Getting Started in General Practice

Many FY2 doctors spend time in General Practice as part of the Foundation Programme. It is a valuable experience even for those who do not intend to pursue GP as a career. This article offers advice on what to expect during the post and some suggestions on where to look for help when you need it.

If you are a GP ST1 or ST2 preparing to start a General Practice placement, much of the following will also apply to you. 

What To Expect: the first week or two

As with any new job, you should receive an induction. Part of this will be learning how to use the clinical software, which will allow you to make consultation notes, prescribe medication, and request certain investigations. Different GP practices use different software – examples include EMIS Web and SystmOne. 

You should also be given the opportunity to shadow members of staff. This will include GPs, but you may also sit with other clinical or non-clinical members of the practice team. There is something to learn from everyone.

If there are any topics in which you feel underconfident, you could be proactive and ask for direct supervision during your shadowing period. Perhaps you have forgotten how to examine a baby, or how to use an otoscope. Watch the GP perform the task the first time it comes up, then next time ask if you can do it while the GP watches.

What To Expect: seeing patients

When you are ready, you will start your own clinics. Initially, you will have long appointments (e.g. 30 minutes) and frequent debriefs with your Clinical Supervisor. As you become more confident, you may choose to shorten your appointments or debrief less often. You may also be given letters to read and action, or repeat prescriptions to sign. Decisions regarding your progress should be made jointly by discussion between you and your supervisor. 

Early on in the placement, think about what you need from it (e.g. portfolio requirements) and talk to your supervisor about how you could achieve your goals. For example, when I was an FY2 in GP, for one afternoon a week my supervisor and I ran a “joint” clinic. We took turns seeing patients while the other observed. We learned from each other and this gave us plenty of material to write up assessments later. 

How to Thrive: sources of help and support

Your Clinical Supervisor is there to support your learning and is likely to be your first port of call for most questions. You are new to General Practice and expected to require a high level of supervision, so if you need help with a clinical matter then do not hesitate to ask. It is normal to have lots of questions because General Practice is fraught with uncertainty – even experienced GPs have to deal with it day-to-day.  

Some queries are better answered by other members of the primary care team. For example, medical secretaries or other administrative staff can tell you where a particular referral form needs to be sent, and may even do it for you. 

There may be local reference resources, such as a website run by the Integrated Care Board (ICB) for the area. These are good places to look for referral pathways, forms, and local guidelines (such as antibiotic guidelines). 

NICE Clinical Knowledge Summaries (CKS) contain guidelines for the diagnosis and treatment of many common conditions seen in primary care. 

Mind The Bleep will have more primary care content added over the coming months.

How to Thrive: further reading for some common worry areas

Paediatrics
  • Paediatric Pearls is a monthly paediatric update newsletter for all health professionals working with children, put together by Dr Julia Thomson, Paediatric Consultant at Homerton University Hospital, London.
  • Don’t Forget The Bubbles is an international website written for paediatricians. It is always an interesting read, however not all the content will be relevant to primary care.
  • Healthier Together has some very useful safety-netting resources and parent info sheets.
Gynaecology
  • Menopause Matters has a dedicated “Professionals” area with an HRT decision tree and a list of treatment options.
  • British Menopause Society and their patient arm, Women’s Health Concern, have lots of excellent factsheets for patients regarding various aspects of menopause including HRT. 
  • UKMEC guidelines are essential for prescribing and advising on contraception.
Dermatology
  • DermNet is a huge dermatology resource based in New Zealand, including an impressive image library.
  • Primary Care Dermatology Society is somewhat similar but UK-based. I find their “General Dermatology Diagnostic Tool” particularly helpful.
ENT
  • ENT SHO is, unsurprisingly, aimed at SHO-level doctors in hospital ENT departments, therefore some but not all of the content is applicable in a primary care setting.

Written by Dr Grace Howson (MRCGP 2022)

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