Surgery Admin Flashcards
You receive a call from a pharmacist. Your morphine script says 56 capsules in words but not in numbers. What is the best way to amend this?
Ask the pharmacist to amend
- Pharmacists can amend schedule 2 and 3 drugs if total quantity is missing one of either words or figures, providing that it is clear the pharmacist has amended
What is a DS1500 form?
The old name for the new SR1 form
(benefits at the end of life)
Your patient has expected less than 12 months to live, what should you advise them RE benefits?
Doctor should fill SR1 form in
If your doctor or a medical professional has told you that you might have 12 months or less to live, you might be able to:
- get benefits at a higher rate or get extra money
- start getting payments quicker than usual
How does an eligible patient gain a medical exemption certificate for diabetes and how long do they last?
Apply through the surgery on form - MEDEX form
We sign form
patient sends off and gets certificate
Usually last 5 years then need renewing
(Prescriptions free over 60 anyway)G
Give an example of 5 conditions covered by MEDEX exemption certificate for free prescriptions?
1) Permanent fistula (for example, caecostomy, colostomy, laryngostomy or ileostomy) which needs continuous surgical dressing or an appliance
2) Hypoadrenalism (for example, Addison’s Disease)
3) Diabetes insipidus and other forms of hypopituitarism
4) Diabetes mellitus, except where treatment is by diet alone
5) Hypoparathyroidism
6) Myasthenia gravis
7) Hypothyroidism which needs thyroid hormone replacement)
8) Epilepsy which needs continuous anticonvulsive therapy
9) Continuing physical disability - cannot go out without the help of another person
10) Cancer and are undergoing treatment for either (or for effects of tx)
What are the flying rules post MI?
Uncomplicated - not for 7 days
Complicated MI - not for 4-6 weeks
What are the flying rules post a) Open abdominal surgery b) Laproscopic abdominal surgery and c) Colonoscopy
a) 10 days
b) 24 hours
c) 24 hours
(Intestinal gas volume expands by up to 30% at 8000 feet)
What are the flying rules with plaster cast on?
Flights under 2 hours - 24 hours post cast
Flights over 2 hours - 48 hours post cast
What are the group 1 driving rules for a patient on a sulphonylurea drug?
(Risk of hypos)
Doesn’t need to inform DVLA as long as no more than 1 severe hypo in last 12 months and more than 3 months ago
What are the DVLA group one rules for driving post angioplasty?
1 week if successful angioplasty
4 weeks if MI and unsuccessful angioplasty
4 weeks for MI’s where no angioplasty done
What is allowed by section 2 of the MHA?
Compulsory admission for up to 28 days
What is allowed by section 3 of the MHA?
Compulsory admission for up to 6 months
What is allowed by section 4 of the MHA?
Compulsory admission for up to 72 hours
What is section 136 of the mental health act?
llows police to take people from a public place to a place of safety
What are the 5 ‘schedules’ of drugs?
Schedule 1 - Not used medically (LSD etc)
Schedule 2 - Full controlled drugs (opiates, methodone etc)
Schedule 3- CD’s like diazepam, tramadol etc
Schedule 4- Minimal control CD’s (Zopiclone)
Schedule 5- Low strength CD’s (Codeine, low dose morphone)
What are the general fitness to fly rules in pregnancy?
Single pregnancy - Should not fly after 36 weeks
Multiple pregnancy - Should not fly after 32 weeks
What are the DVLA driving rules for:
a) Established epilepsy
b) First seizure
a) 12 months fit free to be able to drive again
b) After first seizure must surrender license, can apply again when seizure free for 6 months (as long as complication free)
What are the DVLA driving rules for:
a) Stroke/ TIA
b) Multiple TIA’s
c) Narcolepsy/ cataplexy
a) 1 month off
b) 3 months off
c) Stop driving, restart when good symptom control
What groups of patients are entitled to free prescriptions? (5)
Children < 16
Age 16/17/18 if in full time education
Age 60 or over
Medical exemption
If on income support/ jobseekers
What is a PPC for prescriptions?
Pre-payment certificate
For those not entitled to free prescriptions
Works out cheapest if pays for more than 11 prescriptions per year
What is Roger Neighbor’s five point checklist for a GP consultation?
Connecting, summarizing
handing over
safety netting housekeeping
The MHA 2007 requires two doctors and an approved mental health professional when arranging compulsory admissions. Who can’t act as an approved mental health professional?
Registered medical practitioner (Doctors)
AMHPs are mental health professionals who have been approved by a local social services authority to carry out certain duties under the Mental Health Act - can be nurses, social workers, OT’s, psychologists etc.
What is a super partnership?
As a business model, a super partnership
describes a situation where multiple practices have agreed to merge and/or work together
whilst retaining the traditional partnership model.
The Equality Act 2010 defines a disabled person as ‘someone who has a physical or mental impairment which has a substantial and long-term adverse effect on their ability to carry out normal day-to-day activities’.
Which ONE of the following correctly defines ‘long-term’ (i.e. the duration of the effects of the impairment(s))?
The Equality Act 2010 defines ‘long term’ as being likely to last for at least 12 months
At what stage of pregnancy can a doctor or registered midwife issue a maternity certificate?
It’s important to note that MAT B1s are issued not more than 20 weeks before the expected week of confinement.
When should antenatal screening for haemoglobinopathies take place antenatally? How is a definitive diagnosis made if screening is positive?
Ideally before 10 weeks
Amniocentesis is used to make a definitive diagnosis if screening tests prove positive
Who can report a drug on the yellow card scheme?
Health professionals and patients
What type of treatments can be reported on the yellow card scheme?
All medicines including:
- vaccines
- blood factors and immunoglobulins
- herbal medicines
- homeopathic remedies
- All medical devices
- Nicotine containing e-cigarettes
In what circumstances can the medical records be ammended?
To correct incorrect factual information only
Which of the following has shown evidence for improving patient understanding of info given in consultations?
‘Ask me three’ technique / ‘SPIKES’ technique / Calgary–Cambridge model / ‘Elicit-provide-elicit’ technique / Active listening
‘Ask me three’ technique
Name 4 documents/ logistical aspects that you need to consider when a patient is coming towards end of life?
DNACPR - Can have review date or no review date
Statment of intent - lasts 28 days
Drug authorization form - For anticipatory meds
EMIS prescription of above meds
The Advisory Committee on Borderline Substances (ACBS) advises as to the circumstances in which some foods and toilet preparations may be regarded as drugs. When may suncream be prescribed?
SPF 50 and over only
if abnormal photosensativity
(i.e. vitiligo and those resulting from radiotherapy)
Under the yellow card scheme - what can you make a report for? (Name at leat 5)
Any medicine, vaccine, blood factors, immunoglobulin, complementary medicine
All medical devices
Fake or counterfit medicines
Nicotine containing cigarettes and e-liquids
What is the ‘black triangle’ with regards to drugs?
A system to identify medicines being monitored more closely (usually because they are new)
A 36-year-old man from Nigeria is in the UK for business. Prior to returning home he has developed groin pain which you confirm is consistent with an uncomfortable but reducible right indirect inguinal hernia.
Which is the SINGLE MOST appropriate NHS body to decide whether he is eligible for a hernia repair in the UK?
The secondary care provider
In UK all primary care is free. All secondary care is on a residence basis and the legal duty to assess eligability sits with the secondary care organisation who will provide the care (most hospitals have a team for this)
Who makes the final decision on a patient’s fitness to fly? What are the rules around letters for this?
Airline makes final decision
Pt’s often request letters- this is outside of NHS remit and is chargable/ private service
What is the difference berween primary, secondary and tertiary prevention?
Primary - Stop a disease happening (vaccines, bisphonates if on steroids)
Secondary - Detect and/ or treat pre-symptomatic disease (Childhood surveilance
Tertiary - Reduce morbidity from existing issues (pulmonary rehab, epilepsy checks)
Drug users should be advised to get which vaccinations?
Hep A and B
Tetanus
Some also recommend annual flu
Who is eligable for a pneumoccal vaccine, what type is given to adults?
Pneumococcal polysaccharide vaccine (PPV)
Anyone over 65
Anyone with LTC
Who is eligeable for the shingles vaccine?
Healthy people aged 70 to 79 years who have not yet been vaccinated OR who turn 65 after 1st sept 2023
People aged 50 years and over with a severely weakened immune system
Eligable up to age 80
What are exercise guidance for adults in the UK? (minimum)
Each week, adults should be encouraged to increase their level of physical activity to
- At least 150 minutes (2 1/2 hours) of moderate intensity activity (such as brisk walking or cycling);
- OR 75 minutes of vigorous intensity activity (such as running)
What is the AAA screening programme?
All men at age 65
If aorta <3cm never get called back, otherwise get followed up
Which form is used to register temporary patients, how long can they be registered for?
A GMS 3 or ‘temporary resident’ form is used to register patients temporarily in the practice area for medical services for up to three months.
What form is used to register patients at the surgery on a permenant basis?
GMS 1 form is used to register a patient on a permanent basis.
What is the role of a HSA1 form?
An HSA 1 form is used to certify requirements of termination of pregnancy
What is an RM7 form used for?
Now obselete since 2010
Previously used for sickness certification
What is a SAR? How long do the surgery have to respond?
Patients have a right to request access to their own medical records and can also provide consent for disclosure to third parties. This is called a SAR (subject access request)
Must be provided within 28 days of reciept
How does the equality act define long term with regard to disability?
The Equality Act 2010 defines ‘long term’ as being likely to last for at least 12 months.
What are the eligability criteria for carer’s allowance? (3)
- The carer must be aged 16 years or over, and spend at least 35 hours per week caring for a person
- Patient must be in reciept of attendance or disability living allowance
- Lived in UK 2 of last 3 years
(don’t need to live together)
What makes lasting power of attourney for health and welfare legally enforaceable?
Once registered with the Office of the Public Guardian
Two daughters with lasting power of attourney for their 74 year old father (who doesn’t have capacity) disagree on an emergency decision. Who should make the final decision?
The Court of Protection (for emergency application out of hours)
Daughters have power of attourney so are decision makers, but if don’t agree go to court
What is the maximum amount of shared parental leave allowed, split between partners?
Share up to 50 weeks of leave and up to 37 weeks of pay
What form allows a woman to claim statuatory maternity pay?
MATB1 form
Below what age can children not consent to sex? What action shoudl be taken?
A child under the age of 13 can never legally consent to sexual activity.
Police/ social services referral should be done immediately
At what stage of pregnancy can a doctor or registered midwife issue a maternity certificate?
It’s important to note that MAT B1s are issued not more than 20 weeks before the expected week of confinement
(not more than 20 weeks before due date)
You receive a letter from a lawyer on behalf of the daughter of one of your recently deceased patients. The daughter has an interest in the estate of her deceased father, and she wishes you to release medical information that may be pertinent to this case.
With regard to legislation, what ACT applies to such a request?
Access to Health Records Act 1990
Note right to confidentiality continues after death but have a claim to estate ONLY relevant bits can be sharedW
What is the GMC guidance on disclosure of information to the relatives of patients with genetic conditions without the patients’ consent.
Weigh up pro’s and cons and balance risks vs. benefits of sharing not sharing
Clinician does have discretion to disclose if deemed clinically needed
The UK Code on Genetic Testing and Insurance has what rules about disclosing genetic risk test results to insurance reports?
Under this guidance GPs do not have to disclose information on their patients’ predictive genetic testing for life policies under £500,000. Huntington Disease is excluded and does require declaration.
Statuatory maternity pay:
a) How long entilted to?
b) How long do you need to be employed for to be entiltled?
Statutory Maternity Pay (SMP) is payable for up to 39 weeks and employees are required to have been employed by the same employer continuously for at least 26 weeks
Are advanced care plans legally binding?
No, but need to be considered by doctors at the appropriat time
A patient requests paternity testing, how should you proceed?
Paternity testing is not offered on the National Health Service (NHS). It is appropriate for doctors to signpost the patients to a list of approved providers rather than actually organising the test.
A gypst traveller wishes to register at the practice. They are on a local car park and do not know how long they will be staying. How do you proceed?
Fully register Gypsy traveller patients when they are in the area for any length of time to ensure that they are included in routine screening and child health surveillance. Patients should not be de-registered if they are away travelling for less than 3 months.
Temporary is only for when patients definitely there for less than 3 months
Under the General Medical Services (GMS) contract regulations, which gifts must be recorded in the practice register of gifts?
Any gifts with value over £100 or more
What is BMA guidance about disclosing information about STI’s in insurance reports?
BMA/ GMC guidance states that information should not be revealed about whether an applicant for insurance has undertaken tests for sexually transmitted infections (STIs) – nor should any negative results be disclosed.
Doctors should not reveal information about an isolated incident of an STI that has no long term health implications or even multiple episodes of non serious STIs.
Stott and Davies introduced four key consultation tasks - what are they?
1) Manage presenting problem
2) Modification of health seeking behavior
3) Management of continuing problems
4) Opportunistic health promotion
Murtagh’s model introduces the concept of what?
Uncertainty about the diagnosis and what conditions might be missed
Roughly what percentage of the population are carers? Paid or unpaid?
Approx 10%
What is reattribution?
a technique which tests the thoughts and assumptions by considering alternative causes of events
Flying guidelines for fracture in plaster?
Flight <2hrs - Wait 24hrs
Flight >2hrs - Wait 48hrs
What are the 5 elements of the calvary cambridge model?
initiating the session
Gathering information
Building the relationship
Giving information – (explaining and planning)
Closing the session
Which consulting technique has shown evidence for improved patient understanding of information given during consultations.
Ask Me Three
What is the FRAYED consultation model used for?
FRAYED (Fact Finding, Refuse Request, Acceptable Alternative, Yield or don’t Yield, End Encounter, and Document Diligently)
Used to refuse a patient request
What are illness narratives?
Illness narratives are a form of storytelling that connects physical symptoms with the psychological, social or cultural context of those symptoms
A patient presents TATT. Nice CKS suggests offer investigations, especially if symptoms have lasted longer than…
6 weeks
What are pendleton’s rules?
1) acknowledging what went well before
2) suggesting what could have been done differently
How is collusion defined?
An unquestioning acceptance to the explanation offered by the patient
What are the 5 aspects of a consultation according to Roger Neighbour?
Connecting, summarising, handing over, safety netting and housekeeping
What is the defintion of a young carer?
Anyone under 18
From what age is it presumed that a young person is able to consent to their own treatment?
16
What is the maximum amount of time you can put on a fit note?
In the first six months of a patient’s condition, a ‘fit note’ can cover a maximum of three months.
If a condition has lasted longer than six months, a fit note can be for any clinically appropriate period up to ‘an indefinite period’.
What is Gillick and Fraser competence?
Gilick - Whether child under 16 has capacity to accept (but not refuse) treatment
Fraser guidelines - Contraception only - used to decide if child can consent
Hourglass symbol on medicine packing means what?
Product has a use by date
Your medical workforce patient has HIV, what are the rules arounding disclosing to employer?
1) Encourage them to do it
2) If they refuse, tell them that you will be discussing (risk to patients therefore need to break confidentiality)
When prescribing by telephone OOH, what is the GMC advice on additional measures that should be taken?
A doctor prescribing by telephone should ensure that any instructions for administration or monitoring of the patient’s condition are understood and it is prudent to consider sending written confirmation especially with elderly, vulnerable patients or those living with carers or in care homes.
To what schedules of drugs to CD prescription rules apply?
2 and 3
So wouldn’t include zopiclone, codeine etc
Would include morphine, tramadol, diazepam etc
How long are prescriptions valid for from date written?
Normal medicines - 6 months
Repeat medicines - 12 months
Controlled drugs - 28 days
Max paracetamol pack size sold in:
a) Pharmacy
b) Shop
(without prescription)
a) 32
b) 16
What does the black triangle indicate in the bnf?
Limited experience of use (so have additional monitoring by european medicine agency)
What proportion of primary care prescriptions contains a prescribing or monitoring error?
5%
1 in 20
MED3 notes:
a) Can they be written retrospectively or prospectively?
b) Can they be based on report from another doctor/ AHP
a) Retrospectively yes, prospectively no
b) Yes
What is SSP? How much, how long for?
£94.25
Paid for by the employer, up to 28 weeks
Must be off work sick for 4 or more days in a row
What can patients apply for when their SSP finished?
Universal credit
OR
ESA (Education and support allowance)
What form is filled for Employment and Support Allowance?
ESA113 form
How long do ESA assessment process take?
Approx 13 weeks
What is the current state pension age?
DOB before 1970 - No change
If DOB 1970-1978 = Age 67
If after 1978 = Age 68
What is PIP for?
Costs for those with long term disability
(Based on function not diagnosis)
Has daily living component and mobility component
Name 3 criteria for PIP?
- Lived in UK 2 out of last 3 years
- Condition affecting ADL’s lasted at least 3/12 and be expected to last >9mths
- Age 16-64
What is attendance allowance? What is the criteria?
Helps extra costs if over 65
(Think of it like PIP for over 65’s)
Name 3 criteria for carers allowance eligability?
- Claimant over 16
- Spend over 35/wk caring
- Person caring for must recieve PIP or attendance allowance
- Don’t need to be related or living together
After succesful SR1 application, for how long is a patient entitled?
Expecting death within 6 months
Can keep claiming up to 3 years before needs to reapply
What is the earliest and latest maternity pay can be started?
Earliest 11 days before birth
Lastest day after birth
When can a GP complete the death certificate?
Seen patient in their last illness and within the last 14 days
What are the two crem forms that need to be completed?
Crem 4 - By the GP who looked after in last illness
Crem 5 - By another doctor (who has GMC registration for 5 years) - NB not used since covid
When are overseas patients eligable for NHS care?
<6month stay - not eligable for free non-emergency care
> 6month stay - Eligable as soon as arrive to UK
How are patients who have emigrated treated in terms of eligability for NHS care?
As foreign nationals
How long should patients be allowed to temporary register for?
Up to 3 months
What right do refugee’s have to NHS care?
Same as ordinary resident (so excluded from overseas rules)
How long is an oversea’s patient staying less than 6 months eligable for emergency NHS care?
14 days or less
(If not eligable for all care)
What’s the limit of time by which you should acknowledge a complaint? What is the timeframe to respond?
Acknowledge within 3 days
No time frame for response but should be ‘reasonable’
For how long after an incident can a patient submit a complaint?
1 year
Name 5 diseases that under RIDDOR (Reporting of Injuries, Diseases and Dangerous Occurrences Regulations 2013) must be reported?
Carpal tunnel syndrome
Cramp of the hand or forearm
Occupational dermatitis
Hand arm vibration syndrome
Occupational asthma
Tendonitis or tenosynovitis
Occupational cancer
Exposure to a biological agent
What are the Wilson–Jungner criteria?
The Wilson–Jungner criteria are a set of requirments that any screening programme would meet before implementation.
What is the chi-squared test?
The chi-squared test is a statistical tool used for comparison of unpaired categorical data from large samples to evaluate how likely it is that any observed difference occurred by chance.
When can you remove a patient from practice list? (name 3)
- Immediatley if police called due to patient behaviour
- After 6 months if FP69 shows no longer at address
- 8 day removal request if relationship breakdown
How is the GMS contract negotiated?
The contract is negotiated nationally every year between NHS England and the General Practice Committee.
What are DES?
Directed Enhanced Services (DES) are nationally commissioned through the GP contract by NHS England
Seizure in epileptic after dose change of medication - how long off driving?
6 months
(Recently changed if provoked seizure in epileptic is now 6 months)
You advise patient to talk to DVLA and they refuse. How to act?
Inform patient you need to inform DVLA
- We have duty of care to public
Inform DVLA and tell patient in writing
What are colour blindness driving rules?
None
When should patient’s renew driving licence?
Over age 70 every 3 years
With regard to alcohol issues, what are the different DVLA guidelines?
Dependance - 12 months free
Misuse - 6 months free of alcohol
With regard to drug issues, what are the different DVLA guidelines?
Ecstacy, amphetamines, cannabis etc - Need to be free for 6 months to drive
Opiates, methodone, cocaine, benzo’s, metamhetamine etc misuse - need to be free for 12 months
MUST disclose to the DVLA if dependance condition
Pneumothorax flying guidance?
Not for 2 weeks
Patients with unstable angiona, uncontrolled heart failure etc - flying gudiance?
Shouldn’t fly
Patiens with pneumonia flying guidance?
When clinically improved?
How long no flying post CABG?
7-14 days
How long no flying after MI?
What about if PCI?
7-10 days
(5 days if PCI)
What are rest entitlements in UK law for workers?
At least 20 mins every 6 hours
Following MI - a heavy manual worker should wait how long before returning to work?
3 months according to BHF
Reducing weight by as little as 3kg in an obese patient could decrease CVS by how much?
Up to 50%
Recommended flying rules with DVT?
Patients with DVT should not undertake any extended travel, in particular air travel, until two weeks after effective anticoagulation has been commenced.
How much maternity pay can a GMS contract practice claim back from the PCO?
26 weeks
Only 2 weeks for paternity
