General Practice Flashcards
Define general practice according to the Alma Alta (sections VI)
Essential health cares based on practical scientifically sound and socially acceptable methods and technology made universally accessible to individuals and families in the community by means acceptable to individuals and families in the community by means acceptable to them and at a cost that the community and the country can afford to maintain at every stage of their development in a spirit of self-reliance and self-determination. In forms an integral part of both the the country’s health system of which it is the central function and the main focus of the overall social and economic development of the community. It is the first level of contact of individuals, the family and the community with the national system, bringing health care as close as possible to where people live and work and constitutes the first element of a continuing health care process
What are McWhinneys 9 principles of primary care?
Is committed to the person rather than to a particular body of knowledge, group of disease or special technique
Seeks to understand the context of the illness
Sees every patient contact as an opportunity for prevention or health education
Views his or her practice as a’population at risk’
Sees himself or herself as part of a community network of supportive and health care agencies
Should ideally share the same habitat as their patients
Sees patients in their homes
Attaches importance to the subjective aspects of medicine
Is a manager of resources
What is Leewenhorsts definition of general practice?
The GP is a licensed medical graduate who gives persona. primary and continuing care to individuals, families and a practice population irrespective of age, sex and illness.
It is the synthesis of these functions that is unique
He will attend his patients in his counseling room and in their homes and sometimes in a clinic or hospital. His aim is to make early diagnoses. He will include and integrate physical, psychological and social factors in his considerations about health and illness. This will be expressed in the care of his patients. He will make an initial decision about every problem which is presented to him as a doctor. He will undertake the continuing management of his patients with chronic, recurrent or terminal illness. Prolongued contact means that he can use repeated opportunities to gather information at a pace appropriate to each patent, and build up a relationship of trust which he can use professionally. He will practice in co-operation with other colleagues, medical and non-medical. He will know how and when to intervene through treatment, prevention and education, to promote the health of his patients and their families. He will recognize that he also has a professional responsibility to the community.
What is the relationship between GPs and secondary care?
GPs are the ‘gatekeepers’ to the secondary healthcare system
What is the average length of time a patient stays registered with their GP in the UK?
12 years
What are directed enhanced services?
GPs that provide ‘extended hours’ = must provide 30 min extra for every 1000 patients registered at times agreed with the PCO (Primary Care Organisation) according to local need
What do the following abbreviations stand for in the UK medical GP system: GMS, PMS, APMS and PCTMS?
GMS = general medical services PMS = private medical services APMS = alternative provider of medical services PCTMS = Primary Care led medical services
How many GPs need to work in a practice to make it a prtnership?
2 or more
What are polyclinics?
Large practices housing up to 25 GPs and serving a population of up to 50,000 with other health services (dentists, physiotherapists) and extended opening hours (urgent care 18-24hrs a day
What are polyclinics also known as?
Darzi centres
What is the primary care performer list?
A list of all doctors deemed competent to priced primary medical care
What is a salaried GP?
A GP employed by a PCO (primary care organization), practice or alternative provider of medical services. PCOs and GMS have an agreed salary whereas PMS agree their own salary
What is a GPwSI?
A GP with a special interest
What is probity?
Behaving in a prier fashion ensuring honest and openness in all matters. Avoid conflict between personal and professional roles
What are the advantages of continuity of care?
Builds trust, creates a context for healing, increases patients and practitioners knowledge of each other, increases patient satisfaction, compliance and uptake of care
Why is continuity of care becoming less available?
Doctors careers are more flexible and they move more, become specialized and have more managerial responsibilities.
Patient factors: patients are busy and want to be seen when they’re free, not when the GP is - they don’t mind who sees them
System factors: changing roles - nurse practitioners and other healthcare professionals commonly take on tasks so patients are managed by lots of people.
List the members of the primary care team
Practice manager:staff appointments, supervision, training, and dismissals, rotas
Practice nurse.
Nurse practitioner: Specialist trained nurse.
District nurse: community nursing, home visits
Health visitor: works with the community for health promotion and education
Administrative and clerical staff
Receptionist
Community pharmacist
Social worker: adult specialists and child specialists
What act established the patients right to confidentiality?
The Human Rights Act 1998
What is the name of the person who outlined the principles for disclosure of patient confidentiality?
Caldicott
List Caldicotts 6 principles for disclosure of patient confidentiality
- Justify the purpose
- Don’t use patient identifiable information unless absolutely necessary
- Use the minimum patient information necessary
- Access to patient information should be on a strict need to know basis
- Everyone should be aware of their responsibilities
- Understand and comply with the law
List 3 scenarios where you can breech confidentiality
Children: disclosure can be authorized to parent or guardian.
Mentally incapacitated individuals: capacity must be assessed. People with incapacity can authorize or prohibit sharing of information if the broadly understand the implications.
The deceased: Can be disclosed where there is a claim arising from the death. Where there is no claim, there is no legal right of access.
List some situations where breach of confidentiality may be justified.
Emergencies
Statutory requirement - check the legislation under which it is sought
The public interest: not defined. Difficult
Public health: Reporting of notifiable diseases
Required by court or tribunal
Adverse drug reactions
Complaints against doctors
Define consent
Willingness of a patient to undergo examination, investigation or treatment.
What 3 criteria must be met for the consent to be valid?
Patients must:
- Be competent to make the decision
- Have received sufficient information to take it
- Not be acting under any duress
What criminal offense do you commit if you touch a patient without their consent?
Battery
What information must you include in seeking consent from a patient?
Reasons why you want to perform the procedure.
Nature, purpose and side-effects of the procedure.
The name of the doc with the responsibility.
Whether students or trainees are involved.
Reminder that the patients have the right to seek a second opinion.
Define absolute risk reduction/increase.
The absolute arithmetic difference in rates of bad outcomes between experimental and control participants in a trial, calculated as the difference between the experimental event rate (EER) and the control event rate (CER)
Define bias in the context of evidence-based medicine
Systematic disposition of certain trial designs to produce results consistently better or worse than other trial designs.
What is a case-control study?
Involves identifying patients who have the outcome of interest (cases) and control patients without the same outcome, and looking back to see if they had the same exposure
What is a cohort study?
involves identification of two groups (cohorts) of patients: on that received the exposure of interest and one that did not and following those cohorts forward for the outcome of interest
What is a confidence interval? What is 95% CI?
CI quantifies uncertainty in measurement. Usually reported as 95% CI, which is the range of values within which we can be 95% sure that the true value for the population lies
What is the control event rate?
The rate at which events occur in a control group. It may be represented by a percentage (e.g. 10%) or a proportion (0.1)
