General Practice

• ⚕️Module 1 - Introduction to the NHS

  Founding Principles of the NHS

  • Meets the health needs of everyone
    • People with different health problems can access care via the same system, including mental health care as of 1969
  • Free at the point of delivery
  • Based on clinical need, not ability to pay

• Key milestones of the NHS

  • Linking smoking with lung cancer
  • Performing the first organ transplants
  • Establishing an organ donor register
  • Rolling out national vaccination programmes

• NHS constitution

  1. Provides comprehensive service, available to all
  2. Access is based on clinical need, not ability to pay
  3. Highest standards of excellence and professionalism
  4. Patients are at heart of NHS
  5. Works accross organisational boundaries
  6. Accountable to the public, communities and patients that it serves
  7. Provides best value for taxpayer's money

• 👨‍⚕️ Module 1 - General Practice

  Day-to-Day role

  What have you learnt about what a GP does in their day?

  • Deals with medical, social psychiatric etc issues - wide variety
  • Potential for involvement in CCG, teaching, sports medicine
  • Work with wide variety of other professionals

• What are the reasons GPs cite for enjoying their job? What do they say are the biggest challenges of the job?

  • Easy to take on different roles in education, leadership etc
  • Diversity of patients dealt with
  • Able to help people in their local community to improve their health
  • Gives time for family life

• How will the role of the GP change over the next 20 years?

  • Primary care is becoming increasingly centralised, with the patient relationship being centred towards the practice team as opposed to individual practicioners
  • Some trusts are creating larger 'polyclinics' in which other specialist doctors and nurses also provide care
  • GPs have generally been slow to adopt new technology but this is accelerating, especially due to COVID
  • GPs are becoming increasingly responsible for the management of population health within their catchment area

• Taking Histories

  • Taking a history is when a healthcare professional asks a series of questions and actively listens to the answers to elicit information about the patient and work out what is wrong

  • It is important for doctors to use active listening techniques in order to build rapport

  • A specific framework can be used when obtaining a history:

    • Introducing oneself and identifying the patient
    • Giving the patient the 'golden minute' to describe uninterrupted why they are seeing you
    • Take details about the complaint
    • Ask questions or refer to notes for relevent past medical history
    • Explore the patient's family history if appropriate
    • Ask about day-to-day habits e.g. living conditions, smoking status, social life etc.
    • Verify any drug allergies present if appropriate
    • Elicit the concerns and expectations of the patient

  • Other roles of the GP

    • Referring to and liasing with secondary care providers (hospitals)
    • Engaging in health promotion through their conversations with patients and information provided in the practice
    • Partners are involved in the buisness aspect of the practice including: organising staffing and funding & compliance with regulations
    • Teaching medical students on placement in their practice or as medical educators in a medical school
    • Engaging in research

  • Who else works in a GP practice?

    • District nurses - Visiting homes to provide care to patients who are less mobile e.g. looking after diabetic patients, providing wound care
    • Physician's Associates - Takes on some tasks from the GP such as taking histories, performing basic examinations, providing disease prevention advice etc.
    • Community midwives - Managing the health of pregnant women throughout their pregnancy (and in subsequent pregnancies also)
    • Healthcare Assistants - Provide support for nurses e.g. taking blood pressure or weight, blood samples etc.
    • Pharmacists - Checking medication is safe and appropriate for the patient and giving advice about taking medication
    • Admin staff - Booking appointments, answering patient queries and organising notes
    • Even more staff such as counsellors, students and paramedics may also be present

  • Issues facing GPs

    • There are a record number of patients, including many elderly ones who have several comorbidities. Elderly patients are also more likely to take several medications, which makes their treatment course difficult to balance and more expensive. All this results in an increased workload and stretching of resources
    • Patients who struggle to get appointments often refer themselves to A&E, increasing strain on emergency services
    • 53% of GPs plan to retire early due to pension issues, burnout and increased workload
    • As GPs tend to be older and the GP training programme is undersubscribed, it is expected there will be an acute shortage of GPs in the coming years after many retire

  • Why are GPs closing down? (article review)

    Why are GP surgeries closing around the country? Is it simply to do with funding or are there other issues?

    • Between 2015 and 17, the number of full time GPs in England decreased by 350 while patient demand rose.
      • Brexit has also created recruitment issues for European doctors
    • Younger GPs are unwilling to become partners in their practice due to the financial risk, so older partners are not being replaced
    • Work which was once handled by secondary care is being shifted to primary care e.g. chronic heart and lung diseases and diabetes

  • What impact do you think this will have on patients?

    • Patients lose the relationship they have with their family doctor, which impacts upon trust
    • People have to travel further to see their GP
    • People find it tricky to register in person for practice

  • Which group of patients do you think will be most affected by this?

    • Those who need care the most will be the most significantly affected as they have the most difficulty travelling:
      • Single mothers or busy families
      • Elderly people
      • Disabled people

  • What impact do you think this will have on other GP surgeries?

    • GP surgeries which remain open are forced to pick up the slack, increasing caseload for a lower number of GPs