Handbook for General Practice Flashcards
What is the first point of contact for most people to access healthcare?
Primary care
What two specialties deal with patients who are unsorted?
Primary care
Accident and emergency
What do GPs act as?
Gatekeeper, assessing patient patients and referring selected ones onto secondary services
What medical college oversees GP training?
Royal College of General Practitioner
What is the Royal College of General Practitioners?
Medical college responsible for overseeing GP training
What the 5 areas of capability set out by the RCGP?
1) Knowing yourself and relating to others
2) Applying clinical knowledge and skill
3) Managing complex and long term care
4) Working well in organisations and systems of care
5) Caring for the whole person and the wider community
What does RCGP stand for?
Royal College of General Practitioners
What aspects are undering ‘knowning yourself and relating to others’?
Medical ethics
Fitness to practice
What aspects are under ‘applying clinical knowledge and skill’?
Data gathering and interpretation
Decision making and management
What aspects are under ‘managing complex and long term care’?
Working in a team to ensure optimal care
What aspects are under ‘working well in organisations and systems of care’?
Leadership and organisation skills
Personal learning, teaching and competence
What aspects are under ‘caring for the whole person and wider community’?
Holistic approach to patients
Building relationships with the community
What are 3 general essential features of you as a doctor?
Contextual features
Attitudinal features
Scientific features
What are contextual features?
Understanding own context as a doctor and how it may influence the quality of your care
What are attitudinal features?
Personal capabilities, values, feelings and ethics
What are important factors for contextual features of a doctor?
Environment you work
Community
Culture
Financial and regulatory frameworks
What are scientific features?
Need to adopt a critical and evidence based approach to your work
Lifelong learning
When does applications for GP training take place?
FY2
How long is GP training?
3 years of specialty training
What do GPs have to undertake each year to keep their lisence?
Annual appraisal with an external GP appraiser
What do GPs have to undertake each 5 years to keep their lisence?
Revalidation
How often does revalidation of GPs take place?
Every 5 years
How is general practice also an academic specialty?
Some people will wngage in active research based in primary care
What are the 3 categories of the services provided by GPs?
Essential services
Additional services
Enhanced services
What are essential services?
Ones that all practices must provide
What are examples of essential services?
Management of unwell patients
Chronic disease management
Palliative care
Health promotion
What are additional services?
All practices are expected to provide these but can opt out
What are examples of additional services?
Contraception
Childhood immunisation
Cervical screening
Maternal services
Child health surveillance
What are enhanced services?
Ones commisioned locally by the NHS board on the basis of patient need
What are examples of enhanced services?
Specialised sexual health services
Minor surgery
Care of MS patients
Anticipatory care plans
Polypharmacy reviews
Where does a general practices income come from?
Global sum (money from NHS board based on number of patients and their ages
Quality payments for enhanced services
Income from private work such as medicals and insurance forms
Money to train GP trainees or FY doctors or even students
What is the global sum proportionate to?
Number of patients and their ages
What are things that a practices income is used to pay for?
Premises
Staff wages
Insurance
Utility bills
Indemnity for staff
Drugs (not prescriptions)
Blood tubes and needles
What happens to the left over money after outgoings have been paid for?
GP partners get paid an agreed percentage of what is left
Who are beds in community hospitals run by?
Local practice
What do community hospitals act as?
Rehabillitation between acute care and home
What kinds of things might community hospitals have?
Minor injury units or daytime casualty units
Consultants inpur from care of the eldery
Additional diagnostic facilities such as X-ray and ultrasound
What do some rural practices do in regards to medicine?
Dispense their own, one of their staff is trained up to be a despenser
What does HSCP stand for?
Health and Social Care Partnership
What are Health and Social Care Partnership (HSCP) involved with?
Strategic planning of care based on local needs and delivering service to patients
Who are Health and Social Care Parternships led by?
Integrated Joint Boards
Who composed Integrated Joint Boards?
Health and social care members
What does OOH stand for?
Out of hours
When is out of hours primary care?
From 6pm to 8am Monday to Friday
From 6pm Friday to 8am Monday
How many hours a week are out of hours?
118
How do patients access care out of hours?
Phoning NHS24 where calls are triggered by a nurse practitioner using computerised flowcharts and models
Patients are allocated an appointment, an advice call or a home visit in a timescale of 1, 2 or 4 hours
Calls are passed to primary care emergency centres where the staff on duty may be a combination of GP and nurse practitioners
What is the timescale of out of hours services?
1, 2 or 4 hours
What are the primary care emegency centres out of hours team composed of?
General practitioners and nurse practitioners
What happens to OOH notes?
Passed back electronically in the morning to the practice, handovers are essential for good patient care
Who does the primary care healthcare team consist of?
Practice manager
Administrative, clerical and reception staff
Practice nurses
Healthcare assistancts or phlebotomists
District nurses
Health visitor
Macmillian nurse
Community midwives
Community psychiatric nurse (CPN)
Specialist substance misuse nurse (CPNA)
Primary care mental health worker service
Community pharmacist
Practice pharmacist
Physiotherapist
Occupational therapy (OT)
Social work and home care
What is the practice manager responsible for?
Human recources
Finance
Health and safety
Contract management
Medical rota
Why are practice managers used?
Frees up GPs time for patient care
What do administrative, clerical and reception staff do?
Make appointments and deal with phone calls
What additional things can practice nurses do?
Undergo additional training in management of things like asthma, COPD, hypertension and diabetes
Trained as non-medical prescribers
What do healthcare assistants and phlebotomists do?
Routine work such as BP checks, ECGs, new patient health checks and data collection
Who are district nurses employed by?
Health board rather than the practice
What do district nurses do?
Assess and meet the nursing needs of patients in the community
Important role in palliative care going into patients home once or twice a day
How do you qualify as a health visitor?
Qualify as a registered nurse or midwife and then take an approved programme in specialist community public health nursing
What do health visitors do?
Work with parents to support their needs to give their child the best possible start in life, by giving information and visits
Spot vulnerable familes and can enable parents to express their needs and decide what support they need, by referring families to specialists or arranging access to support groups
Trained to recognise the signs of neglect and child abuse
What training do Macmillan nurses have?
Registered nurse with 5 years experience, including 2 or more in cancer or palliative care
Who are Macmillan nurses employed by?
NHS with post funded by Macmillan for a set time, usually the first 3 years
What do Macmillan nurses do?
Work in hospitals and the community
Caseload management
Advisory consultancy
Education and research
Where do community midwives work?
Across geographic area rather than attached to specific practices
Who are community nurses the first point of contact for?
Any women who is pregnant
What does CPN stand for?
Community psychiatric nurse
What do community psychiatric nurses work within?
Community Mental Health Team (CMHT)
What does CMHT stand for?
Community mental health team
Who are members of the community mental health team?
Community psychiatric nurse
Consultant psychiatrist
Junior medical staff
Social work
Psychologist
What do community psychiatric nurses do?
Assessment of patients
Monitoring compliance
Counselling
What does CPNA stand for?
Specialist Substance Misuse Nursing
What do specialist sibstance misuse nursing do?
Work with adults with drug and alcohol problems
What do primary care mental health worker service do?
Available for patients who would benefit from additional input with the management of anxiety and depression
What contract do community pharmacists work within?
Community pharmacist contract
What are the 4 core areas of the community pharmacist contract?
Minor ailments service
Chronic medication service
Acute medication service
Public health service
What do practice pharmacists do?
Ensure medicine is safe, appropriate and cost effective
Advices on stock control and drug storage practice
Who are physiotherpists employed by?
NHS rather than practice
What does OT stand for?
Occupational therapy
What do occupational therapists do?
Concerned with the assessment and treatment of individuals with physical, mental or social problems
What do social work and home care do?
Form relationships with people and assist them to live more successfully within their local communities by helping them to find solutions to their problems
