptual skills?

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


What are process skills?

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


What are 2 factors that will influence the consultation?

Physical factors
Personal factors (of GP and patient)


What are physical factors that will influence consultation?

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)


What are personal factors that will influence the consultation?

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


What are the 3 different doctor/patient relationship styles?

Authoritarian or paternalistic relationship
Mutual participation


Describe the Authoritarian doctor/patient relationship

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


Describe the guidance/co-op relationship

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


Describe the mutual participation relationship

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


What are 3 different interviewing techniques?

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


What are the 5 different types of questions?

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


What are 3 different forms on non-verbal communication?

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


What 4 points are important to consider with body language?

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


What are other forms of body language?

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